Dr. Shalu Pal

  • "If you want quality and wonderful service, please go to Dr. Shalu Pal! The patience, care, and true concern that Dr. Pal has for her clients is wonderful. "

    --Seleena J
  • " I was pleasantly surprised by finding a hidden gem within Dr. Pal's office"

    --Naveed
  • "Finally a doctor who is extremely knowledgeable, patient and explains things clearly. She is a wonderful human being who really takes the time to care for your needs. The office has a wonderful atmosphere and the staff are just as helpful as Dr. Pal. "

    --Mikail
  • "I couldn't ask for a better Optometrist. She is a delight to deal with, very patient, helpful and extremely knowledgeable. She was very good with my kids who can be very fussy at times.. And who could ask for a more beautiful location. Highly Recommend! "

    --Natalie M.
  • "My wife and I, highly recommend Dr. Pal. The staff, the service, the merchandise, are all top notch. They really make you feel welcomed. It has been several years since I have been able to see this well !!! You and your staff are the best !!!! "

    --Steve and Maria L.
  • "We barely go to optometrists so when we do, we should look for the best! I am super pleased I chose Dr. Pal\'s office. They were helpful from beginning to end, from booking on the phone to my actual visit. Dr. Pal was very detailed and went in-depth about my eye health. She is very patient and made me feel calm. The optician helped me pick a great pair of glasses, they were genuinely friendly which is a huge bonus."

    --Ahmad S
  • "I have been going to Dr. Pal for several years now. My most recent visit on June 6, 2016 was the best experience there that I have ever had. Firstly, the women on the desk were friendly and efficient - a very good prelude to my examination. Dr. Pal, herself, was, as usual, very thorough and encouraging in her examination. And she puts you at ease before we get into the eyes examination by discussing other things in life. That helps to ease any stress I may have. And they now have a man in the office who does that difficult examination (name of which I do not know!). He is so patient and encouraging and made the exam not so difficult for me this time. After all that, I saw Dr. Pal again before I left and she told me my eyes were good! Even had the news been not so good, I believe that I would be able to handle it because I truly believe that Dr. Pal and her staff would have taken good care of me. I will always go back to Dr. Pal and members of her team because I truly believe"

    --A. Howlett
  • " I have been to a few appointments at Dr. Pal\'s office over the last year for dry eye issues and every time it has been a very positive experience. The 3 receptionists at the front desk are warm and friendly. They are attentive and provide a very high level of customer service. I appreciate that they call me by name and remembered conversations we had at previous visits. I find Dr. Pal to be an excellent practitioner who is very thorough with her exams, has a lovely personality and takes the time to answer any and all questions that may arise. I am happy with the computer glasses I purchased and value the honest opinions I received from the staff when selecting frames. It was refreshing to have multiple opinions on styles and I felt they truly wanted me to walk out with a frame that was best suited to me. I highly recommend Dr. Pal \'s office! As a health care practitioner myself, I think all health care experiences should be this personilzed and friendly!"

    --A. Mclean
What is a Macular Hole?


Contents

What is a Macular Hole?

A macular hole is a small break in the macula located in the center of the eye s light-sensitive tissue called the retina. The macula provides the sharp central vision we need for reading driving and seeing fine detail.

A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60.

IS A MACULAR HOLE THE SAME AS AGE-RELATED MACULAR DEGENERATION?

No. Macular holes and age-related macular degeneration are two separate and distinct conditions although the symptoms for each are similar. Both conditions are common in people 60 and over. An eye care professional will know the difference.

WHAT CAUSES A MACULAR HOLE?

Most of the eye s interior is filled with vitreous a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age the vitreous slowly shrinks and pulls away from the retinal surface. Natural fluids fill the area where the vitreous has contracted. This is normal. In most cases there are no adverse effects. Some patients may experience a small increase in floaters which are little "cobwebs" or specks that seem to float about in your field of vision.

However if the vitreous is firmly attached to the retina when it pulls away it can tear the retina and create a macular hole. Also once the vitreous has pulled away from the surface of the retina some of the fibers can remain on the retinal surface and can contract. This increases tension on the retina and can lead to a macular hole. In either case the fluid that has replaced the shrunken vitreous can then seep through the hole onto the macula blurring and distorting central vision.

Macular holes can also occur from eye disorders such as high myopia (nearsightedness) macular pucker and retinal detachment; eye disease such diabetic retinopathy and Best s disease; and injury to the eye.

WHAT ARE THE SYMPTOMS OF A MACULAR HOLE?

Macular holes often begin gradually. In the early stage of a macular hole people may notice a slight distortion or blurriness in their straight-ahead vision. Straight lines or objects can begin to look bent or wavy. Reading and performing other routine tasks with the affected eye becomes difficult.

ARE THERE DIFFERENT TYPES OF A MACULAR HOLE?

Yes. There are three stages to a macular hole:

  • Foveal detachments (Stage I). Without treatment about half of Stage I macular holes will progress.
  • Partial-thickness holes (Stage II). Without treatment,about 70 percent of Stage II macular holes will progress.
  • Full-thickness holes (Stage III).

The size of the hole and its location on the retina determine how much it will affect a person s vision. When a Stage III macular hole develops most central and detailed vision can be lost. If left untreated a macular hole can lead to a detached retina a vision-threatening condition that should receive immediate medical attention.

HOW IS A MACULAR HOLE TREATED?

Although some macular holes can seal themselves and require no treatment surgery is necessary in many cases to help improve vision. In this surgical procedure--called a vitrectomy--the vitreous gel is removed to prevent it from pulling on the retina and replaced with a bubble containing a mixture of air and gas. The bubble acts as an internal temporary bandage that holds the edge of the macular hole in place as it heals. Surgery is performed under local anesthesia and often on an out-patient basis.

Following surgery patients must remain in a face-down position normally for a day or two but sometimes for as long as two-to-three weeks. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye sealing the hole. As the bubble is reabsorbed the vitreous cavity refills with natural eye fluids.

Maintaining a face-down position is crucial to the success of the surgery. Because this position can be difficult for many people it is important to discuss this with your doctor before surgery.

WHAT ARE THE RISKS OF SURGERY?

The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients a cataract can progress rapidly and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward both of which can be immediately treated.

For a few months after surgery patients are not permitted to travel by air. Changes in air pressure may cause the bubble in the eye to expand increasing pressure inside the eye.

HOW SUCCESSFUL IS THIS SURGERY?

Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.

WHAT IF I CANNOT REMAIN IN A FACE-DOWN POSITION AFTER THE SURGERY?

If you cannot remain in a face-down position for the required period after surgery vision recovery may not be successful. People who are unable to remain in a face-down position for this length of time may not be good candidates for a vitrectomy. However there are a number of devices that can make the "face-down" recovery period easier on you. There are also some approaches that can decrease the amount of "face-down" time. Discuss these with your doctor.

IS MY OTHER EYE AT RISK?

If a macular hole exists in one eye there is a 10-15 percent chance that a macular hole will develop in your other eye over your lifetime. Your doctor can discuss this with you.

RESEARCH

Research studies are being conducted to determine other treatments for macular holes. Currently the research is looking at using silicon oil to close the macular hole instead of the gas bubble that is being used now. No definite conclusions have been reached at this time.

Source: The National Eye Institute

 
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