FAQ

Several factors, such as age, determine how frequently an eye exam is needed. All premature infants should go through a comprehensive examination of the eye fundus. Older children should have their eyes tested if squinting or movements in one of the eyes are observed. It is recommended to consult an ophthalmologist if a child suffers from frequent conjunctivitis or eyelids infections. Ophthalmic assistance is also necessary in the case of crossed eyes (strabismus). It should be remembered that it is usually associated with poor vision in the eye that is affected. Crossed eyes can be successfully treated until the age of seven. Then, unfortunately, poor vision remains. Children at school age should also have their eyes tested regularly. In adults, eye exams are usually not necessary unless there is a vision impairment that has to be corrected with new glasses. After the age of forty, eye exams should be performed more frequently, at least once a year, because at that age, the majority of eye diseases, such as glaucoma, cataract or macular diseases, develop.

Vision changes are the most alarming symptom. Each eye should be tested separately in order to assess the problem. Examination consists of checking if the patient is able to see a given object from a determined distance. Other alarming symptoms include: impression that we look through a curtain, reduced vision field or distorted vision. If some of these symptoms are observed it is necessary to consult an ophthalmologist as soon as possible, ideally within 24 hours.

Eye pain is always an indication of a disease. It is usually associated with an ocular surface inflammation, in particular, conjunctivitis or sclerites. Eye pain may also be experienced in dry eye syndrome, but it is typically less intense; it is unpleasant, but from the medical point of view, it is not dangerous. In any case, eye pain requires a medical consultation and a treatment. Pain related to high eye pressure, which is usually associated with angle-closure glaucoma, is much more dangerous. Increased or high eye pressure may cause an irreversible damage to the vision. Patients often have troubles when assessing what kind of pain they are dealing with. For that reason, it is recommended to consult an ophthalmologist to check it.

Itchy eyes are often a symptom of the irritation of the eye by damaging factors. Such factors include: bright light, sunlight, air pollution, wind or other substances that can get into the eye. Itchy eyes are usually not dangerous. Removing the damaging factor from the eye by rinsing it with water is an effective remedy. Clean, boiled water or moisturizing eye-drops available at pharmacies without prescription can be used. But if itching repeats or persists, it is recommended to consult an ophthalmologist.

Dry eye, often referred to as the dry eye syndrome, is a common condition which occurs due to the lack of moisture on the surface of the eye. It is characteristic of many diseases and conditions. That is why every case, as well as symptoms, is different. The symptoms may include itching, burning and, on occasions, eye pain. Some patients complain of pain in one half of the head, while others describe it as a pain behind the eye. Eyes are often so irritated they may water and become red. Dry eye syndrome is usually due to the aging process and changes in the functioning of glands that produce tears to moisturize the eye. The dry eye symptom is often accompanied by a chronic blepharitis (inflammation of the eyelid margin) with Meibomian gland dysfunction. Certain medication that dry out the eyes can also cause dry eye syndrome. It includes heart medication, hypertension medication and hormones. Dry eye syndrome is a nightmare for employees of offices and people who work in front of the computer and in artificial light. Hormonal changes associated with hyperthyroidism, changes in the levels of sex hormones or pregnancy can also cause dry eye syndrome. Eye-drops used in the treatment for glaucoma may also lead to the development of dry eye syndrome. The easiest method of treatment is an attempt to remove or limit the damaging factor, but it is often not possible. In such a case, moisturizing eye-drops should be used. In some cases, when eye-drops are not sufficient, it is necessary to close tear ducts to reduce tear loss, thus increasing the moisture of the eye. Sometimes, the symptoms of the dry eye can be so severe that eye injuries occur. Then, more aggressive treatment tailored to the patient’s needs should be applied.

Eye floaters are described differently by patients. Most of the patients refer to them as flies, specks, grey dots or flecks than appear in their visual field and move when they look around. They usually are small and distinguishable only against a light background. On occasions, they may be big or so large that they almost cover the visual field. Those changes are condensations in the vitreous body. Vitreous body, a jelly-like substance that fills the inside of the eye, ages and gets thicker over time. As the times passes, more changes occur. They become visible, but the whole process is so slow that patients rarely notice that something is happening. Grey spots can appear suddenly, normally after the age of 60, as a consequence of shrinking of the vitreous body, which is referred to as PVD (posterior vitreous detachment). It is recommended to contact an ophthalmologist if any sudden changes appear. If spots are accompanied by flashes, a consultation is needed as soon as possible. Spots appear more frequently in patients with short-sightedness, sometimes about the age of 30, and may be numerous. Laser treatment has become a popular method of treatment for eye floaters. However, its effectiveness is limited. As laser breaks floaters into smaller pieces but it does not remove them completely from the eye, its use is indicated if the changes are small. Surgery is the most effective method of removing eye floaters. If performed by an experienced surgeon, it allows for a quick recovery and carries almost no risk.

AMD stands for Age-Related Macular Degeneration which refers to an age-related condition that affects the macula. Owing to the rapidly aging population, the prevalence of AMD is increasing. Two major types of AMD can be distinguished: dry AMD and wet AMD, also referred to as neovascular AMD. Dry AMD is much more common. It is due to a deterioration of nerve tissue needed for central vision. As a consequence, vision is being slowly deteriorated. Until now, no treatment for this disease has been developed, but taking vitamins and taking care of the overall health can slow down the process.

Neovascular or wet AMD is much less common, but its course may be more serious. In wet AMD, a membrane of abnormal blood vessels grows underneath the retina. As a consequence, liquid accumulates in the retina and the blood vessels may break, causing bleeding inside the eye. All these processes cause damage to the visual cells of the retina. Bleeding can be especially dangerous. If there is much blood, in particular in the central part of the retina, vision may be damaged permanently. In some cases, the disease progresses so fast that vision is lost within a few days.

