Specialty treatments for the preservation and restoration of sight in eye diseases of aging

Offering the first laser treatments in North America for evolving or advanced Macular Degeneration,Vision Rejuvenation Victoria is determined to be a leader in advanced medical and laser eye care

Our goal at Vision Rejuvenation Victoria is to provide the latest and best in techniques for the diagnosis and management of eye diseases, particularly the two eye diseases accounting for most of the cases of blindness in Canada, glaucoma and age-related macular degeneration (AMD). There is often a long delay between the time that a given assessment technique or treatment modality has been shown to be effective and safe, and the widespread adoption of these techniques in medical practice. This is in part due to the fact that physicians generally are generally working very hard. Learning about, and then embracing new technology is a time-consuming process. Furthermore, access to emerging technologies is often limited in the first few years by regulatory issues and the fact that both public institutions and individual practitioners are unwilling to bear the cost of new technology until the pressure to embrace that technology reaches a high level.

We believe that providing the very best eye care requires that we provide access to proven, accredited technology at the earliest date possible, so that years of sight impairment or permanent vision loss can be avoided.

Our Lasers

Vision Rejuvenation Victoria has the widest selection of therapeutic eye lasers of any non-hospital clinic in the country. Laser energy is now used for many purposes in treating eye diseases because they are so precise and yet non-invasive within the eye.

Some lasers such as the YAG or Ultra-Q can combine surgical precision in eliminating unwanted sources of obstruction to the passage of light through the eye, thereby sharpening the image on the retina and producing clearer vision. Yet they can do so without the need for any entry wound or manipulation within the eye. The result is rapid and usually painless procedure without injury to collateral eye structures and rapid recovery, without the risk of introducing infection.

The SLT laser can be used to make small perforations in the drainage channel filter of the eye to lower eye pressure in this way protect the optic nerve in patients suffering from glaucoma. SLT laser treatment can forestall there need for eye drop therapy or allow for drop therapy to be discontinued in some cases. In more severe cases it can be used as a complement to eye drop management of intraocular pressure.

Other lasers such as the 2-RT laser target specific cells within the eye in order to restore their function. These rejuvenated cells can then go to work reversing degenerative change in order to restore more useful eye health and prevent vision loss.

Finally, some lasers can be used to alter the optics of the cornea to change the focussing pattern of light onto the retina. The best known example of this is the Excimer laser that is used around the world to allow people greater freedom from glasses. The Clear-K laser is used in patients with macular degeneration who have lost most of their precious central vision. The Clear-K laser alters the focus of light passing through the central cornea so that it is redistributed to healthy retina just outside the damaged area and thereby restores vision.

Medical Director at Vision Rejuvenation™ - Dr. Lawrence Brierley

After graduating from medical school Dr. Lawrence Brierley first worked as an emergency room physician. He then trained in Ophthalmology at UBC in Vancouver, followed by a fellowship year in Jerusalem. He has had further educational appointments in Nice (France), Stanford (California) and a Detweiler scholarship to study corneal disease and surgery in Paris.

He has delivered numerous papers at ophthalmic meetings around the world and has been a frequent contributor to meetings of ophthalmology societies in Canada, the United States and Europe to which he belongs.

Dr. Brierley has practiced ophthalmology on Vancouver Island for many years, performing over 30,000 Cataract /Implant operations as well as cornea transplants and surface eye and eyelid procedures over that period. In 1999 he relocated his clinic to the Broadmead area of Victoria where the emphasis has been on using state-of-the-art diagnostic and therapeutic techniques to deliver optimal care for patients. Over the years the focus of his professional activities have shifted more from surgical to laser treatments for eye disease.

Dr. Brierley has performed charitable eye surgery and taught in developing countries in Southeast Asia, the Middle East and South America. He is a student of philosophy and a keen cyclist and back-country skier.

New Treatment Option for AMD

AMD is the leading cause of your reversible vision loss in Europe, the United States, and Canada. It is a disease almost always occurring in the over 50 age group.While it can progress at a different rate from patient to patient, to frequently it results in great impairment or complete loss of central vision, leaving patients unable to read, see faces or perform visual tasks. Its cause is of clear, but certain risk factors significantly increase the risk of vision loss. These are:

  • Age over 60
  • Family history of AMD
  • Cigarette smoking
  • Poor diet, particularly deficient in green vegetables and fruit
  • Obesity
  • Hypertension
  • Blue or green eyes with fair complexion
  • High exposure to bright (particularly blue) light.

