Back On Track

Eye procedures repair retinal tears that derailed vision.

James Turner was employed by CSX for more than 20 years, serving primarily in the coal-mining regions of Kentucky, West Virginia and Tennessee. In 2010, James received a promotion and was transferred to the railroad’s corporate headquarters in Jacksonville.

James says that Dr. Moreno went “beyond expectations”
in treating his retinal problems.

“I joined CSX as an assistant trainmaster in the small town of Russell, Kentucky, and moved up from there,” James shares. “An assistant trainmaster supervises the trains and engine crews. Eventually, I became a safety manager, regional manager and locomotive shop superintendent. Here in Jacksonville, I was their chief mechanical officer.”

James retired from CSX this past June, but he wasn’t ready to give up working altogether. After a few months of leisure, James found another job that suits his talents.

“I’m working at Amtrak,” he states. “I’m a supervisor and superintendent. Retirement is nice, but I’m only 59 and I really miss working. I figure I’ll work for another year or two and then try retirement full time.”

James might not be ready to retire, but he’s at the prime age for cataracts to begin forming. His cataracts progressed to the point that he required surgery, but he developed complications about a month later.

“After surgery on my right eye, I noticed floaters that looked like black dots,” James describes. “There were also faint light flashes that looked almost like dishwater was floating around in front of my eye.

“I went back to the place that did my cataract surgery, and they performed a laser treatment to seal a retinal tear. Three weeks or a month later, I started having the same issues with my left eye. They said the retina in that eye was starting to detach and sent me to Florida Retina Institute.”

At Florida Retina Institute, James met with Tomas A. Moreno, MD, a board-certified, fellowship-trained retina specialist. Dr. Moreno performed a second laser procedure for a new retinal tear in James’ right eye and recommended cryotherapy to seal the tear and prevent a retinal detachment in the left eye.

Cryotherapy freezes the retinal tear and creates a scar around it to avert a detachment. Because James’ tear was quite large, Dr. Moreno was not sure the procedure would work, but he wanted to try that before a more invasive procedure known as a vitrectomy.

“Dr. Moreno moved pretty quickly because if the tear was not treated promptly, I could lose the vision in my eye,” James recalls. “Dr. Moreno said there was a 50/50 chance at best that the procedure would work, and unfortunately it didn’t, so a few days later he performed full-blown surgery on me.”

Peeling Wallpaper

James condition was due to changes in a jelly-like fluid inside the eye called vitreous. The vitreous is attached to the retina, the light-sensitive membrane that sits like wallpaper on the back wall of the eye. As people age, the vitreous begins to liquefy and tug at the retina, causing it to peel off the wall.

“Some parts of the vitreous attach to areas of the retina pretty forcefully,” Dr. Moreno educates. “When the jelly detaches from the retina, those parts of the jelly can be very adherent to the retina and cause it to tear.

“A retinal tear can lead to bleeding or pigment inside the eye, which is what people see as floaters. In addition, the retina cannot sense pain, so when it is getting abnormally tugged by the jelly, the only signal it can produce is a flash of light. If people notice flashing lights or a new onset of floaters, they should see a retina specialist right away for an evaluation.”

The vitreous can move through the tear, go behind the retina and lift it away from the back of the eye. That is the cause of a retinal detachment.

Vitrectomy repairs a retinal tear or detachment.

“If people notice flashing lights or a new onset of floaters, they should see a retina specialist right away for an evaluation.” – Dr. Moreno

“During a vitrectomy, we enter the eye with tiny instruments, including a light and a small knife,” Dr. Moreno describes. “We cut out the jelly, which removes the traction against the retina that is causing the tear or detachment, and replace the jelly with plain fluid.

“We flatten the retina against the back wall of the eye, essentially putting the wallpaper back on the wall. We place a gas bubble in the eye, which acts like a Band-Aid to push the retina against the wall and allow it to stick properly. Then, we use a laser to spot-weld the tear so it does not detach again.

“James did very well following his vitrectomy. He is seeing 20/20 or 20/25 in each eye. He saved his vision because he came to us early, as soon as he began to experience symptoms. Had he waited, he could have lost vision in both eyes.”

“Beyond Expectations”

James underwent two laser procedures for retinal tears in his right eye, one by doctors at the practice that performed his cataract surgery and one by Dr. Moreno at Florida Retina Institute. Those treatments were sufficient to seal the tears and resolve his symptoms. But that wasn’t the case with his left eye, which required a vitrectomy.

“I haven’t had any more issues with tearing in my right eye since the laser treatments,” James confirms. “When I continued to have some detachment in my left eye after the freezing therapy, Dr. Moreno performed a surgery where he went into my eye and placed a gas bubble. Then he went all around the retinal tears and sealed them.”

James sought help as soon as he noticed the floaters and flashing lights in his vision, and that early intervention prevented further damage that could’ve cost him his eyesight. He’s grateful that his cataract surgeon referred him to Florida Retina Institute. “Dr. Moreno went beyond expectations, and I don’t say that very often about people in the medical world,” James exudes. “He was extremely patient in telling me what was wrong with my eyes and what steps he could take to help correct them and save my vision. He took time to explain the procedures and all their risks and benefits, and that’s what I wanted to hear: the facts.

“I went to the Florida Retina Institute offices in Jacksonville and St. Augustine. They’re very nice places. The housekeeping is immaculate, Everything is super clean, especially with COVID. The staff is extremely polite, just as good as Dr. Moreno. I absolutely recommend Dr. Moreno and his team at Florida Retina Institute.”

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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • Tomas A. Moreno, MD

      Tomas A. Moreno, MD, is board certified by the American Board of Ophthalmology. He earned a bachelor of science degree from Duke University and his Doctor of Medicine degree from Duke University School of Medicine. Dr. Moreno completed an inter... Read More