AMD always leads to vision loss. First symptoms, especially in dry AMD, may be very subtle. However, in wet AMD vision loss may progress rapidly, even within a few days. Patients often do not notice that their vision is worsening until the disease is too advanced to start an effective treatment. It happens especially when the disease develops only in one eye, as the overall vision is not affected. Patients who are at higher risk of suffering from AMD should have an examination done several times a year. In AMD, it is necessary to perform an OCT (optical coherent tomography) examination, because a standard eye exam may not be sufficient. An AMSLER grid test is a useful tool that can be used at home to assess the functioning of the macula – the central part of the eye. It consists of looking with each eye separately at the grid hold approximately 30 cm from the face. If patient sees wavy lines instead of horizontal or vertical ones, it means that the most important part of the eye, the macula, is probably damaged. Patients diagnosed with macular diseases have to run this test at least once a week. In our Clinic, we conduct a full diagnostic procedure for both dry and wet AMD and we use all available anti-VEGF medication.

Age is the main cause of AMD. It is said that AMD develops as the eye is being used. It normally occurs in people over the age of 60, while it is much less common in younger people. Genetic predisposition for AMD is another risk factor. If one of the parents was diagnosed with AMD, children are at higher risk of developing this disease. They should have their examination done regularly in order to control changes in the eye. Environmental factors related to the lifestyle are also very important. They include smoking, cardiovascular diseases, hypertension and diabetes, among others.

Currently, there is no effective method of treatment for dry AMD. Extensive research on AMD medication is being carried out around the world and there is a chance that such a medication will be available soon. In neovascular AMD, the only method of treatment which was proved to be effective involves administration of anti-VEGF medication in form of intraocular injections. Supportive treatment, such as taking vitamins to improve vision, is essential in both dry and wet AMD. It is also necessary to treat cardiovascular diseases, such as hypertension, diabetes, to lower blood cholesterol and triglycerides levels, as well as to take good care of the overall fitness of the body.

This type of haemorrhage often occurs in the course of neovascular AMD. It constitutes a very clear symptom of the activity of the disease and indicates that the eye condition has worsened. Bleeding is always a signal to start treatment immediately. If the bleeding is slight, it is sufficient to administrate anti-VEGF medication. However, it is necessary to consider at what stage of the treatment the bleeding occurred, because it may indicate that patient became resistant to the medication and it should be changed. If the bleeding is intense, a surgical treatment is needed IMMEDIATELY. Unfortunately, patients are often informed that they have to wait until the blood is absorbed or that there is nothing that can be done. Nothing could be further from the truth! If the blood underneath the retina is left to be absorbed, especially in a large amount, a "scab" may be formed, damaging the eye and affecting the vision permanently. In some cases, it is necessary to perform a vitrectomy as soon as possible and to administrate a medication that dissolves the clot inside the eye. It is the only way to save the patient’s vision. On occasions, bleeding into the retina is so intense that the blood fills the space underneath the retina, reaching the vitreous body. In such cases, the patient can also be told that there is nothing that can be done. Nevertheless, our experience proves that it is not true. Vision always improves after removing the blood from the vitreous body.

Scientific research has demonstrated that in the eye with neovascular AMD too much VEGF is being produced. VEGF stands for vascular endothelial growth factor, which is a substance that promotes epiretinal membrane growth. Anti-VEGF medication, which removes VEGF, must be administrated to block this growth. The first attempts to treat neovascular AMD involved administrating anti-VEGF medication intravenously. However, it turned out that in the case of eye diseases, the medication can be administrated directly into the eye instead of into the whole system. It is not only less burdensome for the patient, but also more effective. Currently, there are three anti-VEGF medicines to treat neovascular AMD available in the market. They include: Avastin (bevacizumab), Lucentis (ranibizumabum) and Eylea (aflibercept).

Avastin – It has been used in ophthalmology for the longest period of time, that is, since 2006. It is a cancer medicine, which was registered to treat cancer of the colon. However, it was proved to be very effective in the treatment for several retinal diseases. Currently, it is not registered as a medicine that can be injected into the eye, but as a one that should be administrated intravenously.

Lucentis – It was especially designed and registered to treat the wet form of AMD. It is a derivative of Avastin produced by the same pharmaceutical company. The mechanism of action and adverse events of Lucentis and Avastin are similar.

 Eylea – It is the latest medicine that we use to treat the wet form of AMD. It is also a cancer medicine, which was tried out in ophthalmology. It turned out that it worked very well in the treatment for retinal oedema. The mechanism of action of Eylea is slightly different from the mechanism of action of Avantin or Lucentis and some patients react better to the treatment.

Over the last six years, many clinical trials on anti-VEGF medication have been carried out. Some research has suggested than some medicines are better than others. However, clinical trials carried out on large populations have indicated that all these medicines show similar efficiency and adverse events.

Dr Agnieszka Nowosielska was one of the first ophthalmologists in Poland to treat AMD with intravitreal injections, starting as early as in 2006. Over the last 11 years, she has performed more than 11 000 injections of that kind. Thanks to her broad clinical experience she has developed the most effective, innovative regimen of anti-VEGF medication administration. Anti-VEGF medicines are administrated in many countries around the world. In the United States, every patient diagnosed with wet AMD receives injections every four weeks till the end of his or her life, regardless of their eye condition. In practice, some patients receive more injections than they need. In our Clinic, we do our best to determine the right dose of the medicine for every patient, depending on his or her individual needs, so that the visual acuity may be restored with as few injections as possible.

It should be remembered that neovascular AMD treatment should be continued till the end of patient's life, but too many injections may be harmful. The effectiveness of this method reaches nearly 100%.

Treatment for neovascular AMD should be life-long. In our Clinic, we offer a regimen of treatment similar to the one applied in the IVAN clinical trial carried out in Great Britain. The treatment that we propose involves three injections, one every four weeks. Then, an OCT examination is carried out in order to assess the effectiveness of the treatment. More injections are not performed, if not needed. Instead, an OCT examination is carried out every four weeks in order to control patient's condition. If follow-up appointments indicate that the disease may recur, consecutive injections are recommended. Every patient diagnosed with neovascular AMD should visit an ophthalmologist at least once a month for a follow-up appointment or a follow-up appointment and an injection. Neglecting the treatment always leads to vision deterioration, even if the examination shows that the eye condition is satisfactory.

