Eye Treatments | Professor Adnan Tufail, MBBS, MD, FRCOphth

Injections (intravitreal injections)

Results of clinical trials led by a number of pharmaceutical companies as well as the The ABC Trial (bevacizumab(Avastin) for age-related macular degeneration) and REPAIR (ranibizumab for myopic choroidal neovascularisation) , led by Professor Tufail, showed that treatments that block a chemical released in the eye called vascular endothelial growth factor (VEGF) can reduce the leakage from abnormal blood vessels that can damage the macula and affect vision.

Today, ophthalmologists and patients are delighted with the results of certain retinal treatments using intravitreal anti-VEGF injections (such as Aflibercept (Eylea), bevacizumab(Avastin), brolucizumab (Beovu), and Ranibizumab (Lucentis), Diabetic eye disease, macular degeneration, myopic degeneration and retinal vein occlusion are some sight-stealing conditions that respond well to medication injections. In those that respond suboptimaly to anti-VEGF, injections of corticosteroid implants OZURDEX® may be considered.

Here is what to expect if you require an intravitreal (eye) injection.

First, you will be given an anaesthetic to numb the surface of your eyeball so you don’t feel pain . Your eye and eyelids will be cleaned with an antiseptic solution to help prevent infection from bacteria near the eye. Your surgeon will place a device called an eyelid speculum on your eye to hold the lids open. Then you will be asked to look in a certain direction so that your ophthalmologist can inject the medicine into a specific part of the eye.

The needle used for the injection is very thin. You will probably feel only pressure, with little discomfort, as the medicine is injected through the white part of your eye.

Laser treatment for the peripheral retina (PRP)

Panretinal Photocoagulation (PRP) helps prevents further growth of abnormal blood vessels in the eye that has been damaged by conditions such as diabetes and retinal vein occlusions.

When the back of the eye is starved of blood or oxygen, the retina may respond by growing abnormal blood vessels in the eye. Unlike the natural blood vessels, these new abnormal ones can bleed into the jelly within the eye(vitreous haemorrhage) causing a sudden loss of vision that sometimes needs surgery to resolve. Rarely, these abnormal vessels cause a painful type of high pressure within the eye (neovascular glaucoma). Prompt treatment can reduce the risk of further visual loss and a blind painful eye. Treatment of these abnormal vessels and be with anti-VEGF injections or laser PRP. Anti-VEGF injections work quickly but need careful long term monitoring and often repeat courses of injections. PRP laser is more likely to give long term protection with needing just one or two treatment sessions. Adnan has experience of both treatments in complex patients and will advise you which treatment best suits your circumstances and the risks and benefits of each relevant to your future eye health.

Laser PRP treatment usually takes 15-30 minutes depending on how much treatment is required in your particular circumstance. Pupil dilating drops will be placed in the eye under-going treatment. This is to allow a good view of the retina. These drops have a temporary effect to make your pupil appear larger than usual. You will noticed blurred vision in this eye for a period of two to four hours and you will notice some mild sensitivity to light while the drops have an effect. You should not drive while you still have dilated pupils. Anaesthetic eyedrops are administered in the eye that is being treated to numb the surface of the eye. You will then rest your chin on the chin rest and head against the bar, similar to the slit lamp instrument that is used to examine the eyes. The surgeon will put a special contact lens on your eye to focus the laser beam to the affected area. The laser light is very bright. You will experience lots of flashing lights and hear the sound of the machine beeping as the laser is delivered. Most people find the treatment relatively comfortable other than the feeling of the lens between their eyelids and the need to stay steady for the treatment. A few people find the laser intermittently uncomfortable. Experienced surgeons like Adnan will communicate with you during the treatment and can adjust the settings of the laser to improve this. If you have only needed one eye treated, you will be able to go home immediately. If both eyes are treated, you will usually be able to go home within 30 minutes.

Find out more on the AAO website here.

Laser treatment for the central retina (macular laser)

Anaesthetic eyedrops are administered to the eye that is being treated to numb the surface of the eye. You will sit at a similar microscope to the one that is used when we examine your eyes. You will rest your chin on the chin rest and head against the bar. After a specific period of 3-5 minutes depending on the treatment required, you will have a special contact lens placed onto your eye to focus the laser beam onto the affected area of the retina. Macular laser takes between 10 and 15 minutes for most patients. The treatment is painless due to the mild settings of the laser, but the bright laser light can cause mild discomfort. After the treatments is complete, the contact lens is removed and you will be able to go home. If you have only needed one eye treated, you will be able to go home immediately. If both eyes are treated, you will usually be able to go home within 30 minutes.

Photodynamic therapy (PDT) laser

Photodynamic therapy (PDT) is a treatment that uses a combination of a “cold” laser after an infusion of special light-sensitive dye (Verteporfin) into the arm to seal up leaking fluid in the macula. Professor Tufail may recommend PDT if your central serous chorio-retinopathy (CSCR or CSR) persists and is affecting your vision or if you if you have a dilated leaking vessels in the macula (polypoidal choroidal vasculopathy)

PDT is a simple and painless procedure that usually takes less than 15 minutes. Before the procedure you will be weighed and your height measured to calculate the correct dose of the Verteporfin dye. A cannula (tube introduced into the vein in your arm with a needle) will be inserted and you will receive the Verteporfin dye through a cannula over a period of a few minutes.

Pupil dilating drops will be placed in the eye under-going treatment. This is to allow a good view of the retina. These drops have a temporary effect to make your pupil appear larger than usual. You will noticed blurred vision in this eye for a period of two to four hours and you will notice some mild sensitivity to light while the drops have an effect. You should not drive while you still have dilated pupils. Anaesthetic eyedrops are administered to the eye that is being treated to numb the surface of the eye. You will sit at a similar microscope to the one that is used when we examine your eyes. You will rest your chin on the chin rest and head against the bar. After a specific period of 3-5 minutes depending on the treatment required, you will have a special contact lens placed onto your eye to focus the laser beam onto the affected area of the retina.

The treatment takes up to 83 seconds to complete (depending on the type of treatment required). The treatment itself is not uncomfortable, merely the sensation of a dim red light. The contact lens is removed after the procedure is completed.

After care: The Verteporfin dye makes your skin very sensitive to day light for up to 48 hours after the treatment. You need to wear clothes to protect from the sun and dark glasses when going outside during daylight hours for this period of time to prevent burns to your skin. After the local anaesthetic drops wear off, the surface of your eye can feel slightly irritated for a day or two. This symptom is usually very mild, but can be relieved with topical lubricant drops.

Download PDF from Moorfields with more information on PDF laser

Posterior capsulotomy (YAG) laser

Download PDF from Moorfields with more information on YAG laser here

Cataract Surgery

Professor Tufail specialises in cataract surgery in eyes with co-existing macular or retinal disorders, such as macular degeneration or diabetic eye disease.

Cataracts and retinal disorders often co-exist. The correct timing of cataract surgery and planning appropriate treatment or prevention for any retinal or macula disorder that may be worsened by cataract surgery is important to achieve the best vision outcomes. Even with co-existing retinal or macular disease that may require simultaneous treatment, treatment can usually be carried out under local anaesthetic and with a minimally invasive technique not requiring any stiches as a day-case procedure. This allows for fast visual recovery and minimal disruption to normal lifestyle.

Download PDF from Moorfields with more information on Cataract here

If you’d like to know more about this treatment, or think that you may benefit from a consultation, please get in touch here.