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Bozeman, Montana 59718

Frequently Asked Questions


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What is a vitreo-retinal specialist?  Retinal specialists are eye physicians and surgeons who focus on diseases of the back of the eye such as macular degeneration, diabetic retinopathy, retinal tears and detachment, eye trauma and intraocular infection. Our physicians are medical doctors having completed many years of training in diseases and surgery of the eye including a 3 year ophthalmology residency followed by a 2 year vitreoretinal fellowship.

What symptoms should alert me to see a retina specialist, such as Dr. Comaratta? The most common symptoms of retinal disease experienced by patients include floaters and flashes, shadows in your peripheral vision, sudden loss of central vision, or blurry/distorted central vision.

Will my eyes be dilated on every visit? And for how long?  Yes. In order to best evaluate your eyes, your pupils must be dilated so that Dr. Comaratta can see the retina. They will stay dilated and the  vision may be blurred for at least several hours and possibly longer for some patients.  Dr Comaratta strongly advises dilation of both eyes on your initial visit as many retinal diseases occur in both eyes even if symptomatic in only one.

Can I drive after my retinal eye checkup?  No.  For your safety, it is better to arrange for someone to drive you home or take public transport

How can Dr. Comaratta help me treat vitreo-retinal problems?  Problems with the retina and vitreous including retinal tear, retinal detachment, macular degeneration, and diabetic retinopathy can lead to vision loss and even blindness. Surgery, lasers and intraocular injections can correct problems before vision is lost and prevent further deterioration from occurring. In many cases vision is often restored.

What is the retina?  The retina is the delicate, light-sensitive tissue that covers the interior wall of the eye. Like the film in a camera, it receives images projected through the lens of the eye. The retina then sends these images to your brain through the optic nerve. When the retina is damaged, your vision may become impaired. Damage to the retina may be caused by injury, illness or as a result of aging.

What is the vitreous?  The vitreous is a gel-like substance that fills the back cavity of the eye and is loosely attached to the retina.

What is a retinal detachment?  When the retina detaches, it separates or pulls away from its normal position lining the inner back wall of the eye. A retinal detachment can occur from retina holes, retinal tears or from traction on the retina from scar tissue on the retinal surface or in the vitreous gel. If not promptly treated, a retinal detachment can cause permanent loss of vision.

What are the symptoms of retinal detachment?  Symptoms include flashing lights, new floaters or a sudden or gradual increase in either the number and or severity of floaters, which are like cobwebs, strings or specks that float about in your field of vision. Another symptom is the appearance of a curtain over the field of vision, typically starting in the periphery and progressing towards the center part of the visual field. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.

Who is at risk for retinal detachment?  A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women.  A retinal detachment is also more likely to occur in people who are nearsighted or have had a retinal detachment in the other eye, a family history of retinal detachment, cataract surgery, an eye injury or certain systemic diseases.

What are floaters?   You may sometimes see small specks or clouds moving in your field of vision.  These are called floaters.  You can often see them when looking at a plain background, like a blank wall or blue sky.  Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear, gel-like fluid that fills the inside of your eye.  Although the floaters appear to be in front of the eye, they are actually floating in the vitreous fluid inside the eye.  What you see are the shadows the floaters cast on the retina, the layer of cells lining the back of the eye that senses light and allows you to see.  Floaters can appear as different shapes, such as little dots, circles, lines, clouds, or cobwebs.

What causes floaters?  When people reach middle age, the vitreous gel may start to liquify and shrink, forming clumps or strands inside the eye.  The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment.  This is a common cause of floaters.  Posterior vitreous detachment is more common in people who are nearsighted, have undergone cataract operations, have had YAG laser surgery of the eye, or have had inflammation inside the eye.  The appearance of floaters may be alarming, especially if they develop very suddenly.  You should contact Dr. Comaratta right away if you develop new floaters, especially if you are over 45 years of age.

Are floaters ever serious?  The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters.

A torn retina is always a serious problem, since it can lead to a retinal detachment.  You should see Dr. Comaratta as soon as possible if:

  • New floaters appear suddenly
  • You see sudden flashes of light

If you notice other symptoms, like the loss of side vision, see Dr. Comaratta.