Intraocular injections, which can be defined as shorts of medicines into the eye, is an innovative method of treatment for eye diseases. It allows to administer the medicine directly to the place where it is needed, thus avoiding the necessity of introducing the medicine into the whole system and dealing with all the related complications. Different medicines are used in ophthalmology. In diseases such as neovascular AMD, diabetes or retinal vein occlusions, anti-VEGF (anti-vascular endothelial growth factor) medication is administrated. In diabetes, retinal vein occlusions and uveitis (inflammation of the middle layer of the eye), steroids are used together with anti-VEGF medication. In bacterial uveitis, on the other hand, it is necessary to administer antibiotics. On occasions, injections are the only method of treatment, but in some cases, they have to be combined with other forms of therapy.

Anti-VEGF treatment consists of administrating anti-VEGF medication into the eyeball. Anti-VEGF stands for anti-vascular endothelial growth factor – a substance that blocks vascular endothelial growth factor. Avastin (bevacizumab) was the first medicine of this group. It was registered by FDA (Food and Drug Administration – an institution that authorizes placing on the market medicines and food in the United States) as a medicine administrated intravenously and indicated to treat cancer of the colon. Avastin is indicated to treat cancer, because, like other anti-VEGF medication, it blocks the growth of new blood vessels, thus preventing cancer from growing due to the lack of blood supply. Similarly, when the growth of new blood vessels is blocked, diseases such as neovascular AMD cannot develop. Research has demonstrated that in neovascular AMD, diabetic macular oedema or macular oedema in the course of retinal vein occlusion, the level of VEGF in the eye is raised. This is the reason why anti-VEGF medication is used to treat these diseases. Currently, it is the most common method of treatment. When talking about intraocular injections, patients usually refer to anti-VEGF medication. There are three anti-VEGF medicines used in the treatment for neovascular AMD available on the market. They include: Avastin (bevacizumab), Lucentis (ranibizumabum) and Eylea (aflibercept). In anti-VEGF treatment, the outset of the treatment as well as the frequency of drugs administration are of vital importance. An inadequate regime of treatment may lead to its ineffectiveness.

As it was previously mentioned, Avastin (bevaxizumab) was the first anti-VEGF medication registered in the world. It has been used in ophthalmology since the turn of the years 2005 and 2006. Philip Rosenfeld from Badcom Palmer University in Florida was the first person who thought that Avastin could be used in the treatment for neovascular AMD. He correctly assumed that if Avastin could stop the growth of cancerous tumour by blocking the growth of its blood vessels, it could be as effective in the case of neovascular AMD, a disease caused by the uncontrolled growth of new blood vessels underneath the retina.

The first attempts to use Avastin consisted in administrating intravenously the same dose that was used in oncology. Currently, a significantly reduced dose (4000 times smaller) is used and administrated directly into the eye instead of into the vein. This prevents patient from suffering from adverse events. Avastin is owned by the company Genentech.

 Lucentis was especially designed and registered to treat wet AMD. From the chemical point of view, it is a derivative of Avastin. It was produced by Genentech, because after the success of Avastin, the company wanted to introduce a medicine developed specifically for ophthalmic use. The mechanism of action and adverse events of Lucentis and Avastin are similar. Clinical trials CATT/IVAN have demonstrated that the effectiveness of Avastin and Lucentis is also akin. The same applies to the adverse events. The effectiveness of treatments is usually related to the regime of treatment and the experience of the doctor who performs it.

 Eylea is the most recent medicine that we use to treat wet AMD. Eylea is produced by Bayer. It is also a cancer medicine, which was tried out in ophthalmology. It turned out that it achieved very good results in retinal oedema and neovascular AMD. The mechanism of action of Eylea is slightly different from Avastin or Lucentis and some patients react better to the treatment.

 Individual sensitivity to these medicines may vary from patient to patient. According to clinical trials of these medicines, they act similarly.

Steroids are widely used in medicine due to their strong anti-inflammatory and anti-swelling properties. They also block the process of cell division. Currently, in ophthalmology, steroids are mainly administrated locally (that is, exactly where they are needed) in order to achieve better medical results and avoid systemic complications. Generally, steroids are administrated if the defects in the eye are caused by systemic changes. It is because steroids have been reported to have numerous adverse events, such as diabetes, gastric ulcers or mood disorders.

Steroids act differently than anti-VEGF medication and, therefore, they are indicated to treat diseases in which anti-VEGF medication fails to deliver the expected results or is less effective. For example, steroids are not an effective method of treatment for AMD. Anti-VEGF medication remains the only available method of treatment for AMD.

The eye diseases that can be treated with steroids include uveitis (inflammation of the middle layer of the eye), diabetic macular oedema and retinal vein occlusion. Triamcinolone, Ozurdex and Illuvien are among the most common medicines from this group. All steroids have similar, local adverse events. They include glaucoma and cataract. Secondary glaucoma (raised eye pressure) occurs in 25-30% of the cases, in which steroids are administrated into the eye. Raised eye pressure is usually temporary; it drops once an adequate medicine is administrated. A very small proportion of patients requires glaucoma surgery. Steroids may also speed up the process of cataract progression. However, it should be remembered that steroids are often used to treat uveitis or diabetes and these are the diseases that may speed up the process of cataract progression themselves. For that reason, cataract is considered to be an unpleasant, but easy to remove complication. If steroids are used in patients after cataract surgery, such problem does not exist.

