Before your consulation you should:
- Bring a list of all prescribed medication that you are taking so you are able to complete the Personal Information Sheet.
- Bring along your reading and distance glasses (if worn).
- Please be aware that a nurse will dilate your pupils before your consultation as Prof. Stanga will need to examine your eyes fully dilated. This normally takes between 10-30 minutes and can take longer in patients with dark irises.
- The appointment structure will depend on your clinical needs; therefore Prof. Stanga may see you before or after your dilating drops.
- You may wish to be accompanied to the consultation as you will not be able to drive with dilated eyes until your vision has returned to normal.
During your Consultation:
During your Initial Consultation, Prof. Stanga will:
- Examine the retina up to the ora-serrata (edge of the retina) to rule out any lesions that require treatment/monitoring.
- Rule out lesions that can predispose the patient to suffer from Retinal Tears or Retinal Detachment.
- Establish whether the Vitreous is attached or not, as the risk of Retinal Tears and of Retinal Detachment decreases after the Vitreous is detached.
- Carry out a Macular examination.
More Information
- Standard Ophthalmic examination with Slit-Lamp Biomicroscopy (a microscope placed in front of the patient’s face and on which the patient rests the chin and forehead while the eye doctor holds in front of the eye a lens that allows to see inside it) only allows partial visualization of the retina. Even adding Indirect Ophthalmoscopy (a scope with a light placed on the doctor’s head while the eye doctor holds in front of the patient’s eye a lens that allows to see inside it) to the examination does not allow visualization of the entire retina. The only way to visualize the retina up to its edge (Ora Serrata) is to perform Indirect Ophthalmoscopy with 360 degrees Scleral Indentation (application of light pressure on the eyelid skin). To increase patient comfort during Indirect Ophthalmoscopy, Prof. Stanga prefers to perform this test with the patient lying on their back on a couch.
- Indirect Ophthalmoscopy with Scleral Indentation is a test generally not done at A&E Services.
The £650 cost of the vitreoretinal examination includes several or all, of the following:
- Slit-Lamp Biomicroscopy
- Indirect Ophthalmoscopy with 360-degree Scleral Indentation
- Ultra-Wide field multi-wavelength retinal scanning
- Ultra-Wide-field Fundus Autofluorescence
- Wide field OCT cross-sectional and 3-D scanning
- Wide field OCT Angiography 2 and and 3-D scanning
- Infrared Swept-Source OCT cross-sectional and 3-D scanning
- Infrared Swept-Source OCT Angiography 2 and 3-D scanning
Prof. Stanga discusses with the patient the results of the examination and the patient subsequently receives a letter with all findings included in the patient’s Electronic Medical Record at The Retina Clinic London.
All patients receive the following warning and have the clinic’s in and out of hours contact details: “any of the discussed symptoms such as a change in/new floaters, flashes of light, loss of visual field, loss of central vision or distortion of central vision need to be reported as an emergency”.
When leaving home please:
- Ensure you are not wearing any face makeup or cream
- Ensure you have eaten a large breakfast or lunch.
- Bring along the details of your pacemaker or internal heart device, if you have one.
- Bring insulin with you, if you are diabetic as we do not have any in the clinic.
- Bring a friend/family member with you to help you get home, as you will not be able to drive.
Before your surgery:
On your arrival, you will be directed by one of the Clinic Coordinators at the front reception where to wait. You will be able to relax in the waiting area and help yourself to any refreshments.
You will then be called in to see Prof. Stanga to go through the consent forms if not done in advance, to discuss the steps of your procedure and answer any new questions you may have.
Following your discussion, you will be taken to meet the Nurse in the Relaxation Room where they will dilate your eyes with drops. This normally takes between 10-30 minutes and can take longer in patients with dark irises. They will talk you through and administer your pre-operative medication, and explain which medication you will need to self-administer after surgery. The Nurse will then leave you to relax for approximately 1 hour before you are taken through to the theatre.
The Anaesthetist will come and introduce his/herself to you and ask you to reconfirm any existing medication you may be taking. He/she will then insert a cannula (a small tube) into a vein in your forearm or in the back of your hand. They will explain what will happen next, what you will hear, feel and see and reassure you that you will not suffer any pain.
Please inform us in advance if you unable to lie flat on your back.
During your Surgery:
You will be taken into the operating room and positioned on the surgery bed. Depending on the type of surgery you are having, the Nurse will position you accordingly. Once comfortable, the anaesthetist will administer the required sedation.
Prof. Stanga, a Nurse and the Anaesthetist will be present throughout the whole procedure.
After your Surgery:
Following your surgery, you will be taken back to the Relaxation Room where you can rest for around 1 hour until ready to go home. The Nurse will come in to check your blood pressure is stable and healthy before you leave. Once you have confirmed your next appointment with the Clinic Coordinators at reception, you are able to head home with your friend/family member.
What happens next?
Prof. Stanga will see you post-operatively, as arranged, to check your recovery and progress. We will schedule the required follow-up appointments as determined by Prof. Stanga.
What is posturing and why must I do it?
This is the position you need to adopt, tilting your head at a certain angle, in order to maximise the chances of success of your surgery. During your operation, a small bubble of air, gas or oil was injected into your eye. Prof. Stanga will tell you which posture is needed following your surgery to effectively support the recovery of your eye.
How do I posture?
Prof. Stanga will go through your posturing position with you and demonstrate what you need to do. The angle and time the posture is required to be held for are completely unique to each patient.
How long do I need to posture for?
In order to reach the best outcome, it is crucial that you follow your posturing instructions given. You are able to move whilst posturing but you must maintain your head in the position specified.
You must remember to take regular breaks every hour to reduce fatigue (the muscles in your neck may feel tight and ache) and allow for your blood to easily flow throughout your body. Whilst on your breaks, you should take regular walks and do leg exercises to stimulate your blood circulation. Alternating between sitting and lying positions whilst keeping your head in the same position can help.
We advise you to follow a healthy balanced diet and stay well-hydrated. You should use your breaks to eat and drink. If you need to go to the toilet, you can break for this whenever required. The side effects of holding your posture for a prolonged amount of time can be constipation and dehydration. If you experience this, you should get in touch with your GP for advice and treatment.
What will my vision be like straight after surgery?
You will experience a significant reduction in vision until the bubble has sufficiently reabsorbed. You will only be able to see large objects in close proximity. Vision will be blurred and this could be comparable with seeing underwater.
What happens to the gas or oil bubble in your eye?
The process is different depending on whether you have had an air, gas or oil bubble injected. If you have an air or gas bubble, this will be naturally absorbed and replaced by fluid produced by your own eye. This can take between 1 – 8 weeks, depending on the type of gas used. You may be able to see the gas bubble in your line of vision, appearing as a blurry black line. As the bubble reabsorbs it will get smaller and will appear to shrink and move down in your line of vision. The bubble may also split into multiple smaller bubbles, whilst being absorbed. On a bright day, you may notice a reflection cast by the gas bubble too so you may wish to wear sunglasses to help with this.
If silicone oil is used, this will require surgical removal at a later date decided by Prof. Stanga. You are able to fly in an aeroplane if you have silicone oil in your eye.
