The retina is like the film in a camera. It is the seeing tissue of the eye. When
the focused light hits the retina, a picture is created and sent to the brain through
the optic nerve (the nerve of the eye), thus giving us vision.
Age-Related Macular Degeneration:
The disease affects the part of the retina called the macula, which is responsible
for central vision. Vision loss from AMD typically occurs gradually and can affect
both eyes at different rates. Even though macular degeneration can cause visual
impairment, the disease usually does not cause peripheral (side) vision loss or
lead to total blindness.
Types: The two common types of macular degeneration are "dry" and "wet."
"Dry form": The most common form of macular degeneration is caused by aging
and thinning of the tissues of the macula. It develops slowly and usually causes
mild vision loss. As this form of the disease develops, people often notice a dimming
of vision while reading.
"Wet form": Rare, and more severe. The wet form of the disease causes new
blood vessels to grow beneath the retina, which leak fluid and blood, often creating
a large blind spot in the center of the visual field. May progress rapidly causing
significant central vision loss.
The causes of macular degeneration are not completely understood. Some scientists
believe heredity may play a part, as well as UV light exposure, nutrition, and cigarette
smoking. Studies are ongoing.
- A dark area or a "white-out" appears in the center of vision.
- Blurred or fuzzy vision.
- Color perception fades or changes.
- Straight lines, such as sentences on a page or telephone poles, appear wavy or distorted.
"Dry form" - There is no proven effective treatment for dry macular degneraation.
Low vision rehabilitation can help those with significant vision loss to maintain
excellent quality of life. High dose antioxidant vitamin therapy may help prevent
some patients with dry macular degeneration from developing the wet form of the
disease. "Wet form" - a variety of therapies are available for we macular
degeneration; including intravitreal injection, photodynamic therapy, and rarely
The cells in persons with diabetes mellitus have difficulty using and storing sugar
properly. When blood sugar gets too high, it can damage the blood vessels in the
eyes. This damage may lead to diabetic retinopathy.
Types Of Diabetic Retinopathy:
Background or nonproliferative diabetic retinopathy - blood vessels in the retina
are damaged and can leak fluid or bleed. This causes the retina to swell and form
deposits called exudates.
Many patients may not notice any change in their vision when they develop this early
form of the disease, but it can lead to other more serious forms of retinopathy
that severely affect vision. Fluid collecting in the macula is called macular edema
and may cause difficulty with reading and other close work.
Proliferative diabetic retinopathy:
New, fragile blood vessels grow on the surface of the retina. These new blood vessels
are called neovascularization, and can lead to serious vision problems, because
the new vessels can break and bleed into the vitreous. When the vitreous becomes
clouded with blood, light is prevented from passing through the eye to the retina.
This can blur or distort vision and frequently causes sudden and severe loss of
vision. The new blood vessels can also cause scar tissue to develop, which can pull
the retina away from the back of the eye. This is known as retinal detachment, and
can lead to blindness if untreated. In addition, abnormal blood vessels can grow
on the iris (the colored part in the front of the eye), which can lead to severe
Treatment of Diabetic Retinopathy:
Good control of diabetes with intensive management and control of blood sugar will
delay, and possibly prevent, both the development and progression of diabetic retinopathy.
Patients with diabetic retinopathy frequently need to have special photographs of
the retina taken. This series of photos is called fluorescein angiography.
Laser photocoagulation is one of the most common treatments for diabetic
retinopathy. Focal photocoagulation consists of laser directed at the retina to
seal leaking blood vessels in patients with background diabetic retinopathy. Panretinal
photocoagulation consists of laser spots scattered through the sides of the retina
to reduce abnormal blood vessel growth (neovascularization) and help seal the retina
to the back of the eye in patients with proliferative diabetic retinopathy. This
can help prevent retinal detachment. There is little recuperation needed after laser
surgery for diabetic retinopathy. Laser surgery may require more than one treatment
to be effective.
Vitrectomy surgery is performed for patients with very advanced proliferative
diabetic retinopathy or retinal detachment. In vitrectomy, the surgeon removes the
blood-filled vitreous and replaces it with a clear solution. This allows light to
pass through the clear fluid to the retina, where the images are conveyed to the
Pharmacotherapy: Increasingly, a variety of medications are being used to
treat the manifestations of background and proliferative diabetic retinopathy.
These involve intravitreal injections of small amounts of medication into
The type of retinopathy, as well as the patient's general health and eye structure
will determine the kind of treatment needed and the type of anesthesia utilized.
Flashes & Floaters:
Some people may occasionally see small specks or clouds moving in your field of
vision. These are called floaters. Floaters are actually tiny clumps of gel or cells
inside the vitreous , the clear jelly-like fluid that fills the inside of the eye.
While these objects look like they are in front of the eye, they are actually floating
inside. When people reach middle age, the vitreous gel may start to thicken or 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. Posterior vitreous detachment
is more common in people who:
- Are nearsighted
- Have undergone cataract operations
- Have had YAG laser surgery of the eye
- Have had inflammation inside the eye
When the vitreous shrinks, it tugs on the retina, creating a sensation of flashing
lights. 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.
As the shrinking vitreous gel pulls away from the wall of the eye, it can cause
a retinal tear in places where the vitreous gel sticks too tightly to the retina.
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
What is a retinal detachment?
As the vitreous gel in the back of the eye starts to liquefy, it can separate from
the retina, a condition called vitreous detachment. If the vitreous gel adheres
too firmly to the retina, a retinal tear can occur with a vitreous detachment. A
retinal detachment occurs when fluid leaks through the tear and separates the retina
from the back of the eye.
Patients with a retinal tear or detachment often, but not always, have flashes and
floaters as their first symptoms. This occurs as the vitreous gel detaches from
the back of the eye. Other patients may have very few symptoms. Patients may describe
a "curtain" being drawn across the peripheral vision or decreased peripheral vision.
If untreated, most retinal detachments will cause progressive loss of vision and
eventually total blindness.
Laser Treatment of the Retina:
Laser is a highly focused and concentrated beam of light that is usually performed
to decrease leakage in the retina, treat abnormal blood vessel growth, or create
a beneficial scarring effect that can help prevent a retinal detachment. Laser treatment
is performed in our office, with no hospitalization, and generally requires no special
Special eye drops are used to numb the eye (topical anesthesia) to reduce any discomfort
during the procedure. Sometimes, an injection of local anesthesia to numb the entire
area around the eye is needed.
Fundus Fluorescein Angiography (FFA):
Fundus Fluorescein angiography is a clinical test to look at blood circulation in
the retina at the back of the eye. It is used to diagnose retinal conditions caused
by diabetes, age-related macular degeneration, and other retina abnormalities. The
test can also help follow the course of a disease and monitor its treatment. It
may be repeated on multiple occasions with no harm to the eye or body. Flourescein
angiography is for those:
- Who have indications of retinal conditions
- Whose doctor has determined that this test is needed for diagnosis of retinal conditions
OPTICAL COHERENCE TOMOGRAPHY (OCT):
Normal OCT :Quick, safe and informative-this new Eye scanner is a glimpse into the
future of patient care… It gives live cross sections magnified slices of various
structures of the eye, giving a better insight in the treatment of the eye disease.
Retinal OCT: Optical Coherence Tomography, “OCT” for short is a non-invasive
technology used for imaging the retina , the multi-layered sensory tissue lining
the back of the eye, is revolutionizing the early detection and treatment of eye
conditions such as macular holes , pre-retinal membranes , macular swelling and
even optic nerve damage.