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The Massachusetts Eye and Ear Infirmary Retina Service provides care to patients with age-related macular degeneration, diabetic retinopathy, retinal vascular occlusive disorders, retinal infections, post-cataract surgery complications, intraocular tumors, retinal degeneration, detachment of the retina or vitreous, trauma-related retinal complications, and many other retinal conditions. The Service is run by a team of 8 board certified retina specialists, with each one with unique clinical and research interests. Each year the Retina Service provides care to more than 14,000 patients and trains ophthalmology residents, medical students and fellows from around the world.
Christopher Andreoli, M.D.
Daniel Esmaili, M.D.
Szilard Kiss, M.D.
Vasiliki Poulaki, M.D.
Corey Westerfeld, M.D.
The office is open Monday through Friday, 8:30 – 5:00
Main line: 617-573-3288
Dr. Evangelos Gragoudas: 617-573-3515
Dr. Ivana Kim: 617-573-3367
Dr. John Loewenstein: 617-573-4274
Dr. Joan Miller: 617-573-3915
Dr. Shizuo Mukai: 617-573-3730
Dr. Lucia Sobrin: 617-573-4279
Dr. Demetrios Vavvas 617-573-6874
Dr. Lucy Young: 617-573-3710
Fax: 617-573-3698
Massachusetts Eye and Ear Infirmary recently acquired the newest laser for treating people with diabetic retinopathy. The Pattern Scan Laser Photocoagulator (PASCAL) by
OptiMedica is FDA-approved primarily for treatment of diabetic retinopathy and diabetic macular edema.
Diabetic retinopathy is the most common diabetic eye disease and is a leading cause of blindness in American adults, according to the National Eye Institute of the National Institutes of Health (www.nih.nei.gov). The disease is caused by damage to blood vessels in the retina near the back part of the eye. The Pascal laser allows for faster, more precise and safer treatment. In contrast to other laser photocoagulators which target a single pulse, the Pascal laser places an array of lower energy pulses across the retina, allowing patients to receive treatment in a single session as opposed to multiple sessions and providing a more comfortable experience with less inflammation and blurring of vision after treatment.
The length of consultations varies depending on the condition and tests required. Multiple tests are often ordered on the same day that may prolong your clinic visit to 2-4 hours. Your pupils will be dilated, which usually creates difficulty with driving.
The biographical information of each physician is available on line. If you are seeking care for ocular tumor, you should schedule with Dr. Evangelos Gragoudas. If you have a pediatric issue, please see Dr. Mukai. For complex diabetic conditions, schedule with Dr. D’Amico or Dr. Loewenstein. For the management of retinal infections, please consult Dr. Young. For retinal degeneration, we recommend Dr. Loewenstein. For the management of age-related macular degeneration, you may consult Drs. Gragoudas, Kim, Loewenstein, Miller and Young.
Laser procedures are performed at our Laser Center located on the same floor as the Retina Service.
Intraocular drug injections and many procedures can be performed in the clinic area. More extensive procedures, however, are performed in one of the Infirmary’s major surgical operating rooms located on the S-floor.
A patient with diabetes should have a dilated pupil examination of the retina at the time of diagnosis and a minimum of once a year for life. Some patients with involvement of the retina by diabetes may require more frequent examination as part of the process of providing care for swelling of the retina (macular edema), bleeding into the eye or development of new blood vessels (neovascularization), or in conjunction with laser or surgical treatments for other ocular problems with diabetic retinopathy.
Diabetes can affect virtually every part of the eye, but involvement of the retina is the most characteristic complication of diabetic eye disease. In non-proliferative or background retinopathy, the center of the retina (macula) may become involved by swelling (edema) from retinal vessels that become altered by diabetes. This macular swelling can cause a visual loss that can usually be stopped by laser treatment. Early macular swelling may not be perceived by the patient, and the importance of routine eye examinations is critical. A second major area of involvement of the retina by diabetes is proliferative retinopathy, i.e., the formation of abnormal new blood vessels (neovascularization) that grow out of the retina into the formerly clear vitreous gel. These vessels will usually bleed into the vitreous, causing any degree of impairment from a few floaters to severe visual loss, or these vessels will undergo traction on the retina resulting in a retinal detachment which can also cause a severe visual loss. In many patients with neovascularization, bleeding and retinal detachment occur together. The treatment of neovascularization is usually by laser if the vessels are detected when the eye clear enough and the retina has not detached. However, patients with severe bleeding or retinal detachment involving the central vision typically require surgery.
No. Even with excellent control, many patients will still develop retinopathy. Consequently, regular eye examinations are very important.
Yes. Good diabetic control produces many benefits, including slowing down the development of retinal complications
For additional information about diabetic retinopathy:
Laser treatments for either macular swelling or new blood vessels are performed as an outpatient with either topical anesthetic drops or anesthetic injection near the eye as the patient and physician prefer. Treatments may be divided into several sessions over a few weeks, depending on what needs to be treated. Although some patients may want a family member or friend to help them with transportation, most patients can handle the treatments easily and without pain.
Vitreous surgery for diabetic retinopathy is surgery within the eye in order to remove blood, re-attach the retina, or both. Miniaturized instruments such as scissors, lasers, and other devices are introduced into tiny openings in the side of the eye, and the procedure is usually done under local anesthesia, similar to modern cataract surgery. Vitreous surgery for diabetic retinopathy is very complicated, and the prognosis may run a spectrum from optimistic to difficult, and careful consultation is suggested in patients who may be advised to undergo vitreous surgery for diabetic retinopathy.
For information on specific retina diseases, visit the DJO (Digital Journal of Ophthalmology), a premiere peer-reviewed ophthalmic journal dedicated to the
dissemination of ophthalmic information over the World Wide Web. The DJO was founded and is contributed to by MEEI physicians
Digital Journal of Ophthalmology
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