Triamcinolone is a derivative of prednizolon. Triamcinolone has strong anti-inflammatory and anti-swelling action and blocks the process of cell division. In ophthalmology, it was among the first medicines to be administrated directly into the eye. It is administrated into the eye "off label" (for an unapproved route of administration), because it is registered as a medicine to be administrated intramuscularly. It is a very cheap and effective medicine. Its effects in the eye can last for about 4-6 months. Following this period, treatment usually has to be repeated. Triamcinolone is administrated into the eye in the form of suspension, so dark floaters may appear in the visual field during the first days after the injection. They disappear after a few days.

Ozurdex is a derivate of dexamethazon. It is an implant designed especially to be injected into the eye. It looks like a piece of white pencil load. Unlike Triamcinolone, it does not cause floaters in the visual field after the injection. Its effects in the eye can last for about 4-6 months.

Illuvien is another implant with steroid medicine registered to inject into the eye. It has been originally created for patients with uveitis, but it can also be used to treat diabetic macular oedema. Its effects in the eye can lasts even up to 2 years! That is why it is very convenient in application. In Poland it is barely used.

Before the injection is performed, anaesthetic eye-drops or gel are administrated into the eye, depending on the preferences of the surgeon or the patient. The eye must be disinfected so that no bacteria are introduced into the eye during the injection. Then, the injection is performed. The surgeon performs it into a safe place in the eye, so that no eye structures get damaged.

Intraocular injections are a safe procedure. They usually have little complications that can be divided into the local ones and the systemic ones. Local complications do not vary, because they are a consequence of introducing a needle inside the eye. They may include: subconjunctival haemorrhage (red eye), eye pinching, eye stinging, foreign-body sensation or seeing black spots. These symptoms are not dangerous. They regress after a few days. Attention should be given to the dry eye syndrome – a symptom that often occurs as a result of a long-term treatment. If injections, disinfection and anaesthesia procedures are repeated frequently, the eye may be irritated, thus becoming permanently sensitive to light and wind. Pinching and stinging may also be experienced. Unfortunately, patients who are treated with this method have to be prepared for those events. However, there are ways to deal with them, for example, using moisturizing eye-drops (ideally without preservatives), such as Hylocomod, Hyloparin, Hyal-eye, Thealoz Duo, Systane, Cornegel, among others.

Eyeball inflammation is the most serious complication. It is a very rare complication, but if it appears it can be really dangerous and requires an immediate treatment. Therefore, if a sudden eye pain and vision deterioration occur after the injection, it is vital to contact the ophthalmologist who performed the injection as soon as possible. Systemic complications, that affect the whole body, can also be distinguished. All anti-VEGF medications (Avastin, Lucentis, Eylea) have a similar general effect and cannot be divided into "better" and "worse". The most severe complications include stroke, heart attack or varicose veins, which are due to the increase of the number of blood clots in the system. The risk of suffering from any of these diseases after administrating anti-VEGF medication has been estimated at around 1%. However, it should be noted that the majority of patients with neovascular AMD or diabetes taking anti-VEGF medication is subject to a higher risk of cardiovascular diseases or they have already experienced such episodes.

Injections are completely painless, as they are performed under local anaesthesia. However, some patients get nervous, because they are aware of what the injection consists of. In such a case, it is advisable to take a sedative before the procedure.

Just after the injection, vision is always worse due to the disinfection procedure itself and the action of eye dilating eye-drops. However, worse vision lasts only for about a few hours. On the first day after the injection, some patients may see black dots or specks. These symptoms usually disappear after one day and they are not dangerous.

The main contraindication for performing intraocular injection is a bacterial infection of the eye surface. In such a case, there is a risk of spreading the inflection to the inside of the eye, which may be dangerous. According to some physicians, it is not recommended to perform injections shortly after a stroke or a heart attack and it is necessary to wait six months of their occurrence, because there is a risk of suffering from another episode of that kind. Unfortunately, the truth is that a stroke or a heart attack increases the risk of further incidents in the same patient. Therefore, it is vital to eliminate the risk related to poor circulation and to take medicines lowering blood clotting. When in doubt, it is always recommended to consider the whole clinical picture and the specific case. It should also be noted that in some cases, waiting six months for an ophthalmic treatment may lead to a complete blindness in some patients. These are very hard decisions, especially because every specialist assesses the patient's situation based on his or her own experience. Patients with neovascular AMD, who receive a long-term treatment with anti-VEGF medication, should take medicines lowering blood clotting permanently (unless retinal haemorrhage occurs).

The eye does not require any special care after an intraocular injection. It is important to be careful so as the eye does not get infected.

No special preparation is needed before performing an intraocular injection. On the day of the injection, it is necessary to follow the daily care routine, have breakfast and take the medication that is taken on a daily basis. Medication lowering blood clotting should not be discontinued.

No important activities should be planned on the day of the injection, because it is difficult to predict how the patient would feel. Patients who receive injections regularly normally know whether their vision after the injection allows them to carry out their daily activities or not.

Glaucoma refers to a condition that causes a progressive damage to the optic nerve. Increased eye pressure is the most common cause of glaucoma, but it can also be due to the alteration of blood flow to the eye. There are two major types of glaucoma: angle-closure glaucoma, which is due to the anatomical characteristics of the eye, and open-angle glaucoma, which is associated with elevated eye pressure and/or alteration of blood flow to the eye.

Neovascular glaucoma is a severe condition which develops as a result of a serious retinal ischemia. It occurs as a consequence of severe diabetes, blood clots or, on occasions, vein occlusions. It always leads to a significant loss of vision. It usually manifests with an acute ocular pain. Until recently, removal of the eyeball due to acute pain has been the only available method of treatment for glaucoma. Nowadays, glaucoma treatment remains difficult, but it can be successful if applied as early as possible. The treatment can be considered a success if the basic vision is maintained. Glaucoma usually leads to a significant loss of vision. When treating neovascular glaucoma, it is vital not only to control the eye pressure, but also to determine and treat its underlying causes.

Diagnostic procedure for glaucoma involves optic nerve examination. It consists of visual field exam, optic nerve head tomography (HRT), and nerve fibre analysis (GDX). Examination should be repeated twice a year.

