Laser Treatment for Proliferative - Explanation

[belyro]

Today I asked my retinal specialist exactly what it was that was being zapped during my laser treatments, because I've always wondered and never got a really straight answer from any source.

It's kinda complicated, but in language those of us who aren't retinal specialists can understand, he said that because my retinal tissue isn't getting enough oxygen, it sends the signal to the brain to make more blood vessels. These are the vessels that are weak and leak easily and really serve no purpose to the retina. So, he's zapping the retinal tissue in the peripheral areas and killing it. (I had always thought he was zapping something "new" that had developed because of the retinopathy, but he's actually zapping regular retinal tissue.) This means that the retina requires less oxygen, so the signals to make new blood vessels are no longer being sent to the brain. Essentially, the peripheral tissue is being sacrificed to save the tissue at the centre that is more important to my vision.

Anyway, that's the quick and dirty version, in case anyone other than me was also wondering. :)

[shockme]

thanks bethany! i always thought they zapped the new vessels,too....trish

[RobiJo]

Good explanation. I was told pretty much the same thing, but he also zapped some of the leaking spots to make them stop leaking. I was trying to count it up today, I think I had about 2,500 in the right eye and around 1,500 in my left.
I can't believe you can look at your screen to type. All I could do afterwards was swallow some Tylenol and sleep it off. My pupils were so big you could barely tell what color my eyes were.

I'm glad this is going well for you. You seem to be handling it very well!

[belyro]

I can't believe you can look at your screen to type. All I could do afterwards was swallow some Tylenol and sleep it off.

I'm glad this is going well for you. You seem to be handling it very well!

When he only does between 300 and 400 it's not too bad. I'm on painkillers, though. :)

I'm handling it all much better now than I was at first. There's been quite a lot of "processing" for me.

[Mich]

Hey Beth,

Glad to hear you're making progress with the zapfest. That processing does take some effort sometimes, doesn't it?
Hope the rest of your treatments go fairly effortlessly. Hugs to you, you're doing well! Mich

[peej07]

Great to hear you are doing well. I also thought the whole zap fest was to stop the growth rather than prevent more growth.

[belyro]

Great to hear you are doing well. I also thought the whole zap fest was to stop the growth rather than prevent more growth.

I think it *may* also stop it, because once the signal stops getting sent I think the little new vessels that are already there shrivel up and go away....but I'm not sure about that. I didn't ask the optho.

[xMenace]

I think it *may* also stop it, because once the signal stops getting sent I think the little new vessels that are already there shrivel up and go away....but I'm not sure about that. I didn't ask the optho.

They usually do. If they don't, hemmhoraging and all the fun with that may follow. Catching them early is definately a bonus.

[Mich]

Thanks also Beth for the clarification on the use of the laser. I,also thought it was to destroy the new growth vessels, rather than to reduce to needed oxygen in the area. It makes sense though and explains why a bit of our peripheral vision is affected.

For further research, the "signal" is called Vascular Endothelial Growth Factor or VEGF. The other way to treat it is to inject either Lucentis or Avastin directly into the overgrowth area.

[xMenace]

Here's another excellent site. Proliferative Retinopathy (http://medweb.bham.ac.uk/easdec/proliferative.html)

As the animations show, new blood vessel growth happens in the optic disc area. Shooting lasers into that space can be very damaging. These are very fine vessels that can barely be seen let alone hit every time with a laser. Obviously surgical removal is risky too.

[noonegetsme]

I have had so many of these zap fest I can't even remember I think I have had 25-30 separate sessions anywhere from 300-700.
I had a Vitrectomy 2 years ago.

My first zapper used a numbing shot . The retinal surgeon called in after the previous zapper said his zapper wasn't sufficient doesn't. I've found the recovery time to be much shorter without the shot any one else find this to be true?

[belyro]

I have had so many of these zap fest I can't even remember I think I have had 25-30 separate sessions anywhere from 300-700.
I had a Vitrectomy 2 years ago.

My first zapper used a numbing shot . The retinal surgeon called in after the previous zapper said his zapper wasn't sufficient doesn't. I've found the recovery time to be much shorter without the shot any one else find this to be true?

I've never had the shot. I've tried to avoid it at all costs, because then I'd pass out for SURE! A needle to the eye?? No thanks!

[noonegetsme]

It was scary ...but they would usually give me valium before the came at with any needles

[RobiJo]

I have had so many of these zap fest I can't even remember I think I have had 25-30 separate sessions anywhere from 300-700.
I had a Vitrectomy 2 years ago.


I'm curious--how has your vision been since your vitrectomy and is your doc concerned about the problems reoccuring???

I've never had the shot. I've tried to avoid it at all costs, because then I'd pass out for SURE! A needle to the eye?? No thanks!

I was never given a shot either, can't say I want one! The best thing about the vitrectomy is that you are knocked out and don't have to look at or focus on anything. You don't see or know what's about to happen.

