- New, smaller instruments allow suture-less incisions for vitreous surgery (surgery in the back part of the eye), allowing for faster recovery. Incisions about half the size of the 1 mm ones that have previously been required are so small they essentially self-seal. "Sutures on the external part of the eye really cause a lot of irritation of the retina and prolong the recovery time," says Dr. C. Douglas Witherspoon, founding partner of Retina Specialists of Alabama. "So any kind of instrumentation that can eliminate suturing externally on the eye is a big advantage."
- Witherspoon and his partner, Dr. Robert Morris, have developed two new surgical techniques.
- Hydraulic thrombotomy is used to treat retinal vascular occlusion, a common cause of blindness in young and middle-aged adults. The surgery involves inserting a needle into the retinal vein that delivers a pulse of saline to flush out the offending thrombus. This is followed by injection of a clot-buster drug to help prevent subsequent clot re-formation. "The procedure's still fairly early in development, but the results are really quite promising so far," Witherspoon says. "There hasn't been any good treatment for central retinal vein occlusion in the past, so this is something that can be very valuable."
- Pneumatic maculopexy is being used to treat chronic macular edema. One of the major complications of retinal vascular disease such as diabetic retinopathy and retinal vascular occlusion, this swelling causes significant decrease in vision, and if it persists for long periods of time, causes permanent damage to the retina. This surgery uses a special laser procedure combined with the injection of an expanding gas bubble inside the eye to help press the swollen retina up against the back wall of the eye while the bonds from the laser surgery heal.
- Everyone has heard of Botox® for cosmetic purposes, but the botulinum toxin is also being used for a condition called blepharospasm, where people develop a rapid, involuntary blinking of the eye. Dr. Lanning Kline, chairman of the UAB Department of Ophthalmology and a neuro-ophthalmology specialist, explains that 30 or 40 years ago, this condition was regarded as psychological, "but it's a real thing and needs to be treated. Botulinum has been a big breakthrough." The toxin is injected into the eyelid, where "it's a very effective form of treatment."
- The new Retisert™ implant from Bausch and Lomb is implanted in the eye, where it releases steroids for 1,000 days. "It's the only FDA-approved treatment for uveitis affecting the back of the eye," says Dr. Russell Read, associate professor of ophthalmology and pathology at UAB. (Uveitis refers to any form of inflammation within the eye, which can be triggered by a number of different underlying causes.)
"It's a welcome addition to the options we have to treat patients. I think it will be particularly useful for macular edema, or swelling of the retina, which is a frequent complication of uveitis affecting any part of the eye and can be difficult to control."
- Earlier detection of glaucoma is the goal of Dr. Jason Swanner, assistant professor, UAB Department of Ophthalmology. Glaucoma is one of the leading causes of blindness in the country, he says. However, the loss of vision is so gradual, most patients don't realize it until it's too late. That's why regular exams are so important, especially for those with glaucoma risk factors. Swanner and other researchers are looking at ways to diagnose glaucoma earlier, before the telltale pressure appears in the eye.
"There are several new imaging studies that are being tested to see if they can diagnose glaucoma before there's visual field loss," he says. "We try to diagnose it based on the shape of the nerve and the nerve fiber layer. If we can do this, the thought is we can begin treatment so the glaucoma will not affect the patient's vision in their lifetime."