Causes of glaucoma vary depending on its type. Angle-closure glaucoma is due the anatomy of the eyeball. Primary open-angle glaucoma (POAG), associated with increased eye pressure, is usually due to the defects of the eye’s inner structures. Pseudoexfoliation glaucoma, which develops in the course of the pseudoexfoliation syndrome, is due to the changes in the lens, which sheds off, leading to raised eye pressure. Secondary glaucoma with lens subluxation results from the wrong positioning of the lens inside the eye.

Treatment of primary glaucoma involves lowering the eye pressure. Pressure-lowering treatment may include special eye-drops, but if they do not work, a surgery is needed. Surgery may be a good solution for patients who, for a number of reasons, do not use eye-drops, keep forgetting about them or do not have the time to use them. In secondary glaucoma, where raised eye pressure is just a symptom caused by another disease, the underlying disease should be treated. Pseudoexfoliation glaucoma and secondary glaucoma with lens subluxation are treated by removing the lens from the eye.

Surgery of open-angle glaucoma usually consists of lowering the eye pressure. There are several pressure-lowering procedures. Given that the eye pressure depends on the amount of the intraocular fluids, the majority of surgeries consists of making a new opening for the fluids to leave the eye or of reducing the amount of fluids produced inside the eye. Trabeculectomy, which involves creating a new channel that allows fluids to drain out of the eye, is the most common type of glaucoma surgery. The surgeon makes a small hole so that the necessary amount of water drains out of the eye. Sclerectomy, a non-penetrative surgical procedure in which drainage is increased without making a hole in the eye, is less common and much more difficult to perform. Canaloplasty, which has recently become much more popular, is another type of glaucoma surgery. It consists of enlarging the drainage canal through which the fluids naturally leave the eye. In very advanced glaucoma, an endoscopic operation (ECP) is performed in order to save the eye and the vision. ECP is carried out in order to reduce the amount of water produced inside the eye, thus lowering the eye pressure. This technique is more precise and safer than others, such as laser cyclophotocoagulation or cryotheraphy of the ciliary body, which cause an irrevocable damage to the eye.

Angle-closure glaucoma, which is due to the anatomical characteristics of the eye, should be treated by removing the lens. It is not necessary to carry out any pressure-lowering procedures. Treatment for secondary glaucoma depends on its causes. The type of the surgery must be chosen based on a specific medical case.

Glaucoma surgery is absolutely painless. Before the surgery, local anaesthesia in the form of eye-drops is given together with analgesics and sedatives administrated intravenously. During the surgery, patients feel nothing but the touch.

Glaucoma surgery does not improve vision. It aims at lowering the eye pressure and thus, slowing down the process in which the optic nerve gets damaged. Regrettably, some procedures may result in vision deterioration. That is why the type of surgery should be always tailored to the specific case.

Postoperative complications may vary depending on the type of glaucoma and the experience of the surgeon carrying out the procedure. The procedure must always be tailored to the needs of the patient. It is also important to consider the benefits of the surgery in comparison to the potential health risks. In some cases, there is always a possibility to opt for a treatment based on eye-drops, even in a large amount, instead of performing the surgery. Everything depends on the individual situation of the patient. The final decision is taken by the patient after a consultation with a physician.

Complete recovery from open-angle glaucoma is not possible. Treatments for glaucoma usually remain effective for some time. Sometimes, it may be necessary to perform another surgery. It depends on the eye pressure, as well as the progression of the damage to the optic nerve. In the case of the angle-closure glaucoma, thanks to removing the lens from the inside of the eye, the angle is no longer blocked and, as a result, the eye pressure drops. Further treatment is not needed. Other types of glaucoma should be assessed individually.

Due to a large variety of glaucoma surgeries and different circumstances of glaucoma itself, patients are required to talk with their leading doctor in order to be qualified for the surgery.

Glaucoma surgery is an outpatient procedure; therefore, it is not necessary to stay in the Clinic overnight after the surgery. Patients are allowed to leave the Clinic and return home just a few hours after the surgery. On the day of the surgery, it is recommended to rest and not to plan any activities. Highly sensitive people may feel exhausted because of the stress related to the surgery. From the medical point of view, this surgery is not burdensome for the body. The day after the surgery, during the follow-up appointment, the bandage (which was previously placed in the eye) is removed by the doctor. During the first days and weeks after the surgery, it is essential to follow strictly all the instructions given by the doctor. For about three weeks after the surgery, it is necessary to take the prescribed eye-drops, avoid physical exercise and crowdy areas, such as shopping centres in order to reduce the risk of infections. It is also important to protect the eye from any possible injury, such as hits.

It is recommended not to use creams and make-up products for a few weeks after the surgery.  All these products may irritate the eye. It is not dangerous but it can make the patient rub the eye.

The day before the surgery, the patient is not allowed to consume alcohol and caffeine. It is recommended not to use make-up products, face cream and eye cream. Patients who suffer from high blood pressure or diabetes have to watch the fixed time of taking their medication so that their blood pressure or blood sugar do not fluctuate. High blood pressure during or after the surgery may result in intraocular haemorrhage. High blood sugar levels, on the other hand, can make the process of healing much more difficult and increase the risk of postoperative infections.  Blood-thinning medication containing acetylsalicylic acid, such as: Acard, Aspirine, Aspro C, Asprocol, Alka-Prim, Calcipirine, Cardiopirine, Polopiryne, Rhonal, Ring N, Solucetyl, Thomaphyrin should be discontinued seven days before the surgery and instead, Clexane should be taken. Patient should be supervised by a physician or a cardiologist.

The period of healing lasts for about a month. The patient can drive a vehicle as soon as his or her vision stabilises so that he or she can assess the distance correctly. After the surgery, the patient is allowed to read, watch TV and work with a computer. However, during the first weeks, it is not recommended to do so for more than one, two hours per day.

