Stroke Awareness Month – Tennessee Retina
May is Stroke Awareness Month in the US! Did you know that not only can you have a stroke affect your brain tissue, but also the Retina?
These “Strokes” are essentially occlusions, or blockages, to one of the arteries feeding the retina, called Central Retinal Artery Occlusion and Branch Retina Artery Occlusion (CRAO and BRAO). This event restricts or completely cuts off the blood flow to the Central or a Branch Artery in the back of the eye. Unfortunately, this Occlusion event often leads to unrecoverable vision loss as the affected area of the Retina, which is nerve tissue, goes an extended period without proper blood flow. In some rare cases, the artery may “perfuse” and some blood flow may return to the affected area of the Retina.
The usual suspect for the embolism in these Retinal Artery Occlusions is a piece of plaque, usually comprised of cholesterol, calcium, or other platelet fibrin. These emboli usually originate from a partially blocked artery elsewhere in the body, such as the carotid artery. This process of an embolism happening within a Retinal Artery is the similar to the process of a blockage occurring in an artery in the brain, leading to a stroke. Because of this fact, CRAO and BRAO events are taken very seriously as they could be indicators for a patient being at higher risk of a stroke.
According to a recent article publish at AAO.org, a study found of 89 identified patients with a CRAO, in the 15 days before and after CRAO, 2 patients had ischemic strokes and 1 patient had a nonischemic stroke (3.4% of the study population). In addition, 2.2% of patients had a Transient Ischemic Attack (TIA) and 10.1% experienced Transient Monocular Vision Loss (TMVL). The American Heart Association published a scientific statement which stressed that CRAO is a medical emergency requiring an emergent workup. This is because CRAO is thought to be the equivalent of a stroke or TIA. All of the patients who developed a stroke or TIA in the time period before and after CRAO had an embolic etiology, showing the importance of a full workup surrounding the event. (https://www.aao.org/editors-choice/increase-in-stroke-complications-seen-several-days)
To learn more about RAO's and other conditions we treat please visit our learning center.
Content provided by TN Retina Member
Michael Nore, COA
Assistant Clinical Manager
Clincally reviewed by Dr Kenneth Moffat, M.D.
Tennessee Retina is dedicated to saving sight. Retinal detachment symptoms may be subtle, but it's very important to take note of them when they occur. Ignoring signs or symptoms can lead to vision loss. Read this informative article about retinal detachments, featuring one of our RCA colleagues at Vitreoretinal Consultants in New York, Dr. Philip Ferrone. In this article Dr. Ferrone and other specialists share some important information regarding the risks of ignoring signs of a retinal detachment. Retinal detachment symptoms may be subtle, but it's very important to take note of them when they occur. Early symptoms of a retinal detachment may begin with a few dark spots or wavy lines in your field of vision and even flashes of light. These symptoms are painless and may seem non urgent but if you experience any of these symptoms it could be an indication for a retinal tear which could lead to a detachment. If the tear is left untreated, this could lead to permanent damage loss. Read more about the risks in this interesting article in the Wall Street Journal featuring our RCA colleague, Dr. Philip Ferrone.
Eye protection is very important especially when you only have one eye that has good vision. Protective eye wear is one way to protect your eyes while playing sports or even performing chores at home. The importance of eye safety gear is crucial when you only have one eye with good vision.
There are also more ways to protect your eyes other than just physical protective eye gear.
- A good, healthy diet is also a great way to help your eye health, including a healthy retina. A diet including colorful vegetables and leafy greens are just a couple examples of some good food items to add to your diet.
- Smoking can be very harmful to the health of your eyes. It is important to try and refrain from smoking to help keep your eyes healthy.
- Regular eye exams are also a great way to protect yourself from vision loss. Regular, dilated eye exams are important to check the back of your eye for the possibility of any new changes that may be asymptomatic to you.
As part of Healthy Vision Month this April, do all that you can to protect your vision!
For more information about retinal diseases please visit: Retina > Our Services (tnretina.com)
Did you know that if you have diabetes, it is recommended you have a dilated eye exam by your eye doctor every year, starting from the day you're diagnosed? Saving your vision is about prevention and early detection.
Diabetes damages blood vessels all over the body, including the eyes. This damage to vessels in the retina is known as Diabetic Retinopathy- an eye condition that can cause vision loss and blindness. Symptoms may not occur suddenly but could affect your vision drastically over time. Visual changes that could occur include blurriness around the edges of your vision, dark spots, central blurry vision, straight lines that look wavy, and colors that appear dull or washed out. It is especially important to have regular dilated eye exams if you are diabetic to monitor for these changes. Early detection is important to minimize damage to the retina and decrease the risk of vision loss over time. Read more about the research we're doing to develop treatments for Diabetic Retinopathy here.
