Too often I see patients who could have avoided problems if they had known how. Sometimes people do not benefit from medical services because they don't know about them. Worse still, some people do not get treatment because they think nothing more can be done.

This newsletter contains useful information about caring for your eyes and handling problems of the retina and also officially introduces you to our private practice at the Retina Group.

I opened the Center while still primarily involved at the Albert Einstein medical school.

At the medical school, I liked the research and teaching, but I enjoy caring for patients even more. I still work closely with doctors at the medical school, but now we consult mostly about helping individual patients. I am still involved in the surgical training of resident ophthalmologists, but now I have more time to help more patients more ways, including publishing this newsletter.

This information can help people make smart choices about caring for their eyes. Sometimes the smart choices are simple ones, such as realizing the importance of prompt, proper medical care.

As many of you know, I'm a retinal specialist so I only treat problems affecting the gel (the "vitreous") inside the eye and the light sensitive retina lining the inner eye. Even in these complex, fragile areas, many problems are treatable and preventable.

Knowing facts about retinal care helps patients and their doctors form a solid partnership fighting disease. I hope you'll use the information to help you understand the complex issues related to retinal disorders. An informed patient is better equipped to recognize symptoms requiring immediate attention.

If you have questions about anything in these articles-or any questions at all about retinal problems-please call the Retina Group at (914) 376-2273.

When the vessel broke, a clot quickly formed to stop the bleeding. the clot also blocked her vision.

"All though at first I was told my blindness might be permanent," Mrs Cunningham said, "my daughter, who is a nurse, wanted me to get a second opinion." After several inquiries, Mrs. Cunningham took her problem to Dr. Chess. "For the next few months, he just checked my eye regularly because it was improving slightly by itself," she said.

When her eye stopped improving on its own, Dr. Chess recommended an operation called a vitrectomy. "I was ready," said Mrs. Cunningham, a retired medical records secretary." For instance, have you ever tried driving using just one eye?

"Dr. Chess performed the operation at the hospital, but I was awake the whole time. Of course I had plenty of medication so I didn't feel a thing.

"My sight seems to be improving every day," she said, two weeks after the operation. "I wore glasses before the problem occurred, and I always will, but I'm just thrilled to be able to see well again."

"Vitrectomy has come a long way," Dr. Chess says, "and I'm excited about yet another advance to help patients such as Mrs. Cunningham. It's a new ophthalmoscope delivery system allowing me to do retinal laser therapy without touching the eye. this Will make the procedure more comfortable for her, and I can perform it in my office. I can also treat the retina's periphery more easily; this area is more difficult to reach with other laser delivery systems.

Phone calls:

Anytime you have questions, call the Center at (914) 376-2273. Dr. chess or a staff member often can help you immediately.

Location and Transportation: See the maps for information on easy ways to reach the Retinal Center by car, bus, subway and train.

If those transportation options don't work well for you, call us at (914) 376-2273. The Retinal Center's patient car coordinator often can arrange special transportation - at no charge to you. Our transportation service won't include a chauffeured shopping tour of Manhattan, but it will be safe, reliable, convenient transportation to and from our office. Our service can handle wheelchairs and other special needs, too. For instance, if you'd like us to meet you at the curb, just let us know in advance.

Financial Matters:

We will file all your insurance forms, free of charge.

We accept most health insurance plans and Medicaid. We even take assignment for Medicare, which means we accept the fee Medicare recommends. We're allowed to charge more, but we don't want money to limit retinal care for the elderly. That's why we follow the government's recommendations to collect 80 percent of the assigned fee from Medicare and 20 percent from the patient.

If you'd like to discuss making financial arrangements for your medical care, please call our office staff at (914) 376-2273.

Medical Services:

the Retina Group specializes in the retina and vitreous of the eye. Because treating these areas may be very complex, other doctors often refer their patients to the Retina Group for consultation. We maintain close communication with the patient's primary eye doctor so the patient can receive the best, coordinated care.

