Retinal Conditions

Age-Related Macular Degeneration, also called AMD, is a disease associated with people over the age of 60. This disease destroys the sharp, central vision that we use in everyday activities such as reading and driving. AMD affects the macula; the part of the eye that is located in the center of the retina and allows the eye to register fine details. It gives us our sharpest central vision (20/20) and our best color perception.

People with a family history of macular degeneration are at greater risk of developing the disease. Macular degeneration is divided into two forms. The “dry” form is the most common and accounts for about 90 percent of all macular degeneration cases. The “wet” form, also called the exudative or neovascular form, accounts for the other 10 percent. It is the more severe form and can be associated with more rapid and severe vision loss.

Wet macular degeneration is associated with the development of abnormal blood vessels that grow within the layers of the retina. The “neovascularization” can bleed, leak and physically cause damage to the retinal layers. Wet macular degeneration also affects both eyes and can destroy vision in a matter of days or weeks. Vision loss is often severe.

Symptoms

There is no pain associated with AMD, but the symptoms of this disease can have a profound effect on daily routines. As the cells of the macula break down, people suffering from dry AMD will register straight lines as wavy or see blurred spots in the center of their vision. Sufferers of wet AMD, or advanced AMD, may experience rapid vision loss. As abnormal blood vessels grow behind the macula and begin to leak, central vision deteriorates quickly.

Treatment

There is no cure for either type of macular degeneration. Treatment is available for wet macular degeneration only. Intravitreal injections (injections into the eye) are usually performed by a retina specialist. Injections are often successful in causing regression of the abnormal “neovascular” tissue. The injections usually are repeated.

If dry macular degeneration is diagnosed early, you can take steps to help slow its progression, such as taking vitamin supplements, eating healthfully and not smoking. Some patients with moderate to severe forms of the disease might consider AREDS eye vitamins. Please consult your doctor before starting any vitamins. Regular eye exams are important to identifying the problem in its early stages.

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Diabetic retinopathy is an eye disease caused by diabetes. Though diabetes is a leading cause of blindness, severe vision loss can usually be prevented with regular and timely eye examinations. Patients with diabetes should be examined at least once a year, regardless of symptoms or sugar control. With regular dilated exams, the chance of severe vision loss is less than 1 percent over the patient’s lifetime.

Symptoms

Patients with diabetes tend to develop cataracts at an earlier age. Symptoms of cataracts include blurry vision, which can be indistinguishable from blurry vision caused by diabetic retinopathy. Patients with cataracts and diabetes may require treatment of the diabetic retinopathy before successful cataract surgery or other vision correction surgery like LASIK can be performed.

Treatment

Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping progression of the condition. If you have mild or moderate diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment.

Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.

If you have advanced diabetic retinopathy or macular edema, you may need some type of surgical treatment.

Diabetic macular edema is treated by laser, Avastin®, Eylea or steroid injections.

Many patients who have diabetes, but not advanced diabetic retinopathy, may be good candidates for laser vision correction. Ask your eye doctor to discuss these options with you.

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For most people, the cause of eye floaters and flashes is age-related. As you get older, the vitreous gel that fills the inside of the eyeball can liquefy and separate from the retina. Small, momentary flashes of light are commonly experienced during vitreous separation. The vitreous pulls on the retina which makes you think you are seeing a light, but it is actually caused by movement of the retina. Sometime the flashes persist for a few months until the vitreous is finished separating. Rarely flashes are associated with a tear in the retina. Another cause of flashes are acephalgic (without pain) migraines.

Floaters are small specks or strands in the vitreous gel that move into your field of vision. The floaters present in different shapes very similar to small dots, circles, clouds, lines and even cobwebs. Floaters move as your eyes move; if you try to look at them directly, they may seem to dart away.

The primary difference between flashes and floaters is that floaters are usually seen during daylight or in lightened areas, whereas flashes are typically noticed at night or in a dark room.

Factors that can increase your risk of floaters include:

• Age over 50
• Nearsightedness
• Eye trauma
• Complications from cataract surgery
• Diabetic retinopathy
• Eye inflammation

Flashes and floaters are generally harmless, but should they suddenly appear, it is important to seek the services of a specialist in order to rule out a serious cause such as bleeding in the eye (more common with diabetes) or a retinal tear or detachment. A retinal detachment requires surgery and can lead to permanent vision loss if left untreated.

Symptoms

Most floaters and flashes may disappear or become less noticeable over time. However, contact your ophthalmologist immediately should you experience:

• Rapid decline in vision
• Blurred vision
• Gradually reduced side (peripheral) vision.
• A new or sudden onset or change in the pattern of floaters and flashes
• The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision.
• Flashes of light in one or both eyes
• Blurred vision.

These painless symptoms could be caused by a retinal tear, with or without a retinal detachment — a sight-threatening condition that requires immediate attention.

Treatment

Treatment, including surgery, depends on the cause of the floaters and flashes. Your eye specialist will perform an evaluation and recommend the appropriate treatment.

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Macular Pucker

Macular Pucker is a common cause of decreased vision and distortion. This disorder is also known as an epiretinal membrane (ERM) or cellophane maculopathy. This usually occurs in healthy eyes. Vitrectomy to remove the tissue off the surface of the retina can be highly successful in preventing further vision loss and can also lead to improvement.

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Macular Holes

Macular Holes occur more often in women than men. As with any disease of the macula, patients complain of decreased central vision with/without distortion. Repair of the macular hole requires vitrectomy surgery with possible use of intraocular gas following the operation. Surgery is highly successful in “closing” or repairing the macular hole.

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Retinal Detachments

Retinal detachments are potentially blinding and may require emergency surgery.  Most retinal detachments are preceded by warnings of flashes and floaters followed by loss of vision starting on the side and moving toward the center. Alert your eye specialist if you develop new flashes of light, floaters or loss of vision.

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Retinal Tears

Retinal Tears can develop into a retinal detachment. Most retinal detachments are caused by a tear in the retina. The most common symptoms of a possible retinal tear are new flashes or floaters. If detected before a retinal detachment forms, laser treatment is usually highly successful. Our goal is to identify and treat a retinal tear before it develops into a retinal detachment.

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Retinal vascular occlusions can lead to sudden loss of all or part of your vision. There are four types of vascular occlusions:

• Central Retinal Vein Occlusion (CRVO)
• Central Retinal Artery Occlusion (CRAO)
• Branch Retinal Vein Occlusion (BRVO)
• Branch Retinal Artery Occlusion (BRAO)

Retinal vascular occlusions vary in the degree of loss of vision. In many situations, coordination with your primary care doctor is essential as certain vascular occlusions may be associated with systemic disease.