Age Related Macular Degeneration is a disease that causes severe or permanent vision loss in people typically over the age of 60. Macular Degeneration affects the macula which provides your central vision. There are two forms of macular degeneration - Dry AMD and Wet AMD. Dry AMD patients have yellow deposits in their retina known as drusen. With Dry AMD over time, the light sensitive cells in your macula get thinner and die, which causes a central blind spot in your vison.
Wet AMD is when blood vessels grow into and under your macula. When the blood vessels form and grow, they leak fluid into your retina. When this happens, you will have distortion. Distortion would include straight lines looking wavy and central blurred vision. Left alone, these leaking blood vessels can form a scar, which leads to permanent central vision loss. Treatment for Wet AMD includes intravitreal injections of medication to stop and prevent the bleeding to save your vision. It is important if you have Dry AMD to check your vision daily, one eye at a time. If you recognize changes in your vision, you should make an appointment with a retina specialist immediately. Early treatment is key!
To learn more about AMD, visit our Learning Center:
For many people, changes in insurance and finances can make healthcare decisions difficult, especially at the beginning of the year. Tennessee Retina strives to make our services accessible to patients who have high deductible plans or no medical insurance coverage and has multiple programs in place to provide assistance. The Tennessee Retina Financial Counselors are available by phone or at the time of your visit and can discuss possible options, including financial assistance and structured payment plans for those who meet required guidelines and qualify for assistance.
Our self-pay option allows a patient to receive the treatment needed and pay for services rendered in our office at the time of service, often at a discounted rate. The first estimated visit cost for a self-pay patient will be due upon checking in at our office. This cost will include basic testing and the initial exam. If additional testing or treatment is needed, the patient will be responsible for those discounted rates as they check out and according to any payment plan set up.
If you don't have insurance or have questions about covering costs, call our office at (615) 983-6000 and ask to speak to one of our Financial Counselors before your appointment. To learn more about our financial policy and print out an application, visit our Forms area here.
On December 10th, friends and neighbors in our surrounding counties and states suffered tremendous loss from the tornadoes. The amount of devastation that occurred has been catastrophic. Our deepest condolences go out to all the families that were affected by these storms. During this holiday season, please remember these families that have lost loved ones, homes and businesses. Join the Tennessee Retina doctors and staff in support of those in need through volunteering, donations, and nonprofit organizations like Mother to Mother @mothertomotherinc or Be the Village of Tennessee. Our special thanks to Anderson Brock, Janie Busbee and Mother to Mother for their incredible cooperation to help families in need.
Donation Drop off:
1064 Evergreen Street
Dresden is in need of volunteers to help clean up the damage from these storms. If you or someone you know is interested in volunteering you can report to the Disaster Relief Headquarters located at the First Baptist Church on 490 Morrow Street Dresden, TN 38225. Thank you for your help in supporting this town now and in the days to come, as they recover from this national disaster.
Diabetic retinopathy is a complication of diabetes that affects eyes. It is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).
At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness.
The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication.
Treatment depends largely on the type of diabetic retinopathy you have and how severe it is and is geared to slowing or stopping progression of the condition. Treatment can include the following:
- Laser treatment that can stop or slow the leakage of blood and fluid in the eye, or it could shrink the abnormal blood vessels
- Surgery, called a vitrectomy, that would remove blood from the middle of the eye (the vitreous) or remove tissue that is tugging on the retina.
- Injections into the eye with a medication called anti-VEGF therapy that helps to stop growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels
Your doctor may recommend any of the treatments alone or in combination with one another, depending on your condition.
Surgery and treatment often slows or stops the progression of diabetic retinopathy, but it's not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.
Even after treatment for diabetic retinopathy, you'll need regular eye exams. At some point, additional treatment may be recommended.
Written by Tennessee Retina team member
Audi Stovall, COA, OSC
Assistant Clinical Manager
Presumed Ocular Histoplasmosis Syndrome (POHS) causes atrophy (wasting) around the optic nerve and multiple scars, called histo spots, in the choroid. These symptoms are accompanied by new blood vessel growth (neovascularization) that starts adjacent to a histo spot. Histoplasmosis is a disease caused by Histoplasma capsulatum (H. capsulatum), a soil fungus prevalent in certain parts of the American continent, in particular the Ohio and Mississippi River valleys.