Can floaters be removed?  Floaters may be a symptom of a tear in the retina, which is a serious problem.  If a retinal tear is not treated, the retina may detach from the back of the eye.  With the onset of floaters it is important to see a retinal specialist as soon as possible.  Floaters themselves are harmless and fade over time or become less bothersome, requiring no treatment.  Surgery to remove floaters is rarely required.  Vitrectomy surgery can be performed to remove floaters in severe cases. Vitamin therapy will not cause floaters to disappear.  Even if you have had floaters for years, you should schedule an eye examination with Dr. Comaratta if you suddenly notice new ones.

What causes flashing lights?  When the vitreous gel rubs or pulls on the retina, you may see what look likes flashing lights or lightning streaks.  You may have experienced this same sensation if you have ever been hit in the eye and have seen “stars.”

The flashes of light can appear off and on for several weeks or months.  As we grow older, it is more common to experience flashes.  If you notice the sudden appearance of light flashes, you should contact Dr. Comaratta immediately in case the retina has been torn.

What is an ocular migraine?  Ocular migraine is a syndrome in which patients will suddenly develop an array of visual symptoms including:  flashing lights, blurred central or peripheral vision, a sudden blind spot or even total loss of vision.  The hallmark of this condition is that it is temporary, lasting anywhere from several minutes to an hour.  It usually occurs in several episodes from days to weeks.  It is more common in patients with a personal or family history of migraine headaches.  There is no headache associated with ocular migraine.  What differentiates an ocular migraine from the flashes and floaters associated with a retinal tear is the temporary nature and recurrent episodes.

I have a nevus in my eye.  Should I be concerned and how often should I have it checked?  A choroidal nevus is essentially a “freckle” in the eye.  Most choroidal nevi remain benign and cause no problems.  However, a choroidal nevus should be examined at least once a year by an eye specialist to ensure no changes in the nevus have occurred.

What is diabetic retinopathy?  Diabetic retinopathy is a complication of diabetes that weakens the blood vessels that supply nourishment to the retina. When the weak vessels leak, swell or develop thin branches, vision loss may occur. In its advanced stages, the disease can cause blurred or cloudy vision, floaters and blind spots and eventually, blindness.

Can diabetic retinopathy be prevented?  Yes!  Your risk of diabetic retinopathy can be reduced if you control your blood sugar levels by following your prescribed diet and medications, exercising regularly, controlling your blood pressure and cholesterol levels and avoiding alcohol and cigarettes. Regular eye exams are an integral part of making sure your eyes are healthy.

Can diabetic retinopathy be treated?  Yes.  Many of the problems caused by diabetic retinopathy such as swelling of the retina, bleeding in the vitreous and scar tissue on the retina can be treated with modern techniques such as injections, laser or surgery. The earlier problems are found, the easier they are to treat and in general, the better the visual results. Early and periodic dilated eye exams are very important.

What is macular degeneration?  Macular Degeneration is a disease characterized by degeneration of the macula, the center, most sensitive part of the retina, the area we use to read and carry out our finest visual tasks.

What are the two main forms of macular degeneration?

Dry macular degeneration – is associated with degeneration of the pigment cells under the macula and development of drusen. The pigment cells are necessary for normal retinal function so when the cells are lost, the overlying retina stops functioning and blind spots and distortion may occur.  Drusen are by-products of retinal metabolism that accumulate under the macula causing distortion and blind spots.

Wet macular degeneration is associated with abnormal blood vessel growth under the macula which can lead to leakage of fluid, bleeding and scar-tissue growth under and within the retina. The onset of vision loss with the wet form of macular degeneration is usually more rapid and severe than in the dry form of macular degeneration.

What causes age-related macular degeneration?  Studies have found that both genetic and environmental risk factors like smoking play a major role in the development of age-related macular degeneration. Rarer forms of macular degeneration can occur in younger people and can be inherited or associated with trauma, infection or systemic disease.

What are the symptoms of macular degeneration?