The term vitrectomy derives from the Latin word ‘vitreus’, which means ‘vitreous body’. Vitreous body is a colourless fluid that fills the central cavity of the eye. In normal conditions, it must be transparent (invisible) and clear enough for the light to easily pass through it. Vitrectomy is a surgery that consists of removing the vitreous body from the middle of the eye. It is normally the first stage of the surgery, as the removal of the vitreous body is necessary to access the inner structures of the eye. During the vitrectomy, the epimacular membrane or any diabetes-induced changes may be removed from the eye or the retina may be unfolded. All these procedures are performed in order to restore the correct anatomical structure of the eye.

Vitrectomy is a type of eye surgery undertaken to treat a variety of conditions, including retinal detachment, macular holes, epiretinal membrane, diabetic retinopathies, vitreous haemorrhage, macular oedema, macular haemorrhage in the course of wet Age-Related Macular Degeneration (AMD), as well as retinal vein occlusion and eye inflammation. It can also be performed in the case of postoperative complications after the surgical removal of cataract. Some of these conditions, for instance retinal detachment, require an early treatment within days of occurring, while others, such as epiretinal membrane, can be treated within several months, depending on the eye condition and visual acuity. In each particular case, the decision whether the surgery is necessary shall be taken on the basis of medical examination and individual patients’ needs.

Vitrectomy is a surgical procedure that consists of removing the vitreous body that fills the central cavity of the eye. After removing the vitreous body, the access to the inner parts of the eye, such as the retina or the choroid, opens up. The procedure varies from one patient to another, as every eye is different and requires an adjusted treatment. Therefore, there is a number of procedures that can be performed during the surgery, including membrane removal, membrane staining or photocoagulation. In the course of the surgery, a special substance is frequently administrated into the eye in order to maintain the eye pressure at its normal levels, stop the bleeding or unfold the retina. Some of these substances, such as Decalin, are removed at the end of the procedure, whereas others, such as a gas bubble or silicone oil, remain inside the eye for several weeks until its full healing. The gas bubble is naturally absorbed. The silicone oil, on the other hand, must be removed at a later date in an additional surgery. Both gas bubble and silicone oil can temporarily affect the quality of vision – at first, patient may be unable to see as if his or her eye was completely healed. Unfortunately, in some cases there is no other way to hold the retina in place and cure the eye condition. Therefore, patients must arm themselves with patience and wait until the gas bubble is absorbed or the oil is removed so that they can fully recover.

For the vitrectomy to be successful, the type and the scope of the procedure must be chosen according to the needs of every individual patient. Success of the vitrectomy is also determined by the experience and the proficiency of the ophthalmologist.

The surgery usually lasts for two hours. Patient is dismissed and may return home after having rest for a few hours. In some cases, special head positioning is required in order to achieve the desired clinical effect. In such a situation, the medical staff provides the patient with a set of specific instructions to follow.

The vitrectomy technique was developed in the United States nearly 40 years ago. In Poland, it is performed by a small group of ophthalmologists; therefore, the majority of doctors who work in ophthalmic clinics in Poland have little experience using this method. As recently as 15 years ago, vitrectomy was performed only in very difficult cases or as a last resort. This was due to the fact that in the past the understanding of eye diseases as well as the technology itself were poorly developed. Even today, some ophthalmologists see the vitrectomy as a last resort and perform it once all other options have been exhausted.

Both the experience of the surgeons and the technological progress contributed to the improvement in the security of vitrectomy, its reproducibility and, most importantly, increased the possibility to achieve visual improvement. In view of the experience gained in the recent years, many conditions may be successfully treated by performing a vitrectomy. However, a frequent mistake is to perform it at the last possible moment. Patients should be referred to a specialist earlier that it happens now. When performed by an experienced surgeon, vitrectomy is not a means of last resort, but an effective method of treatment which cannot be replaced by eye-drops or tablets.

Vitrectomy is performed under the neuroleptanalgesic anaesthesia – a local anaesthesia, also referred to as a sedation, in which sedatives and analgesics are administrated intravenously. After the surgery, the patient normally does not feel any pain, only tingling and scraping in the eye. Common pain killers help to relieve those symptoms.

The day after vitrectomy, the patient does not fully restore normal vision. By contrast, after cataract surgery, the patient often restores full visual acuity on the next day. It is due to the fact that vitrectomy is a much more complicated procedure and the patient subjected to this kind of surgery normally suffers from more complex health problems. What is more, after the vitrectomy, some substances are inserted into the eye in order to maintain the correct eye pressure and unfold the retina at the same time. They may temporarily influence the quality of vision; for example, if a gas bubble was administrated, patient may see a black round shape. The gas bubble is naturally absorbed within a few days or weeks and, consequently, vision improves. If silicone oil is administrated, vision is better comparing to when the gas bubble is used, but it is necessary to wait till the eye is completely healed and the oil is removed from the inside of the eye. Vitrectomy is a surgery of retina. Depending on the disease from which the patient suffers, retina may heal for about a few or several months. That is why, visual acuity may improve long time after the gas bubble is absorbed or the silicone oil removed.

Postoperative complications can be divided into two groups: the minor ones and the severe ones. Minor, medically insignificant complications include conjunctival haemorrhage, burning eyes, stinging, and tearing. These complications are caused by the surgery itself and subside after a few days. High intraocular pressure may be experienced sometimes. If so, additional eye-drops must be used. Among severe complications there are eye haemorrhage, secondary cataract (if the lens had not been removed before), and retinal detachment. However, they are not frequently observed and may be treated in order to restore vision. It is worth bearing in mind that the sooner the surgery is performed (the less advanced the disease is), the better its result and the slighter the risk of complications will be.

Generally, there are no contraindications for performing vitrectomy. If the general condition of the patient allows for the carrying out of a surgery under local anaesthesia, the vitrectomy can be performed. Some patients ask for performing the surgery under general anaesthesia for psychological reasons. It is possible, but it should be noted that this kind of anaesthesia is much more burdensome for a patient’s body.