Histo spots (Figure 1) are considered the earliest stage of the disease. Less than 5% of individuals with histo spots will develop neovasculization in the central macula (at the middle of the retina). Because the histo spots themselves usually do not cause symptoms, patients typically do not develop symptoms until neovascularization grows in the central macula. Symptoms include painless, progressive blurring of central vision and wavy vision (metamorphosia), which can be sudden or develop slowly.
Figure 1. Henry Kaplan, MD. Presumed Ocular Histoplasmosis Syndrome. Retina Image Bank 2013; Image 4951. © the American Society of Retina Specialists.
Ocular coherence tomography (OCT) and fluorescein angiography (FA) are performed to evaluate for neovascularization in patients who visit their doctor with symptoms of visual loss (Figure 2).
Figure 2 John S. King, MD. Presumed Ocular Histoplasmosis Syndrome. Retina Image Bank 2012; Image 421. © the American Society of Retina Specialists.
Treatment and Prognosis
Treatment is generally required only when there is neovascularization. Given that H. capsulatum does not seem to play a direct role in the development of POHS, antifungal agents are not used to treat POHS. However, injections of medications that inhibit neovascularization are recommended. These medications include bevacizumab (Avastin® ), ranibizumab (Lucentis® ) and aflibercept (Eylea® ). Prior to injection, the eye is given an anesthetic drop or gel and is cleaned with povidone iodine; the injection generally causes minimal, if any, pain. Injections are initially administered monthly until the neovascularization improves, as confirmed by OCT or FA. If neovascularization is treated early, before advanced scarring develops in the central macula, the prognosis for vision is generally good.
For more information about other inflammatory conditions and retinal diseases we treat, visit
Information courtesy of ASRS Retina Health Series
What is a CRAO?
When one of the vessels that carries blood to your eye’s retina gets blocked, it can cause you to lose your eyesight. This problem often happens suddenly and without any pain. This is called a Central Retinal Artery Occlusion (CRAO).
Your retina is the layer of nerve tissue at the back of your inner eye that senses light. Like a tiny video camera, your retina turns images into electrical signals. Your optic nerve carries these signals to your brain. If a blockage of a blood vessel happens in your retina, it can be very serious. The blockage usually comes from a blood clot or cholesterol deposit in your blood vessel.
The signs of CRAO are easy to spot.
- Sudden blindness in one of your eyes
- Sudden, complete blurring of eyesight in one eye
- Steady loss of eyesight in one eye over a few weeks
The symptoms may last a few seconds or minutes.
Like other vascular blockages, CRAO is a serious condition, and you should seek prompt medical attention. If a blood clot breaks free and moves to the brain, it could cause a stroke.
For even more information about CRAO, visit our learning center at https://www.tnretina.com/Treatment_&_Diseases_of_the_Retina/
Written by Tennessee Retina team member
What is Retinopathy of Prematurity (ROP)?
- ROP is a retinopathy eye disease that can affect premature infants born weighing less than 1250 grams or before 31 weeks of gestation. Abnormal blood vessel growth can cause bleeding and scarring in the eye, and in the most severe cases, lead to retinal detachments with potentially permanent vision loss.
- ROP is an eye disease that arises as a result of incomplete development of the retina (the light-sensing tissue that lines the inside of the back of the eye). Babies who are born before 32 weeks of gestation (I.e., 2 or more months premature) or with a birth weight less than 3 pounds are most at risk. Incomplete retinal development may lead to the growth of abnormal blood vessels, which in turn can bleed or scar. If not diagnosed and appropriately treated, ROP can lead to permanent vision loss or blindness due to retinal detachment. Between 500 and 1000 infants go blind from ROP in the United States each year. The rates of vision loss are higher in poorer countries.
ROP- Left Eye
How is ROP diagnosed?
- Fortunately, the vast majority of premature infants, when cared for by experienced specialists, will not suffer significant vision loss from ROP. Evaluation of premature infants for ROP is performed by an ophthalmologist, typically in the Neonatal Intensive Care Unit (NICU) within a healthcare facility or hospital, or sometimes in the office as an outpatient. The ophthalmologist performs a retinal exam through dilated pupils to assess the development of the retina.
- Evidence-based guidelines have been established that determine when to begin exams, how frequently to continue exams, and when it is safe to stop. Typically, exams are repeated routinely until retinal vessel development has reached satisfactory maturity or the baby has achieved an age by which ROP is no longer seen. In some cases, the ophthalmologist may decide treatment is necessary based on these exam findings.
Can ROP be treated?
In experienced hands, the chance of blindness from ROP is exceedingly low. The conventional treatment is laser surgery to the retina, to induce regression of abnormal blood vessels. In some cases, injections of special medication (so-called anti-VEGF medication) into the eye are used for the same purpose. The choice and timing of these treatments are determined by the severity of the ROP and the overall health of the infant. In severe cases, more advanced retinal surgery may be required to repair retinal detachment.
