Retina Specialist London

Mr James Neffendorf, Consultant Retinal Surgeon, providing expert care for all retinal conditions.

Excellent

4.96 out of 5

What is the Retina?

The retina is a thin structure which lines the inside of the eyeball. It is the layer which enables you to see, akin to the film of the camera. It is a complex structure, made up of many layers and millions of cells. Despite this, it only measures approximately 0.5mm in thickness. A healthy functioning retina is crucial to ensuring you can see clearly.

The retina captures light that is focused upon it. The centre of the eyeball is called the vitreous cavity, and this is filled by a gel-like structure made up of water, hyaluronic acid and collagen.

Retina and Vitreous Conditions

Many conditions can affect the retina and vitreous. These range from common issues such as floaters to sight-threatening emergencies such as retinal detachment.

The retina can also be affected by systemic conditions such as diabetes and high blood pressure. In some cases, examination of the retina can identify these conditions before they have been formally diagnosed, which demonstrates the importance of a regular eye check-up.

There are also some conditions of the retina and vitreous which do not present with any symptoms in their early stages and therefore regular review by an expert can help you identify, monitor and treat a problem early.

When to See a Retina Specialist?

You should see a retina specialist if you develop symptoms that signal a retinal problem. Early identification of symptoms and an early diagnosis can make a significant difference to the long-term visual outcome.

Why Timing Matters

Early identification of symptoms is important because most conditions of the retina and vitreous which require laser, injections or surgery have a far better long-term visual outcome if they are treated early, rather than late.

If you experience any of these symptoms, an assessment by Mr Neffendorf can help identify the underlying cause and guide treatment.

Why Choose Mr Neffendorf

Choosing the right specialist can feel overwhelming. Mr Neffendorf is one of a small number of ophthalmologists who is highly specialised at looking after patients with diseases or problems of the retina and vitreous.

Consultant Ophthalmologist at King’s College Hospital NHS Foundation Trust
Fellowship-trained in Vitreoretinal Surgery at St Thomas’ Hospital, London
Known for his communication skills, patient-centred approach and taking time to explain conditions and treatment clearly
Published 39 scientific papers and presented at 40 international and national meetings
Recipient of multiple awards, including recognition from the American Academy of Ophthalmology and EURetina
Examiner for the Royal College of Ophthalmologists and reviewer for multiple leading peer-reviewed journals

Symptoms

There are many symptoms that might indicate problems in the retina and vitreous.

Symptoms that may indicate a retinal or vitreous problem:

A curtain or shadow across your vision
Flashes of light in your field of view
New or worsening floaters
Areas of lost vision (blind spots)
Distorted central vision
General vision changes, becoming reduced or cloudy

If you experience any of these symptoms, an assessment by Mr Neffendorf can help identify the underlying cause and guide treatment.

There are also some conditions of the retina and vitreous which do not present with any symptoms in their early stages, and therefore regular review by an expert can help you identify, monitor and treat a problem early.

Conditions Treated

Specialist care for conditions affecting the retina and vitreous.

Vitreous Floaters

This is a situation where you notice things floating in your vision. There are many different causes, some of which are harmless, and others can be the sign of serious problems such as a retinal detachment or inflammatory disease of the eye. If you have floaters in your vision, it is important to be examined by a retina specialist within 24-48 hours to identify the cause and whether there is any underlying problem that needs to be addressed (see below).

In many cases, floaters are not indicative of a serious underlying problem. In this scenario, they can be annoying as they might interfere with your vision, but they do not cause harm and often will become less noticeable with time. Laser or surgery can be performed for persistent troublesome floaters.

Epiretinal Membrane (ERM)

An epiretinal membrane is a condition where a thin layer of scar tissue forms on the surface of the retina at the macula. The macula is the central part of the retina which is important for achieving fine vision. Sometimes epiretinal membrane does not cause any visual symptoms and it can be left alone. However, in some cases, it can contract and result in visual deterioration, often with distortion of vision. Patients often report this as seeing bends or kinks in straight lines. If your vision is affected by ERM, a surgical procedure can be performed to remove the membrane and improve the vision. Mr. Neffendorf can advise you on whether surgery would be helpful for you.