After the vitrectomy, it is highly recommended to follow strictly all the doctor’s instructions. It is necessary to put the adequate eye-drops, keep the head in a proper position (which may vary depending on the patient) and keep all the follow-up appointments with the doctor. Given that the eye is cut during the surgery, it is essential to apply the hygiene rules so that no bacteria is introduced into the eye. During the first two weeks after the surgery, crowded areas, such as cinemas, theatres and shopping centres, should be avoided. During the first month after the surgery, physical effort, such as riding a bike, heavy lifting or working out at the gym, should be avoided. Professional activity should also be limited at that time. Normally, it is not possible to drive for a few weeks after the surgery due to the limited vision in the eye. However, detailed instructions should be specified on a case by case basis, depending on every patient.

The day before the surgery, it is not allowed to consume alcohol and caffeine. It is recommended not to use make up, face cream and eye cream. Patients who suffer from high blood pressure or diabetes have to watch the fixed time of taking their medication so that the blood pressure or blood sugar do not fluctuate. High blood pressure before or during the surgery may cause eye haemorrhage. High blood sugar, on the other hand, can make the process of healing much more difficult and increase the risk of postoperative infections. Blood-thinning medication containing acetylsalicylic acid, such as: Acard, Aspirine, Aspro C, Asprocol, Alka-Prim, Calcipirine, Cardiopirine, Polopiryne, Rhonal, Ring N, Solucetyl, Thomaphyrin should be discontinued seven days before the surgery and instead, Clexane, should be taken. The patient should be supervised by a physician or a cardiologist.

It is recommended not to use creams and make-up products for two weeks after the surgery. All the cosmetics may irritate the eye. It is not dangerous, but it can make the patient rub the eye and thus, injure it and affect the results of the surgery.

It depends on the individual situation of the patient. In most cases, on the day of the surgery, the medication that is normally taken in the morning should be taken (swallowed), drinking some liquid. On the day of the surgery, the patient should come on an empty stomach (without having breakfast), but MEDICIATION MUST BE TAKEN, especially the one for blood pressure and heart problems.

MEDICATION FOR DIABETES SHOULD NOT BE TAKEN ON THE DAY OF THE SURGERY, as before the surgery, the patient is not allowed to have breakfast. Patients with diabetes eat their first meal after the surgery and that is when they can take their medication for diabetes.

One can distinguish many different types of laser treatment. Laser treatment can be used to treat a number of eye diseases. Procedure varies from one case to another. For example, photocoagulation of the retinal periphery is recommended to treat pathologies that may lead to retinal detachment. If this is the case, laser treatment consists of "welding" the retina to the surface so that it remains in place. Pan-retinal photocoagulation (PRP) is another type of laser surgery, which is performed if retina is damaged by diseases such as diabetes or retinal vein occlusion. This type of laser treatment is used only in the parts of the eye that are not responsible for vision. It cannot be performed, for example, in the macula. Selective laser trabeculoplasty or iridotomy are indicated to treat glaucoma. They consist of creating a hole on the edge of the iris. In some patients after cataract surgery, it is necessary to perform capsulotomy, which is indicated to treat posterior capsule opacification.

Laser has a broad scope of application in ophthalmology. It is used to treat retinal diseases, glaucoma, cataract or to remove eye scum.

Laser eye treatment is a safe procedure. Complications are usually not significant. They may include: pinching, blurred vision, sometimes stinging or foreign-body sensation.

No, it is painless, as it is performed under local anaesthesia administrated in the form of eye-drops.

In most laser eye surgeries, a special glass is placed on the eye or the eye is dilated; therefore, vision is worse for a few hours after the surgery.

The only contraindication for performing laser eye surgery is an active ocular surface inflammation.

No special care is required after the laser eye surgery. On occasions, ophthalmologist may prescribe anti-inflammatory medication.

No special preparation is required.

In most laser eye surgeries, a special glass is placed on the eye or the eye is dilated, causing temporary vision problems shortly after the surgery. Therefore, the capacity to work with a computer or drive a vehicle shortly after the surgery may be limited.

Cataract refers to the clouding of the lens, which gradually loses its transparency and becomes as opaque as matt glass. Unfortunately, the clouding of the lens is a normal, age-related process. It is typically developed by elder people, especially over the age of 60. However, it can also occur in younger people as a consequence of other medical conditions, such as diabetes, or as a result of an eye trauma. Another type of cataract, a so called congenital cataract, can occur even in very young children. This kind of cataract must be removed immediately; otherwise, child’s vision will be hampered permanently. Cataract can develop slowly, leading to a progressive vision deterioration, or progress very quickly.

Complicated cataract refers to the clouding of the lens which is secondary to other eye diseases or changes. This type of cataract most frequently coexists with different types of glaucoma. If this is the case, an ophthalmologist has to decide whether to treat cataract and glaucoma at the same time or not. Complicated cataract frequently occurs in patients with far-sightedness. The bigger the lens is, the more difficult the surgery becomes. Another type of cataract is a subluxated cataract, in which suspensory ligaments of the lens (a mechanism that normally holds the lens in place inside the eye) do not work properly. In such cases, it may be not possible to insert a standard lens. If so, a special one, which can be attached to the eye, must be ordered.

The most common symptoms of cataract include: cloudy or blurred vision, fading of colours, double vision, rapid deterioration of vision, seeing "halos" when looking at light or sun, difficulty with vision at night. Unfortunately, all these symptoms are also characteristic of other eye diseases. That is why, the patient should consult an ophthalmologist in order to learn what disease he or she is dealing with.

Developing a cataract is a normal, age-related process. Clouding of the lens can be compared to the appearance of wrinkles or grey hair – it concerns everybody, but it may occur at different ages. Clouding of the lens is a result of its "usage", but it may also be due to eye trauma, harmful radiation or other eye diseases. Cataract can also be genetically predetermined, but it regards another type of cataract that occurs in children or in very young adults.

The only available method of treatment for cataract is its surgical removal. The procedure involves removing the natural lens and inserting an artificial one inside the eye simultaneously, using a special ultrasound device.