Does ROP end in infancy?
Unfortunately, ROP is a lifelong disease. While the acute risks can be controlled within the first few months of life, premature infants are at a higher lifelong risk for myopia, strabismus, cataract, glaucoma, and retinal detachment. For this reason, these children should be seen regularly by an optometrist or ophthalmologist familiar with these potential complications.
Content Provided by Tennessee Retina
Author: Michael Nore, Assistant Clinical Manger
Review: Franco Recchia MD, TNR Pediatric Retina Specialist
What is the Retina?
The retina is a light-sensitive tissue lining the back of the eye, it can be compared to the film of the camera.
It converts light rays into electrical impulses that travel through the optic nerve to our brain where they are interpreted as the images we see.
A healthy, intact retina is key to clear vision.
What is Central Serous Retinopathy?
Central serous retinopathy (CSR) is a condition in which fluid accumulates underneath the retina in the central macula, causing vision loss.
For unknown reasons, tiny areas of the retinal pigment epithelium (RPE), a layer of cells under the retina, become defective. Fluid builds up and accumulates under the RPE, much as liquid in a blister collects under the skin. As a result, a small detachment forms under the retina, causing vision to become distorted.
CSR usually occurs in one eye and can affect men or women. The cause of CSR is not fully understood, but there are several factors that are more common in those who develop the condition.
- Men 30-50 years of age
- People with the “Type A” personality
- Steroid Use (e.g., prescription medication, skin creams, joint injections, nasal sprays, inhalants, or performance enhancers)
Changes are most often confined to the macula, the central part of the retina responsible for our central vision. With that said, patients will often experience loss of central vision, central distortion, decreased color vision, or a central blind spot. Patients may also notice objects may appear farther away than what they really are.
To understand if you have developed central serous retinopathy, you will need to see your regular eye doctor or a retina specialist for examination and testing.
CSR is diagnosed by dilated eye examination and confirmed through specialized testing such as optical coherence tomography (OCT) and fluorescein angiography (FA).
CSR Fluorescein Angiogram
CSR Fundus Photo
The fluorescein angiography requires the injection of a mild mineral based dye injected through the vein in your arm. Photographs are taken as the dye passes through the retinal vessels, highlighting the abnormal areas.
The OCT will take a cross-section image of the retina, showing retinal thickness and any swelling of the retina.
Most cases of CSR are managed by observation of the condition, as CSR often resolves without treatment within several weeks or months, and your eyesight often returns to normal or almost normal once the swelling subsides. Patients taking steroids may need to discontinue or modify dosages, if possible and only after consulting their physician.
Recovery does require time and patience, as improved vision typically occurs within 1-4 months. However, there are instances when treatment may be desirable. These instances include when there is persistent swelling or significantly reduced visual acuity.
Patients with chronic CSR may need laser treatment, oral medication, or eye injections which may prevent significant loss of vision.
● Photodynamic therapy or “cold” laser
● Medication (oral, injection in arm, injection in eye)
● Thermal laser treatment to seal leaking blood vessels.
Read even more about CSR and other conditions we treat here.
Written by Tennessee Retina team members
Cora Brady & Mirna Stevens
Retinal Vein Occlusion
Retinal Vein Occlusion (RVO) happens when a retinal vein becomes blocked or clogged. It occurs most commonly in patients with medical conditions such as high blood pressure, diabetes, high cholesterol and other health problems that affect blood flow. RVO can range in severity from subtle, with no visual symptoms noticed, to severe, with significant decreased vision. Two common causes of vision loss resulting from RVO are macular edema (swelling) and retinal neovascularization (abnormal blood vessel growth). In severe cases, neovascularization can cause the pressure in the eye to go up to a dangerous level. Although there is no way to unblock a retinal vein, there are available treatments for including anti-VEGF injections and laser. If left untreated, a retinal vein occlusion can lead to permanent vision loss. If you have any vision changes or symptoms, it is important to follow up with your eye doctor quickly.
About the Injections:
An intravitreal injection is an in-office procedure typically performed by a retinal specialist. Eye injections are used to treat many serious retinal conditions that could lead to vision loss by introducing a small dose of medicine directly into the gel-filled center of the eye called the vitreous, using a syringe with a very tiny needle.
The thought of an eye injection sounds terrifying to most. However, it is a very quick procedure & virtually painless. The injection is given in the white part of the eye only after the eye has been numbed and sterilized.
After an eye injection, your vision maybe somewhat blurry, so it is recommended to arrange transportation home. It is also common to see floating spots or bubbles in the injected eye for a day or two and do resolve on their own.
