Retinal Reattachment Surgery
Dr. Ronald Spatola
Board Certified Veterinary Ophthalmologist
Head of Retinal Reattachment Surgery
A native of Cincinnati, Ohio, Dr. Spatola attended Elder High School and soon realized his passion for medicine shortly after graduating from New York University in 2003, ultimately deciding on veterinary medicine as the best fit for his personality and career goals. He graduated from The Ohio State University College of Veterinary Medicine in 2011 with Doctor of Veterinary Medicine and Master of Science degrees. His master’s research focused on canine corneal cells and topical drug toxicity. Following Dr. Spatola’s graduation from OSU, he decided to further his education through a one-year rotating small animal internship in Charlotte, North Carolina, with Carolina Veterinary Specialists. After a year in Charlotte, he took a one-year ophthalmology internship with Animal Eye Care Associates in Chesapeake, Virginia, where Dr. Spatola was fortunate enough to be offered a comparative ophthalmology residency position in 2013.
In July of 2016, Dr. Spatola completed his residency, passed the ophthalmology board examination, and became a diplomate of the American College of Veterinary Ophthalmologists (ACVO). He then spent one year in Hampton Roads, Virginia practicing as an associate ophthalmologist with Animal Eye Care of Chesapeake. He finds both the joys and challenges of veterinary ophthalmology extremely satisfying, and feels very fortunate to be with such a progressive and diverse practice here in Cincinnati. His clinical interests are cataract surgery, vitreoretinal surgery, blepharoplasty and autoimmune diseases of the eye. In his spare time, Dr. Spatola enjoys staying active outdoors fishing and camping, exercising, spending time with family, and photography. He is beyond excited to be back home in the Cincinnati area, and looks forward to providing the community with the best in ophthalmic pet care for many years to come.
EDUCATION:
Bachelor of Science, New York University
Doctor of Veterinary Medicine, The Ohio State University
Master of Science, The Ohio State University
Internship, Medicine and Surgery, Carolina Veterinary Specialists
Internship, Ophthalmology, Animal Eye Care Associates
Residency in Comparative Ophthalmology, Animal Eye Care Associates
Diplomate, American College of Veterinary Ophthalmology
PROFESSIONAL AFFILIATIONS:
Cincinnati Veterinary Medical Association (CVMA)
American College of Veterinary Ophthalmologists (ACVO)
Retinal Detachment and Retinal Reattachment Surgery
The retina is a thin piece of nervous tissue lining the back of the eye. When comparing the eye to a camera, the retina is the film in the camera. Light enters the eye and is focused onto the retina, where specialized light gathering cells transform light energy into electrical energy. That electrical energy is then sent to the brain to be interpreted as vision. Retinal detachment is a condition where the retina separates from its normal position inside the back of the eye, causing damage and dysfunction of the light gathering cells with resulting vision loss. If the retina is left detached, permanent blindness results.
There are many potential causes for a retinal detachment in dogs including infection, inflammation, high blood pressure, congenital abnormalities, trauma, and cancer to name a few. If treated promptly, patients with a retinal detachment can regain vision when the retina reattaches. Depending on the cause of detachment, treatment can be primarily medical or surgical. Many times if the retina is detached but not torn, medical therapy can lead to reattachment of the retina without the need for surgery. When retinal tissue is torn (a rhegmatogenous retinal detachment) or is being “pulled on” by inflammatory membranes, (tractional retinal detachment) surgery is required to reattach the retina. The goal of surgery is to remove any source of traction, reattach the retina back to its normal anatomic position, and seal any holes or tears in the retinal tissue. In some cases, a laser can be used to create
what is called a barrier retinopexy, to prevent further retinal detachment in a visual eye with a partial retinal detachment. However, the ideal treatment is to address the underlying cause of the detachment and reattach any retinal tissue that is detached.
Retinal reattachment surgery is a complex, multistage procedure that in dogs almost always involves complete removal of the vitreous gel in the back of the eye (vitrectomy), using heavy fluids such as perfluorocarbon to “push” the retina back to its normal anatomic position, precise laser burns to “spot weld” the retina onto the back of the eye, and injection of silicone oil into the back of the eye to replace the vitreous and help hold the retina in place while it heals from surgery. Similar to cataract surgery, the procedure is performed under general anesthesia with the aid of a surgical microscope.
