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Retinal Diseases


Macular Degeneration

Macular degeneration is the leading cause of severe vision loss in people over age 60. Macular degeneration occurs when the central portion of the retina, known as the macula, deteriorates. The retina is the light-sensing nerve tissue at the back of the eye. Because the disease develops as a person ages, it is often referred to as age-related macular degeneration (AMD). Although macular degeneration is almost never a totally blinding condition, it can be a source of significant visual disability. There are two main types of age-related macular degeneration: dry AMD and wet AMD. Currently, the only treatment for dry AMD is nutritional supplements. However, the treatment of wet macular degeneration has been revolutionized by a class of molecules called vascular endothelial growth factors (VEGF) inhibitors.


Diabetic Eye Disease

Diabetic retinopathy (DR) is the leading cause of blindness due to injury or eye disease among Americans younger than age 65. Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, new, abnormal blood vessels grow on the surface of the retina. This can cause severe vision loss and even blindness. Controlling your blood sugars with the assistance of your primary care doctor or an endocrinologist is the best thing you can do to protect your eyes. Having a yearly eye exam is also critically important in detecting the disease early. Those with retinopathy may need to be seen at more frequent intervals. In some cases, laser treatment or even injections of steroids and anti-VEGF medications may be necessary.


Epiretinal Membrane


Epiretinal membranes typically progress slowly and affects central vision by causing blurring and distortion. Later, the pulling of the membrane on the macula may cause swelling. Epiretinal membrane is a scar tissue-like membrane that grows over the macula, the tissue near the center of the eye’s retina that’s responsible for central vision. It’s also known as macular pucker, macular wrinkling, scar tissue or cellophane membrane. Many cases of epiretinal membrane are mild enough that no treatment is necessary. If vision is significantly affected, your doctor may recommend a vitrectomy with membrane peeling. The procedure improves vision by smoothing out the macula.


Flashes & Floaters

Many people see what looks like small specks of dust or cobwebs drifting across their vision. Blinking does not get rid of the specks or webs. Floaters may appear to be in front of your eye, but they are actually inside your eye. What you actually see are the shadows they cast on the retina. As you age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. Floaters often occur when the vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. In some cases this can tear the retina. A torn retina is always a serious problem, as it can lead to retinal detachment. The appearance of floaters may be alarming, especially if they develop suddenly. You should see an ophthalmologist right away if you suddenly develop new floaters, especially if you are over 45 years of age.


Retinal Tear or Detachment

When the retina detaches, it separates from the back wall of the eye and is removed from its blood supply and source of nutrition. The retina will degenerate and lose its ability to function if it remains detached.

If a retinal detachment is not repaired, vision can be permanently lost. The causes of retinal detachment can be divided into three main categories:

  • Rhegmatogenous Retinal Detachment: Due to a retinal break or tear that allows the liquid vitreous that fills the center of the eye ball to pass through the break and detach the retina. This is the most common type of detachment.
  • Exudative Retinal Detachment: Due to leakage from under the retina which creates fluid (exudate) that detaches the retina. Tumors and inflammatory disorders can create exudative detachments.
  • Traction Retinal Detachment: Due to pulling on the retina usually from fibro–vascular tissue within the vitreous cavity. Proliferative diabetic retinopathy is a common cause of traction retinal detachments.


Macular Hole

A macular hole is a small break in the macula, located in the center of the eye’s light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60. The symptoms are similar to those of someone with age-related macular degeneration, but these are two different disease. Unlike age-related macular degeneration, macular holes can be surgically repaired and the vision can improve dramatically. The success of the surgery hinges on maintaing a face-down position for extended periods of time.


Vascular Occlusion


There are 4 major types of vascular occlusions that occur in the eye: (1) central retinal vein occlusion (CRVO), (2) branch retinal vein occlusion (BRVO), (3) central retinal artery occlusion (CRAO), and (4) branch retinal artery occlusion (BRAO). Patients typically experience a rapid loss of vision or wake up and notice a significant decrease in vision. This can occur without symptoms. Risk factors include atherosclerosis, hypertension, and diabetes. Vision sometimes improves on its own, but permanent deficits can remain. There are not many well-proven treatments for vascular occlusions in the eye. Secondary problems from the occlusion can occur later, so continued follow-up with an opthalmologist is critically important.