AMD affects the central retinal, or macula which is loaded with vision cells, the photoreceptors. These cells need to receive nutrition and oxygen from the underlying blood vessels in the choroid, and they also produce waste products need to be eliminated. The cells that regulate these functions, the retinal pigment epithelial cells (RPE), progressively fail in AMD. Their failure results in accumulation of these waste products, or drusen, and progressive loss of the ability to transport nutrients and oxygen to the photoreceptors, impairing their function and ultimately causing their death.

AMD can progress from gradually increasing accumulation of these waste products with accompanying slow decline in vision to one of two potentially catastrophic outcomes of Late AMD, Geographic Atrophy or Neovascular AMD. GA represents permanent death of the photoreceptors. Neovascular (or “wet”) AMD results when the waste deposits result in a breakdown of the barrier separating the retina from the blood vessel rich adjacent layer, the choroid, permitting the ingrowth of new vessels that can leak and bleed into the retina with very damaging consequences for vision.

Treatment for early and advancing AMD to prevent end stage progression

Actual treatment using the 2-RT Laser

The 2RT laser uses very low energy and short duration laser pulses to stimulate production of new and rejuvenated RPE cells and these cells are then more cable of performing their functions of clearing waste products and enhancing the nutrition and oxygen delivery to photoreceptors.

There is now strong evidence that 2RT laser treatments greatly reduce the likelihood of early or intermediate AMD progressing to Late (and potentially blinding) AMD. Patients with Late AMD or those transitioning into Late AMD may be be helped with 2RT, but its usefulness in such patients is hard to ascertain. In any case, by that stage much irreversible damage may have already occurred, or further progression may not be avoidable.

Treatment of advanced vision loss from AMD

AMD can unfortunately lead to profound visual loss, resulting in an inability to read, operate a motor vehicle or identify facial features. We have never had more to offer to these patients than magnification and navigation tools. Magnification can modestly improve visual discrimination, but it does so by creating disabling tunnel vision. A new laser is now showing promise in improving vision without resorting to magnification.

The Clear-K laser uses a process of photovitrification to alter the optics of the cornea in order to disperse light around the macula, allowing functioning retina just eccentric to the macular centre to receive well-focused light. This entrains these paracentral areas to provide more high quality vision. Many patients have been able to recover several lines of vision on the vision chart, dramatically improving their ability to function visually.

A Non-Invasive Treatment for Floaters

Vitreous opacities or “floaters” are a common frustration associated with aging, although they can be troubling for some patients even in their twenties.They may result from the separation of some surface elements from the inner retinal surface when the vitreous body detaches from the retina, as it inevitably does at some point, or they may occur as a natural degenerative change in the vitreous body. Most floaters are only an annoyance, but for some patients they can be a major

In 2016 Vision Rejuvenation Victoria became the first clinic in western Canada to use the Ultra-Q laser to treat problematic floaters. The Ultra-Q is specifically designed to accurately deliver energy at all depths within the vitreous, allowing treatment of opacities in proximity to the retina in the back and the natural lens in the front of the vitreous.

Not all patients with vitreous floaters are good candidates for laser floater removal. Some patients have very dense clouds of floaters that might be improved with LFR, but not eliminated. These patients may be more appropriately treated with vitrectomy surgery, although this surgery is more invasive and has more significant risk to vision. Others have opacities that extend forward to near the crystalline lens, and cannot be safely treated without risking injury to the lens and certain cataract development.

LFR with the Ultra-Q laser is not an MSP insured service and our charge for this service is $900 per eye. Frequently the treatment requires a second or even third treatment, and these treatments, if required, are included in this fee.

Treatment for Floaters - Ultra-Q laser

Laser Floater Removal

Patient Story: Laser Floater Removal – Steve Migliore

Working with computers daily, Steve was bothered by his floaters: they made him tired and he found it difficult to concentrate on his work and simply everyday tasks.

“It is actually phenomenal because the floaters have gone away. And so I no longer have the tiredness, I no longer have the distraction and I’m able to focus on my work.”