Successful surgery is measured in two ways. Anatomic success, or being able to successfully reattach the retina, is the primary goal of surgery. Factors that can influence anatomic success include retinal membrane formation, the degree of torn retinal tissue or size of retinal holes, decreased visibility from bleeding and scar tissue formation, concurrent inflammation, and congenital or acquired anatomic abnormalities. Anatomic success is achieved in 95-98% of dogs undergoing retinal reattachment surgery. The second type of success, and the type that is most important, is functional success. Namely, if the retina is reattached successfully, will it regain function and return vision to the patient. The most important factor that helps determine functional success is the duration the retina has been detached prior to surgery. Studies suggest that reattachment of the retina within 1 month of detachment give the best chance of functional success. Functional success ranges from 60-90%. The variability in success rates is based on several factors that vary from patient to patient. A thorough patient history and ophthalmic examination will help the surgeon determine the likelihood of functional success for a given patient.
What to expect during your visit to The Animal Eye Institute
The morning of surgery you will arrive with your pet at The Animal Eye Institute. A technician will perform several diagnostic tests to evaluate your pet’s tear production, intraocular pressure, and presence or absence of a corneal ulcer. Following these tests, your pet’s eyes will be dilated in preparation for a complete ophthalmic examination. Dr. Spatola will perform a complete ophthalmic examination, including a detailed exam of the posterior segment and retina. An ocular ultrasound may also be performed to help better assess your pet’s candidacy for retinal reattachment surgery. Upon completion of the ophthalmic examination and any additional testing, Dr. Spatola will thoroughly discuss his findings with you, and determine your pet’s candidacy for retinal reattachment surgery. If your pet is a candidate for retinal reattachment surgery and you elect to pursue surgery, the procedure will be performed that morning.
Once your pet’s procedure is finished, they will recover in our hospital for the remainder of the day. It is important that we make sure your pet recovers safely from general anesthesia, and that their intraocular pressure is stable in the immediate hours after the procedure. Provided your pet recovers as expected, they will be discharged that evening. Your pet will be sent home with several drops to help decrease inflammation, prevent infection, and keep intraocular pressure from becoming high. Additionally, oral medications will be sent home to decrease inflammation, prevent infection, and reduce discomfort associated with the procedure. A recheck examination will be performed the following morning to assure your pet is healing as expected 24 hours after surgery, and that their intraocular pressure is within normal limits. The next recheck exam will be recommended for one week following the procedure. The one week recheck exam can be performed with your primary veterinary ophthalmologist, or with Dr. Spatola. If you elect to have the one week recheck exam with your primary veterinary ophthalmologist, Dr. Spatola will communicate with her/him as needed.
Recheck examinations are generally recommended at 1 week, 1 month, 2 months, and then every 4 months following surgery. However, recommendations for the frequency and timing of recheck examinations is dependent on how each patient is healing and whether or not complications are developing. Dr. Spatola will work closely with your primary veterinary ophthalmologist to assure the best postoperative care for your pet.
When will my pet see again?
This is a very common question following retinal reattachment surgery. The answer is variable and depends on multiple factors. In general, the time it takes for vision to return following surgery correlates with the duration that the retina has been detached prior to surgery. The longer the retina has been detached, the longer it can take for vision to return. It can take up to two months for vision to return in some patients, however in those that regain vision (approximately 75% of patients) most have regained vision within one month following surgery. Vision will be assessed at each recheck examination.
TESTIMONIALS
Dear Dr. Spatola,
You were so amazing in helping Roxy to gain her complete sight back again. Your time to explain things and show the inside of her eyes problems was so helpful and laid to rest a lot of worries. Your staff helped make it so much easier when calling back in with questions and prescriptions.
You caught the fact she had two detached retinas and not just one as the animal eye specialist up in Minnesota told me and then took the time to show me what Roxy was up against.
As you might remember as I left Minnesota to go to Kentucky she was running into the our cats and parked cars, etc. outside because she just couldn't see. Within a two days after surgery she was looking up in trees again at birds, squirrels and not tripping on sidewalk curbs. After three weeks I had to hold her back because she wants to go after flying dragon fly's, little toads hopping on the driveway at night, etc. Oh my, let the fun begin!
She is a totally a happy dog and your firm brought a new life back to her in such an amazing way.
The costs made me think twice if I should spend the money but now my wife and myself thank God everyday for helping us make the right decision. I can't encourage others enough to make the investment for your pets quality of life and the joy we witness everyday in watching Roxy interacting by chasing and playing with the cats and squirrels again.
Thank you Dr. Spatola, your staff and firm!
Blessings to all.
Sincerely,
William Schrader