Macular Holes (MH)

A macular hole is a when a hole develops at the back of the eye in the part that is responsible for fine vision, called the macula. Most of the time, this causes the vision to become blurred and some people notice distortion of their vision, including parts of their central vision having a gap. Some macular holes are not full thickness holes, and these tend to not cause severe vision loss. Most of the time, they do not require surgery. For full-thickness holes, the vision is usually significantly reduced, and surgery is usually recommended in these cases. Surgery is highly successful in closing a macular hole (over 90% chance), and this usually results in visual improvement. It is important to be aware that even with successful surgery, the vision does not usually return to as good as it was before the hole developed. Mr. Neffendorf is happy to discuss your options if you have a macular hole, and his academic thesis included chapters on the management of macular holes.

Posterior Vitreous Detachment (PVD)

When we are born, the vitreous gel inside the eyeball is firmly attached to the inner wall of the eye. With time, the normal aging process results in detachment of the vitreous gel away from the inner lining of the eye. This tends to occur from the age or 40 onwards, and usually happens more often and earlier in short sighted people (myopia). It is an important situation because it is often the condition which can cause a number of problems that require the expertise of a retina surgeon such as Mr. Neffendorf.

The main symptoms of a PVD are flashing lights and/or floaters. If you develop these, it is important to be examined by a retina specialist within 24-48 hours. Approximately 10% of patients who develop a PVD have a retinal tear which requires urgent laser or cryotherapy treatment to reduce the chance of a retinal detachment (see below) developing. Untreated retinal tears carry a significant risk of a retinal detachment which is a sight threatening emergency.

Retinal Tear

The main cause of a retinal tear is a PVD. This is when the vitreous gel detaches from the retina, causeing traction on the retina. Other scenarios such as trauma can cause a retinal tear. Most patients who have a retinal tear notice a sudden increase in vitreous floaters. A retinal tear requires urgent laser or cryotherapy treatment to significantly reduce the likelihood of progression to retinal detachment.

Retinal Detachment

The retina is the part of the eye which is responsible for collecting the light that enters the eye and allowing us to see. It cannot work properly if it is detached. The usual cause for a retinal detachment is a PVD (see above) that results in a retinal tear. This allows fluid to pass through the tear and peel away the retina from the wall of the eye. It is a sight threatening emergency that requires urgent surgical intervention in the majority of cases to preserve sight.

It is more common in short-sighted people (myopia), those who have previously had cataract surgery, and those with a history of trauma to the eye. There are other forms of retinal detachment without retinal tears due to traction on the retina (e.g. in diabetic patients) or excessive fluid production under the retina. The symptoms that might indicate a retinal detachment has occurred are flashing lights, floaters and a curtain/shadow in the vision. Some patients do not present with all symptoms, and sometimes a retinal detachment can be asymptomatic (have no symptoms). The majority of retinal detachments progress and with time will cause a rapidly progressing shadow of vision loss that eventually affects the central vision and ultimately entire vision of the eye. It is therefore important that if you develop any of these symptoms you are seen urgently by a vitreoretinal surgeon, such as Mr. Neffendorf.

The vast majority of retinal detachments need to be repaired urgently. Delay in surgery can result in severe loss of sight and blindness. The earlier a retinal detachment surgical repair is performed, the more likely you are to preserve your sight. There are different ways to repair a retinal detachment, which Mr. Neffendorf will discuss with you in a consultation. Further information is available in the Patient Information Leaflet in the Patient Info. section.

Frequently Asked Questions

Can I fly with a gas bubble in my eye?

In some operations, Mr. Neffendorf will insert a gas bubble into your eye during surgery. This is done to maximise the chance of surgical success or support the eye during the recovery period. You will be informed if you have gas in the eye, as well as the likely duration that it will be present before it is naturally absorbed by the body. You must not travel in an aeroplane whilst you have a gas bubble in your eye. This would result in severe pain and irreversible loss of sight.

What is posturing?

After some operations where a gas bubble is inserted into your eye, Mr. Neffendorf will ask you to keep your head in a certain position as much as you can for a specific period of time (up to 1 week). This is known as posturing, and the exact positioning (e.g. lying left cheek to pillow) will be explained to you. The reason this is done is so that the gas bubble moves via gravity to exert a pushing affect on a specifc area of the retina in order to help the retina heal and maximise the chance of surgical success.