What Retina Specialists Treat and How They Help

Some symptoms may indicate a retinal detachment or another sight-threatening emergency. If you experience any of the following, contact a retina specialist immediately or go to the nearest emergency room.

• A sudden increase in floaters (spots, strings, or cobweb-like shapes drifting through your vision)
• Flashes of light, especially in your peripheral (side) vision
• A curtain-like shadow or dark area spreading across your field of vision
• Sudden loss of vision in one eye

A retinal detachment is a medical emergency. Without prompt treatment, a detached retina can lead to severe and permanent vision loss.

Not every retinal problem announces itself with dramatic symptoms. Many conditions develop slowly over months or years. You may notice that central vision becomes blurry or distorted, that reading is harder than it used to be, or that dark spots appear in the middle of your sight. In people with diabetes, vision may fluctuate as blood sugar levels change. These gradual changes deserve evaluation just as much as sudden ones.

If you are already receiving retinal treatment, certain new symptoms should be reported right away. Sudden worsening of vision, increasing eye pain, or significant redness after an intravitreal injection (a medication delivered directly into the eye) could indicate endophthalmitis, a rare but serious infection inside the eye. Do not wait to contact your retina specialist if these symptoms develop.

Wet AMD, DME, diabetic retinopathy, and retinal vein occlusion all involve abnormal blood vessel growth or leakage driven by a protein called vascular endothelial growth factor (VEGF). Anti-VEGF medications block this protein and are delivered through intravitreal injections, meaning the medication is placed directly into the vitreous cavity of the eye.

Several anti-VEGF medications are available. Aflibercept (Eylea) is among the most widely used and is typically given every four to eight weeks after initial loading doses. A higher-dose formulation of aflibercept (Eylea HD) may allow treatment intervals of up to 16 weeks. Ranibizumab (Lucentis) was the first anti-VEGF approved specifically for eye use and is given on a monthly basis. Faricimab (Vabysmo), a bispecific antibody that targets two separate pathways, can be given every four to 16 weeks depending on how the eye responds. Bevacizumab (Avastin) is used off-label in small doses for retinal conditions and is FDA-approved for cancer treatment. Anti-VEGF injections are used specifically for wet AMD and vascular conditions and are not a treatment for dry AMD.

Geographic atrophy, the advanced form of dry AMD, involves the progressive loss of retinal cells and requires a distinct treatment approach from wet AMD. Two complement inhibitors are FDA-approved specifically for this condition. These medications target the complement pathway, a part of the immune system that contributes to retinal cell loss. Pegcetacoplan (Syfovre), the first approved, targets the C3 complement protein. Avacincaptad pegol (Izervay) targets the C5 complement protein. Both are delivered as intravitreal injections and are intended to slow the rate of tissue loss rather than restore vision that has already been lost.

Laser photocoagulation uses a thermal (heat-based) laser to seal leaking blood vessels or reduce areas of abnormal vessel growth. It is used in diabetic retinopathy and retinal vein occlusion. Photodynamic therapy (PDT) combines a light-activated drug injected into the bloodstream with a laser applied to the retina, closing abnormal vessels with less impact on surrounding tissue. Non-thermal transscleral diode laser is another approach applied from the outer surface of the eye (the sclera) to treat certain retinal conditions with reduced thermal effect on overlying structures.

When medications or laser treatments are not sufficient, surgery may be the appropriate next step. A vitrectomy involves the surgical removal of the vitreous gel inside the eye, providing direct access to the retina for repairing tears, removing scar tissue, or clearing blood. A scleral buckle places a silicone band around the outside of the eye to support a detached retina. Pneumatic retinopexy uses a gas bubble injected into the eye to press the retina back into position. Cryoretinopexy uses a carefully controlled freezing treatment to seal retinal tears. The choice of procedure depends on the nature and extent of the problem.

Retinal medicine continues to advance. Port delivery systems are small implantable devices that release anti-VEGF medication slowly over several months, potentially reducing the number of injection visits needed. Biosimilar medications offer additional versions of established anti-VEGF therapies. For certain inherited retinal diseases caused by specific gene mutations, gene therapy approaches such as voretigene neparvovec (Luxturna) address the underlying genetic cause of vision loss. Our practice participates in ongoing clinical research, which may give eligible patients access to emerging therapies through carefully supervised trials.

Most injection visits take between one and two hours from check-in to departure. The injection itself lasts only a few seconds, but the appointment also includes imaging, numbing the eye, preparation, and a brief post-procedure check. If you are early in your treatment, your physician may also spend time reviewing results and discussing your care plan in detail. Planning for the full window gives you a realistic expectation and keeps your day on track.

Most retina visits involve dilating the eyes with drops, which temporarily blurs near vision and makes eyes sensitive to bright light for several hours. Many patients find driving uncomfortable or unsafe during this period. We recommend arranging for someone to drive you, especially for your first few visits. If you must drive yourself, waiting until your vision has fully cleared before getting behind the wheel is important for your safety and that of others.

The eye is thoroughly numbed before every injection, so most patients describe the sensation as pressure rather than pain. Some report mild stinging during or just after the injection, which passes quickly. A gritty or slightly sore feeling for the rest of the day is common and expected. If you experience significant pain, sudden vision changes, or worsening redness in the hours or days following an injection, contact us promptly, as these may signal a complication that requires immediate evaluation.

An ophthalmologist is a medical doctor trained to diagnose and treat the full range of eye conditions, including performing eye surgery. A retina specialist is an ophthalmologist who has completed an additional one to two years of fellowship training focused specifically on diseases and surgery of the retina and vitreous. This advanced training equips them to handle complex retinal conditions that go beyond the scope of general eye care. At New England Retina Associates, all of our physicians are fellowship-trained vitreoretinal surgeons who focus exclusively on retinal disease.

Treatment frequency depends on your specific condition, the medication being used, and how your retina responds over time. Some patients require injections every four weeks, while others may be able to extend intervals to 12 or 16 weeks as their condition stabilizes. Your physician will review OCT imaging at each visit and adjust your schedule based on what the retina shows. Consistent follow-through with appointments is one of the most important factors in protecting your long-term vision.

Earlier treatment generally leads to better outcomes, but that does not mean nothing can be done if a condition has already progressed. Treatments for geographic atrophy, for example, focus on slowing future tissue loss rather than reversing what has already occurred. In retinal detachment, the outcome depends significantly on how long the retina has been separated and whether the macula has been affected. Even in more advanced cases, treatment may help stabilize vision or prevent further decline. The most important step is always to be evaluated as promptly as possible so your physician can explain which options are appropriate for your specific situation.