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"

  • "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. "

  • "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
Epiretinal Membrane

The space in the back part of the eye, behind the inner crystalline lens, is filled with a gelatin-like substance known as the vitreous, also called the vitreous humour. The vitreous makes up about 80% of the volume of the eye and helps it keep its normal, round shape. Part of the function of the vitreous is to hold the retina in place against the back of the eye which helps to provide clear, undistorted vision.

The vitreous contains numerous fine strands of connective tissue that hold it in position and attach it to the inside of the eye. As we age, this gelatin gradually shrinks and will usually pull away slightly from the retinal surface in a common condition called a posterior vitreous detachment (PVD). Most of the time, there are no adverse effects on vision except for an increase in vitreous floaters. Floaters get their name from their appearance in the field of view, like small particles or cobweb-like strands; floaters are not serious and rarely causes any effect on vision at all, although they may be somewhat annoying.

Sometimes, however, vitreous shrinkage can cause microscopic damage to the surface of the retina, and cause the formation of scar tissue that is attached to the retina and can pull on the retina and cause puckering or distortion. It is this sheet of scar tissue that forms the epiretinal membrane (ERM) is located just above the retina and usually doesn’t effect vision unless it forms in front of the macula, where the retinal nerve fibers are the most sensitive and provide our clear central vision. When this happens, the scar tissue may cause vision to blur or become hazy and distorted. The changes to vision shown in the illustration are usually more severe than that experienced by most people with ERM, but it does show how a pattern of lines called an Amsler Grid might appear: the lines could be wavy, slanted or even have areas that are missing.

Other names for epiretinal membrane include macular pucker, premacular fibrosis and cellophane retinopathy. Epiretinal membrane is a separate and distinct condition from age-related macular degeneration (AMD) or a macular hole, although these can have similar symptoms.

Frequently Asked Questions

What causes an epiretinal membrane? Usually ERM is related to a posterior vitreous detachment (PVD), which commonly occurs in people over the age of 50. Other disorders such as detached retina and inflammation of the eye, called uveitis, can trigger the formation of ERM, as well as diabetes. ERM can also be caused by trauma to the eye, either by surgery or accidental eye injury. The incidence of ERM in the fellow eye is increased after it develops in the first eye.

What are the symptoms of ERM? Although ERM can cause severe vision loss if the scar tissue is thick and occurs in front of the macula, most vision loss is minor and is sometimes not noticed at all. Mild difficulty with seeing detail and fine print, a gray area in the vision or mild disturbances such as straight lines that appear wavy. Occasionally there may be a blind spot.

Most people with ERMs have no symptoms, although metamorphopsia (a difference in the perceived size of an image). Some people notice double vision in the effected eye.

Can ERM be prevented? There is no evidence of any effective treatment for ERM that isn’t caused by trauma or surgery; there are no eyedrops or nutritional supplements that have been shown to be effective in preventing the development of an ERM.

How is ERM treated? An ERM usually needs to treatment, because in many cases the symptoms of distortion and blurriness are mild and not noticeable. Most people with an EM become accustomed to any mild distortion and don’t notice the vision changes.

Sometimes the scar tissue that forms the ERM separates from the retina and clears upon its own. Rarely, vision deteriorates until it affects daily routines and activities, and in these cases, surgery may be recommended. The procedure consists of removing the vitreous humour and replacing it with a saline solution. Because the vitreous is formed mostly of water, people don’t notice any vision changes between that and the saline. Removing the vitreous removes the scar tissue that has formed, so the cause of the wrinkling of the retina is gone. Called a vitrectomy, this procedure is usually performed under local anesthesia.

After the vitrectomy, the eye will be patched for a day or two to protect the eye, and antibiotic eye drops will be needed to prevent infection.

How successful is surgery for ERM? A vitrectomy is a very delicate surgical procedure; most of the time vision improves, but usually not to the same level as before the ERM developed. On average, vision is restored to about half that lost to the membrane. While some people have better results, others may experience significant vison loss. Recovery of vision may take up to two or three months.

What are the complications of vitrectomy surgery? Complications of vitrectomy are the same as for any other ocular surgery, with infection being the biggest risk, followed by retinal detachment either during or after the surgery. The incidence of cataract formation was thought to be increased after surgery, but it is unclear whether the cataracts may have occurred anyway, or were caused by the surgery after several years had passed in some cases.

There is a small risk of recurrence (about 1%) of ERM.

How can I find out if my symptoms are caused by an epiretinal membrane? See your eyecare practitioner for a vision and eye examination. Because ERM has similar symptoms with other conditions, the only way to be sure is to consult an expert.

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