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
Branch Retinal Vein Occlusion and Central Retinal Vein Occlusion


Branch Retinal Vein Occlusion and Central Retinal Vein Occlusion

Introduction and Overview

We are reminded daily to live a healthy lifestyle, including a good diet and lots of exercise, but we don’t usually associate the risks associated with not doing so with the loss of our eyesight.

During a comprehensive vision examination, an eyecare practitioner will view the inside of the eye to look for any unusual changes there, especially concerning the circulatory system and the tiny arteries and veins that carry oxygen and nutrients to the tissues of the retina. It is fascinating to consider that what the circulatory system is doing elsewhere in the body, it is also doing in the eye, and that the view of the inside of the eye allows the only direct view of the arteries and veins without the need for surgery. If there are problems with the circulatory system in general, the effects will be evident in the eye.

Normally, the retina is nourished by the oxygen and nutrients brought to it by the arteries and the depleted blood is then drained away by the veins. When a vein has been blocked for some Reason the blood will build up and cause bleeding and swelling in and around the retina.

Above: a view of the inside of a normal eye showing the optic nerve head (white circular disc) and macula (dark spot to the right of the disc) and normal blood vessels

A blockage in a vein located within the eye is called a Branch Retinal Vein Occlusion (BRVO). When the central retinal vein is blocked, the drainage to the entire eye is affected; this is called Central Retinal Vein Occlusion (CRVO). The only difference between the two is the location of the blockage and the area that can be damaged, either just the part of the retina served by that particular branch or the entire retina if the central vein is blocked. However, even in a branch vein occlusion, blood and fluid can leak from the vessels and interfere with vision in the entire eye.

Risk Factors

Patients at risk for BRVO or CRVO may have one or more of the following:

  • Hardening of the arteries (arteriosclerosis)
  • Plaque formation in the arteries (atherosclerosis)
  • Diabetes
  • Hypertension (high blood pressure)
  • Inflammation of the veins (vasculitis)
  • Use of certain medications such as oral birth control containing estrogen, or hormone replacement therapy
  • Some rare blood disorders that cause a greater-than-normal tendency for the blood to clot.

Ocular Complications

The extent of the damage and the visual symptoms that result depends on the size of the blocked vein and its exact location. For example, if the blockage happens in the outer part of the retina, symptoms may be barely noticeable, but if it occurs near the central part of the retina, especially around the macula, vision is much more likely to be reduced or distorted.

About one in five patients that have a BRVO can develop a further complication in the form of the growth of new blood vessels around the blockage called neovascularization. Neovascularization sounds at first like it might be a good thing, but because the new vessels are extremely fragile and may easily break, they usually only add to the problem of excess blood in the eye.

The vision is blurred and distorted because of the swelling and leakage into the eye of blood and fluid.


The eyecare practitioner looking into the eye at a BRVO (or CRVO) will usually see a lot of bleeding, swelling and leakage of blood and fluids into the normally clear vitreous humour and ocular tissues. However, most of this will resolve on its own over the course of a month or more, much as a bruise under the skin would disappear over time. The fluids are gradually re-absorbed into the circulatory system and carried away. (A bruise, in fact, is caused by bleeding and swelling under the skin, which is what causes the discoloration associated with it.)

In much the same way, vision loss may also return over time. The blocked vein may come unclogged on its own, or nearby vessels may contribute to returning normal circulation.

In cases where neovascularization is seen, laser photocoagulation to prevent new vessel breakage and bleeding is indicated.

In the long term, there is no particular way to speed the healing process, although Kenalog (triamcinolone acetonide, made by Bristol-Myers Squibb) injection has been used successfully to improve the visual prognosis in BRVO, CRVO and macular edema arising from various other causes.


While a branch retinal vein occlusion may look to an eyecare practitioner to be much more serious than a branch retinal artery occlusion, the visual outlook is usually much better in the former. Even without treatment of any kind, the fluids and blood will usually be reabsorbed and resolve on its own.

However, frequent vision examinations to be sure that retinal neovascularization or macular edema is not occurring are essential. In addition, systemic circulation factors such as those noted above in the list of risk factors should be monitored and treated by the patient’s primary care physician. Treating the underlying causes is important for both general health and for prevention of further occlusions.

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