The anesthetic and sterilizing drop that are used can be very drying to the cornea (surface of the eye). After treatment, the eye may feel irritated once the numbing has worn off. It is very important to avoid rubbing the eye to lessen the risk of a scratch or abrasion.
While there are other complications or risk associated with receiving an injection, these treatments have been proven to be very effective in managing illnesses that could compromise the vision. The number of scheduled treatments is based on the patient’s specific eye disease and response to the medication used.
For more information and videos about intravitreal eye injection and/or other treatment options please consult your retina specialist or visit https://www.tnretina.com/Treatment & Diseases of the Retina to learn more.
Branch Retinal Vein Occlusion, Photo by TNR photographer
Written by Tennessee Retina team members
Marcia Drivas and Emily Griffith
Tennessee Retina is thriving and growing as middle Tennessee's largest and most established retina practice. We are pleased to announce that our Murfreesboro location is expanding! Renovations are underway that will more than double the current space available.
Visit our photo gallery of the ongoing construction: https://www.tnretina.com/custpage.cfm?frm=220362&sec_id=220362
Stay tuned for more information on how the space is transforming and what patients can look forward to at our Murfreesboro location.
Ocular Oncology is the diagnosis and treatment of a variety of eye tumors and cancers. As part of Ocular Melanoma Awareness month, Tennessee Retina wants to encourage others to learn about this rare condition. #ocularmelanoma
Uveal Melanoma is cancer that started as a mole in one of the structures of the uvea (iris, choroid, ciliary body). The development of a mole (also called a "nevus") is very normal and occurs in about 7% of all people. These moles are usually benign, but there are some moles that contain cells which mutate (change their DNA and their cellular properties). This mutation can lead to uncontrolled growth and the development of cancer.
Eye Cancer Symptoms and Signs:
Many times, an eye doctor finds melanoma during a regular eye examination. Uveal melanoma is a rare cancer and behaves differently than most other cancers. Uveal melanoma is unique in that it rarely grows to surrounding tissue. When it does spread, it spreads through the bloodstream. The most common symptom of a uveal melanoma is a painless loss of vision, but people with eye cancer may experience other symptoms or signs:
- Having trouble seeing
- Losing part of the field of vision
- Seeing flashes of light
- Seeing spots, squiggly lines, or floating objects (floaters)
- Having a dark spot on the iris
Some people with eye cancer do not show any of these symptoms, and these symptoms may be caused by a medical condition that is not cancer. If you are concerned about one or more of the symptoms on this list, please talk with your eye doctor.
The most common therapy for uveal melanoma is radiation, which needs to be applied in a very specific way to a very small space. It is usually accomplished through a surgical procedure called Plaque Brachytherapy, where a very small radioactive device is placed in the needed area to deliver the radiation and is then removed in a second surgery.
About our Team:
We strive to provide our patients with sincere care and to be available through the whole process to answer any questions you may have. Our care starts with our remarkable Oncology Team- Dr. David Reichstein and the Oncology Coordinators.
You can also learn more about ocular melanoma and how to support the cause at acureinssight.org
Visit https://www.tnretina.com/Our_Services/Ocular_Oncology/ for more about our team.
Did you know that less than twenty years ago, most people diagnosed with advanced age-related macular degeneration (AMD) were destined to become legally blind? Dr. Awh was recently a guest on ASRS’s Retina Health for Life podcast discussing advances in the diagnosis and treatment of AMD made possible by retina specialists that allow many patients with advanced AMD to keep reading, driving and enjoying their independence. Watch on YouTube (youtu.be/lDMHDajKlDU) or visit asrs.org/RetinaPodcast to listen today. #RetinaSpecialist #AMDAwarenessMonth
Read more about AMD here.
Tennessee Retina is dedicating 2021 to helping you stay informed!
The retina plays the biggest role in our ability to see. It's important for you to understand the procedures and terminology behind your diagnosis involved with this complex but delicate part of the eye. In 2021 we want to encourage patient learning and support healthy vision for you and your loved ones. Understanding symptoms and the importance of getting treatment quickly can have a great impact on protecting your vision!
Have a question about the retina, what to expect at your visit, or have a general concern? Visit our FAQ submission form and submit a question for a chance to be featured in our monthly FAQ, answered by our physicians and staff!
"This office runs the way every doctors' office should. Staff were amazing, so nice and extremely helpful and efficient! I couldn't be more grateful that I got the doctor I did, Dr. Thomas. He was extremely insightful, never made you feel rushed. I am so blessed and grateful I called this office and got scheduled with Dr. Thomas."
via Patient Survey