  • Blurring of central vision
  • Blind spots in the central vision
  • Difficulty seeing detail—up close and at a distance
  • Distortion of lines and shapes
  • Diminished color vision

Are there special tests to diagnose macular degeneration?  Yes. Your doctor will examine your eyes with special lenses to view the interior of the eye through the pupil. Other tests for macular degeneration include:

Acuity Tests
this test measures the sensitivity of your central vision at specific distances in specific lighting situations.

Amsler Grid Test this test checks for blind spots, loss of sight and distortion.

Fluorescein Angiogram Test: a dye is injected in the vein of your arm and then photos are taken of the retina and the macula in order to identify new blood vessel growth and leakage from blood vessels.

Optical Coherence Tonography (OCT) –
this test takes a cross sectional image of almost microscopic detail of the layers of the retina and underlying structures affected by macular degeneration. It is very helpful in determining if there is fluid leaking in or under the retina, and abnormal blood vessels or scar tissue in the macula.

Can macular degeneration lead to total blindness?  Most people with macular degeneration retain peripheral vision and learn to optimize the use of their remaining vision. Low vision aides can sometimes be helpful too.

Can macular degeneration be prevented?  No, the most important thing to do is to have regular eye exams, which may allow early detection and diagnosis. This is particularly important if a close relative has been diagnosed with macular degeneration.

What treatment options are available for dry macular degeneration?  The progression and severity of dry macular degeneration can be reduced with certain vitamins, minerals and Omega III fatty acids. Controlling high blood pressure and quitting smoking can be helpful.

What treatment options are available for wet macular degeneration?  There is no cure for wet macular degeneration. However, several treatment options are available.

Thermal Laser – was the first treatment used to treat wet macular degeneration and is still occasionally used.   A laser beam is focused on the blood vessels to cauterize them.

Photodynamic therapy (PDT) uses a low intensity laser to stimulate a light sensitive drug that is injected intravenously to cause shrinking of the abnormal blood vessels in the macula associated with macular degeneration. This treatment has the advantage of destroying the leaking abnormal vessels without damaging the healthy retinal tissue.

Anti-VEGF medication is the newest and best treatment for wet macular degeneration. These medications are injected into the eye and decrease leakage from and the progression of the abnormal blood vessels growing under the retina in macular degeneration. Anti-VEGF medications are not a cure and continued treatment is necessary to minimize the adverse effects of the abnormal blood vessels and maximize the patient’s vision.

Treatment for wet macular degeneration can involve combining these types of treatments.

What are the risk factors associated with macular degeneration?

  • History of hypertension
  • History of cardiovascular disease
  • Smoking
  • Family history of macular degeneration
  • Myopia (nearsightedness)
  • Light skin & eye color
  • Lens opacities

Is macular degeneration curable?  No, but treatment can slow or even stop the progression of the disease and in some cases, reverse some of the damage. The earlier the diagnosis is made, in general, the better the outcome. Amsler grid testing is the best way to monitor your macular degeneration and make an early diagnosis allowing for effective treatment.

What is a macula pucker?  A macula pucker is a distortion of the macula from scar tissue growing on the surface of the macula or from the vitreous gel pulling on the macula. The wrinkles, creases or bulges formed lead to symptoms of blurred central vision, distorted or “wavy” central vision, difficulty reading or performing tasks that require detailed vision, and gray and/or cloudy areas in the central vision. Vitreous surgery with removal of the scar tissue is very successful in restoring vision and decreasing or eliminating distortion.

What is a macula hole?  The macula is the central vision area  of the retina responsible for our fine, detailed vision. It occurs when the shrinking vitreous gel adheres to and stretches creating a hole in the macula. As the hole progresses and enlarges, a blind spot develops in your central vision and impairs the ability to see at both distant and close range. Vitrectomy surgery is the most effective treatment option to repair a macula hole.

How long will I have to maintain face down positioning following my surgery for a macular hole?  Dr. Comaratta generally recommends strict face-down positioning for the first 5-7 days following your surgery.  The length of time needed for face down positioning is usually dependent on the size of the hole and the length of time it has been present.  The larger the hole the longer the need for face-down positioning.

How do I schedule an appointment?  Call 406.284.2370 to schedule an appointment at our office.  Or, visit our website at , click on Appointments, and fill out the electronic form for someone to get back to you.