[xMenace]

I have had so many of these zap fest I can't even remember I think I have had 25-30 separate sessions anywhere from 300-700.
Not likely. That's at least 25*300 or 7500 blasts. I don't know what the max is, but my reading suggests the 3,000 range. This stuff can easily blend together.

My first zapper used a numbing shot . The retinal surgeon called in after the previous zapper said his zapper wasn't sufficient doesn't. I've found the recovery time to be much shorter without the shot any one else find this to be true?

I had one. I would never take one again. IMO it's a stupid solution to fixing what amounts to high stress. i bet your doctor has no bedside manners either.

I was never given a shot either, can't say I want one! The best thing about the vitrectomy is that you are knocked out and don't have to look at or focus on anything. You don't see or know what's about to happen.

Interesting:stupido3: I was awake for most of mine, including another shot to the back of the eye socket. Mind you I was heavily sedated, so it barely bothered me.

Vitrectomy (http://www.retinavitreouscenter.com/ret-procedures_vitrectomy1.htm) is typically performed under local (injection) anesthesia, with sedation. In other words, the patient is awake during the procedure, but does not feel pain or see the procedure being performed. General anesthesia may be used instead in some cases. It is an outpatient procedure; no hospital stay is required.

I did see the procedure. The assistant didn't believe me, but I accurately described the vacuum cutter in action to him.

[RobiJo]

Interesting:stupido3: I was awake for most of mine, including another shot to the back of the eye socket. Mind you I was heavily sedated, so it barely bothered me.

I did see the procedure. The assistant didn't believe me, but I accurately described the vacuum cutter in action to him.

Scary! I would have never made it. Glad I was knocked out!!!!!

[belyro]

Scary! I would have never made it. Glad I was knocked out!!!!!

Are you and XMenace perhaps both talking about that stuff they use to drug you up REALLY good so that you're not supposed to remember anything, but maybe it worked better on RobiJo than on XMenace? I had that stuff when I got my wisdom teeth out. All I remember is when they asked me to get off the table and onto the stretcher when they were done. Or, RobiJo, did they actually give you general anaesthetic?

[noonegetsme]

Im not sure what you mean by not likely. I assure you that was the case.

No bedside manner at all. I have this very strange doctor who has these weird procedures and I swear to you he has to be announced when he walks in a room. I think I have even seen some bowing going on.

Unfortunatly he is the only option I have. The second doctor was great and very good bedside manner. The Vitrectomy seems to have worked . My vision hasnt gotten better at all in either eye. I have very little vision in my right eye .

[noonegetsme]

You know what gets me? I spend all day with my sunglasses on trying to keep the light out of my eyes,they are very sensitive. And as soon as I get to the doctors office they shine the sun in my eyes.

[Mich]

I don't know if any of you read my blow-by-blow of my Avastin injection or my vitrectomies, but I have to tell you my imagination had made everything much worse than it really was.

For the Avastin injection, I couldn't possibly think of anything in the world worse, and I've had several surgeries and a couple of broken bones. WELL, my doc used some kind of numbing drops in my eye. He knew how nervous I was and thought I'd never stand for it. He kids around a lot. He said "put your head like this, look at the wall and pretend this isn't happening." Yeah, right. I did though and it was over pretty quickly and painlessly though I did feel the sensation, I breathed deeply, then held it.

For the vitrectomies, all three, they gave me a local anesthetic and also an intravenous sedative that made me REALLY NOT CARE. I was completely there, just DIDN'T CARE. I chatted with them the whole time, remembered it all afterward, including a few comments my doc made that he swore me not to repeat the next day in his office. At the end of the surgery, they gave me an antidote to the sedative and I got up off the table and sat down in the wheelchair. I left for home 20 minutes later.

My daughter the nurse knew exactly what the sedative was, so it is pretty widely known.

I guess my point is that we all can do things we thought we couldn't and modern medicine sure makes it easier.

Mich

[RobiJo]

Are you and XMenace perhaps both talking about that stuff they use to drug you up REALLY good so that you're not supposed to remember anything, but maybe it worked better on RobiJo than on XMenace? I had that stuff when I got my wisdom teeth out. All I remember is when they asked me to get off the table and onto the stretcher when they were done. Or, RobiJo, did they actually give you general anaesthetic?

Yes. I had general anthesia (sp). for both eyes. I had the retina doc, an anathealogist, another doc, and a surgical nurse. I was hooked up to an IV, and wheeled away. They never even asked me to count backwards...I was out. I woke up in the recovery room with a patch on my eye. I had it done at the Kellogg Eye Center in Ann Arbor, which to my knowledge is one of the leading eye hospitals in the country. I had no idea this is not how this procedure is performed elsewhere. It was nothing like getting my wisdom teeth out, which I do remember being in the room, them in my mouth, but unable to do anthing etc.

[Georgia]

Thanks for the explanation :)