Problems we commonly diagnose and/or treat include: diabetic eye disease, retinal detachment, macular (retinal) degeneration, uveitis (an inflammation) and retinal blood vessel occlusion. Other conditions include optic neuritis (inflamed nerve), intraocular tumors, congenital conditions, choroiditis (an inflammation), endophthalmitis (infection within the eye) and penetrating ocular injuries.

Equipment and procedures for diagnosis and treatment in the office include: fundus photography and angiography, ocular ultrasounography, retinal cryopexy, binocular indirect and standard argon laser, and computerized visual field analysis. Others include direct and indirect ophthalmoscopy with scleral depression if necessary, plus slit lamp microscopy and other standard techniques.

Even more equipment is available at nearby hospitals. Dr. Chess served as ophthalmology director for six years at Jack Weiler Hospital of the Albert Einstein medical school and at the Rousso Diagnostic and Treatment Center, and he continues to operate as an attending staff ophthalmologist at the Einstein-Montefiore hospitals.

When a patient needs help other than retinal and vitreous care, our doctors will refer to one of many other highly trained specialists available.

A patient with a retinal problem has enough medical concerns without worrying about the office visit. So I'm especially proud that my staff works hard to make a patient's visit as easy as possible.

The entire focus of the Retina Group is patient care. Gina Di Biase is our full time patient care coordinator. She can provide a low-sugar snack for a diabetic or help tackle the most complicated insurance issues...whatever it takes to make patients more comfortable. She even coordinates our transportation service which, if needed, will bring patients to our curb, where a staff member can meet them and provide further assistance.

On a patient's first visit, we measure old glasses and help obtain a medical history. We also take insurance information, which makes it easier for our office to file insurance claims. Since the exam requires dilating the pupil of the eye, we can provide sunglasses if the patient has not brought any.

Other staff members also are trained to help patients in many ways. but mind reading is not one of our skills. So we encourage patients to speak up. We take requests for everything from, "More cookies in the reception area, please" to, "This bandage doesn't feel right. Can you fix It?"

At the Retina Group, all staff members help each other, but each member has special skills

too. For instance, ophthalmic technicians (George De Angelo and Barbara Currie) perform many tests, including checking glasses and measuring the patient's ability to see clearly and distinguish colors. We take a complete medical history and other background information so we can get a gook, over-all picture of a patient's health. With that information in mind, I then can focus on a patient's most serious retinal problems.

Other valuable help comes from medical photographer Jack Brush. We rely on him for help with fluorescein angiography. This procedure gives pictures of the circulation of blood in the retina, which may be affected by a variety of conditions. this test lets me observe more than by simply looking inside the eye.

Such solid support makes our Retinal Center Better able to properly care for patients with retinal and vitreous problems.

Diabetic retinopathy is a big term for a big problem. This condition is one of the most common cause of blindness in the United States.

Only diabetics can get the problem, but that means only several million people. those at highest risk are diabetics who cannot keep their diabetes under control, but retinopathy may also occur after many years of having diabetes, despite excellent medical care.

Fortunately, regular check-ups and prompt treatment often are effective in battling diabetic retinopathy.

When retinopathy occurs, the tiny blood vessels in the light-sensitive retina fail to provide enough nourishment for the retina. Leakage of fluid into the retina (macular edema) or bleeding within the eye itself (vitreous hemorrhage) can blur vision either permanently or temporarily. Scar tissue may damage vision by causing retinal detachment.

Evaluating the extent of diabetic retinopathy requires special examinations including fluorescein angiography. This technique involves injecting a dye into the arm vein and taking pictures of the yellow dye when it circulates within the retina. This test may be done at the Westchester Retinal Center.

Treatment can include laser photo coagulation, also available at the Center. Using a laser to treat the damaged retina helps stabilize and ultimately preserve vision.

In more troublesome cases, vitrectomy may be needed. Dr. Chess and Dr. Haft perform this surgical procedure using appropriate aneshesia at the hospital. This microscopic intraocular surgery can remove blood from within the eye and remove scar tissue that causes retinal detachment.

Diabetic retinopathy tends to recur, even with treatment, so regular check-ups are extremely important. since the problem is so common, all diabetics should have regular eye check-ups.