Ultrasounds break a hard lens into small pieces, that are later removed from the eye with suction. This can be compared to the functioning of a little vacuum cleaner. After removing the lens, a new, artificial one is inserted in the same location. The whole surgery normally lasts about 20 minutes and the patient is allowed to return home an hour after the procedure is completed. Until now, no eye-drops or tablets have been proved to stop the process of cataract progression.

The only available method of treatment for cataract is its surgical removal. The procedure involves removing the natural lens and inserting an artificial one inside the eye simultaneously, using a special ultrasound device.

Ultrasounds break a hard lens into small pieces, that are later removed from the eye with suction. This can be compared to the functioning of a little vacuum cleaner. After removing the lens, a new, artificial one is inserted in the same location. The whole surgery normally lasts about 20 minutes and the patient is allowed to return home an hour after the procedure is completed. Until now, no eye-drops or tablets have been proved to stop the process of cataract progression.

It should be noted that choosing the right lens is an individual matter. What is good for one person may not necessarily be the best option for another patient. When choosing a type of lens, it is essential to consider all the diseases which the patient suffers from, both ophthalmic and general. On occasions, it is the patient's health that determinates the choice of lens. The final decision should be taken in consultation with a doctor.

Cataract surgery is absolutely painless. Before the surgery, local anaesthesia in the form of eye-drops is administrated together with analgesics and sedatives administrated intravenously. During the surgery, patients feel nothing but the touch.

After the cataract surgery, vision always improves. However, the degree of improvement depends on whether the eye is healthy or affected by any other disease. If, apart from cataract, the patient suffers from other eye diseases, such as glaucoma, AMD or diabetes, vision will improve only as much the eye condition allows it to.

It is not possible to answer the question whether the patient will restore normal vision after the surgery. Vision after the cataract surgery will not be the same as in times of youth. Artificial lens, that corrects the vision after the surgery, is a prosthesis. Every prosthesis, even the most expensive and advanced, has its limitations. Cataract surgery does not consists of replacing the eye with a new one, young and healthy, but of improving the condition of the eye considering its circumstances. However, it should be noted that lenses that guarantee the greatest possible improvement are available on the market. The lens can be adjusted so that there is no need for glasses. The decision about what lens to choose should be taken according to the individual situation of the patient and in consultation with the ophthalmologist carrying out the surgery.

Cataract surgery is a safe procedure. According to the statistics, it is the procedure burdened with least postoperative complications. However, it should be remembered that every eye is different and has different circumstances. More complications may arise in the case of complicated cataract. On occasions, it is not possible to insert the lens and an additional procedure has to be performed. Nevertheless, current technical and surgical capacities lead to vision improvement in almost every case.

Cataract surgery does not need to be repeated. The lens, once removed, does not regrow, so it does not need to be removed again. However, the posterior lens capsule, in which an artificial lens in inserted, can sometimes become cloudy, leading to the development of a secondary cataract.

Secondary cataract does not refer to the re-growing or recurring cataract. It is due to the clouding of the posterior lens capsule, that is a special bag in which an artificial lens is placed during the surgery. The posterior lens capsule is the residue of the lens, which can become less transparent over time. The problem may be solved by performing a laser procedure. It is quick and painless and the vision is restored, as just after the surgery.

There are no particular contraindications for performing a cataract surgery. Every cataract can be removed.

Cataract surgery is an outpatient procedure; therefore, it is not necessary to stay in the hospital overnight after the surgery. Patient is allowed to leave the Clinic and return home just a few hours after the surgery. On the day of the surgery, it is recommended to rest and not to plan any activities. Highly sensitive people may feel exhausted because of the stress related to the surgery. From the medical point of view, this surgery is not burdensome for the body. The day after the surgery, during the follow-up appointment, the bandage (that was previously placed in the eye) is removed by the doctor. During the first days and weeks after the surgery, it is essential to strictly follow all the doctor's instructions. For about three weeks after the surgery, it is necessary to take prescribed eye-drops, avoid physical exercise and crowded areas, such as shopping centres in order to reduce the risk of infections. It is also important to protect the eye from any possible injury, such as hits.

On the day before the surgery and just before it, it is not allowed to drink alcohol. It is recommended not to use make up, face cream and eye cream. On occasions, the patient may be asked for discontinuing blood-thinning medication containing acetylsalicylic acid, such as: Acard, Aspirine, Aspro C, Asprocol, Alka-Prim, Calcipirine, Cardiopirine, Polopiryne, Rhonal, Ring N, Solucetyl, Thomaphyrin seven days before some eye surgeries. However, before the cataract surgery this is not required so that patients do not have to consult a cardiologist.

If these medicines are not discontinued, after the surgery the eye can be reddish due to the bleeding, but it is not dangerous as the blood is absorbed within a few days after the surgery.

If such an inconvenience of a purely cosmetic nature is not a problem for the patient, he or she does not have to discontinue blood-thinning medication.

It is recommended not to use creams and make-up products for a few weeks after the surgery.  All these products may irritate the eye. It is not dangerous but it can make the patient rub the eye.

It depends on the individual situation of every patient. In most cases, medication that the patient usually takes in the morning should be taken, drinking a small amount of liquid.  On the day of the surgery, the patient should come on an empty stomach, but the MEDICINE SHOULD BE TAKEN STRICTLY.  This is particularly applicable to medicines for blood pressure and heart.

MEDICINE FOR DIABETES SHOULD NOT BE TAKEN ON THE DAY OF SURGERY as the patient is not allowed to have breakfast before the surgery. Patients with diabetes eat their first meal after the surgery and that is when they take their medicine for diabetes. Patients are allowed to eat about one hour after the surgery.

The period of healing lasts for about a month. The patient can drive a vehicle as soon as the vision stabilises so that he or she can assess the distance correctly. After the surgery, the patient is allowed to read, watch TV and work with a computer. However, during the first weeks, it is not recommended to do so for more than one, two hours per day.