Open Angle Glaucoma

Open angle glaucoma is a prevalent condition in Canada, particularly among people in their sixties and beyond. In OAG, there is a gradual loss of vision-carrying nerve fibres passing from the retina into the optic nerve. This results from either high pressure within the globe, or increased vulnerability to pressure of the very small blood vessels that feed the optic nerve at this entry point. Loss can be due to the excessive pressure or unhealthy optic disc vessels alone, but more often is a combination of the two.

Loss of vision in OAG is gradual and imperceptible, with the inessential peripheral vision first affected. It often takes years or even decades for significant loss to develop. Regular follow up visits and elaborate testing measures need to be carried out to pick up earliest evidence of loss, as well as progression, in patients felt to be at risk. At VRV, in addition to standard pressure measurement, peripheral visual field assessment and high definition imaging (Ocular Coherence Tomography (OCT), The Diopsys instrument is used to measure the electrical signal produced and transmitted by the retina in response to light, which has been shown to be impaired in glaucoma years before damage to the retina or to the visual field can be detected.

At the present time we are unable to directly treat the site of the damage, the optic disc, but can only manage open angle glaucoma by lowering the intraocular pressure. For this, eyedrops and sometimes oral medications can be used to reduce the output of aqueous humour, the fluid that inflates the eye and nourishes its internal lining cells. Other eyedrops can be used to increase the outflow from the uptake channel which carries this liquid back out to the bloodstream, through a filter known as the trabecular meshwork.

At VRV, Selective Laser Trabeculoplasty (SLT) may be used to painlessly, and with a high degree of safety, make small perforations in this filter. SLT can achieve the same end, increasing outflow of aqueous humour. It can also be used in conjunction with eyedrops for additional pressure lowering effect.

Finally, numerous surgical drainage procedures can be employed to divert fluid from the internal eye environment to the space underneath the surface membrane covering the front of the eye, the conjunctiva, where it is returned to the general circulation.

Management of open angle glaucoma is a long-term process and requires commitment from both patients and their doctor, but with proper care and attention to instructions, blindness from this condition is now quite rare.

Angle Closure Glaucoma

At VRV, patients with risk of angle closure glaucoma are managed on a referral basis. Treatment involves performance of laser peripheral iridotomy (LPI) which can often be curative. For this the YAG laser is used to creat a small hole in the iris, allowing aqueous humour to pass freely from the posterior chamber where it is produced, into the anterior chamber where it can pass out of the eye through a filter, the trabecular meshwork, located in the angle between the cornea and iris peripherally. This angle narrows with age, and in some people can block completely with a condition known as angle closure glaucoma. This can occur gradually over years, but more typically occurs as a rapid onset event accompanied by considerable deep eye pain, halos around lights and ultimately vision loss, in an acute angle glaucoma attack. This is a medical emergency, and can be broken with LPI if treated in time.

Cataract is normal feature of aging, to some extent presentation anyone over the age of 50 years. It’s progression is often a contributing cause of vision loss in patients suffering from other eye diseases of aging.

At Vision Rejuvenation Victoria we no longer perform cataract or refractive lens exchange in house as it is no longer the main thrust of our medical work, but will arrange it for patients where it may be helpful in optimizing vision for our patients.

n most basic terms, visual loss can be categorized as either optical or retinoneural.

Optical sources involve any obstruction or scattering of light along the clear pathway through the eye. Such problems as opacities of the cornea, cataract or vitreous opacities would be examples of optical sources vision loss. The effect of optical sources on overall vision loss can be objectively determined by using wavefront aberrometry using the i-Trace aberrometer and glare disability testing using the C-Quant psychometric glare tester.

Retinoneural sources involves impairment of the function of the electrical events involved in reception of light in the retina where an electrical signal is formed, transmission of the electrical impulse through the pathways (optic nerve, optic chiasm, optic tract and radiations) to the brain and finally the areas of creation of the sense of sight in the visual part of the brain (posterior cortex) with integration and interpretation elsewhere throughout the brain.

At VRV we study the impairment of the electrical signal creation and it’s transmission to the brain with pattern ERG and visually evoked potential [VEP] using the Diopsys instrument. This can be invaluable in finding earliest evidence of vision loss in condition such as glaucoma or retinal toxicity, as May occur with the use of certain drugs such as hydroxychloroquine (Plaquenil) frequently used in long-term management of rheumatological conditions.

The combined use of optical and retinoneural assessment can permit more accurate localization of the source of vision loss.

If you have concerns regarding your vision,call us or your eye care professional.