Retina and Vitreous Disorders
What is the retina?
A healthy retina is necessary for good vision. The retina is a thin layer of tissue that lines the back of the eye on the inside. It is located near the optic nerve. Its purpose is to receive light that passed through the lens, convert the light into neural signals, and send those on to the brain to translated into clear images.
What are some common retinal diseases and conditions?
Click below to learn about some of the most common retinal diseases and conditions we treat at San Antonio Eye Center.
What is aged-related macular degeneration?
Age-related macular degeneration (AMD) is a progressive eye condition affecting as many as 15 million Americans. It is the number one cause of severe vision loss and legal blindness in adults over 60 in the U.S, and escalates with age. AMD attacks the macula of the eye, destroying the clear, “straight ahead” central vision necessary for reading, driving, identifying faces, watching television, doing fine detailed work, safely navigating stairs, and performing other daily tasks we take for granted. It can make it more difficult to see contrast and can change the way color is seen. Peripheral (side) vision may not be affected, but many AMD patients see only dim images or black holes at the center of their vision.
Once vision is lost due to AMD, treatment cannot restore it. This is why regular eye exams and early detection of AMD are so important.
What are the symptoms of AMD?
- Words on a page look blurred
- A dark or empty area appears in the center of vision
- Straight lines look distorted
What are the two types of AMD?
“Wet” or Neovascular AMD: 10 % of people with AMD have "wet" AMD. Many of these people develop significant vison loss as a result of abnormal blood vessel growth underneath the retina. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.
“Dry” or Atrophic AMD: 90% of people with AMD have the "dry" form. This condition is caused by cell damage and results in thinning macular tissue. Vision loss is gradual. Many with dry AMD also have difficulty adjusting to changes in light, such as the transition from outdoor light to indoor.
How is AMD treated?
There is currently no cure for macular degeneration, but there are some treatments available to control certain forms of the condition:
- Nutritional supplements
- Anti-VEGF injection
- Laser surgery
The procedures may save more of your sight overall. However, even with advanced medical treatment, many people with AMD still experience vision loss.
What is diabetic retinopathy?
Most patients develop diabetic changes in the retina after approximately 5-20 years. The effect of diabetes on the eye is called diabetic retinopathy.
Diabetic retinopathy is the leading cause of blindness in young and middle-aged adults today. The longer a person has diabetes, the greater their chance of developing diabetic retinopathy. There are two types of diabetic retinopathy.
What are the two types of diabetic retinopathy?
- Non-proliferative diabetic retinopathy (NPDR): Also known as background retinopathy, is an early stage of diabetic retinopathy and occurs when the tiny blood vessels of the retina are damaged and begin to bleed or leak fluid into the retina resulting in swelling (diabetic macular edema) and the formation of deposits known as exudates. Many people with diabetes develop mild NPDR often without any visual symptoms.
- Proliferative diabetic retinopathy (PDR): PDR carries the greatest risk of loss of vision and typically develops in eyes with advanced NPDR. PDR occurs when blood vessels on the retina or optic nerve become blocked consequently starving the retina of necessary nutrients. New, fragile, vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. Unfortunately, these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous, causing spots or floaters, along with decreased vision.
What problems often accompany PDR?
- Vitreous hemorrhage: Proliferating retinal blood vessels grow into the vitreous cavity and break down. Both the hemorrhaging and resultant scar tissue may interfere with vision.
- Traditional retinal detachment: Scar tissue in the vitreous and on the retina cause the retina to detach.
- Tractional and rhegmatogenous retinal detachment: Scar tissue creates a hole or tear in the retina causing it to detach.
- Neovascular glaucoma: Abnormal blood vessel growth on the iris blocks the flow of fluid out of the eye causing the pressure to increase and damaging the optic nerve.
What are the symptoms of diabetic retinopathy?
Generally, people with mild NPDR do not have any visual loss. A dilated eye exam is the only way to detect changes inside the eye before loss of vision begins. People with PDR experience a broader range of symptoms:
- See dark floaters
- Experience loss of central or peripheral vision
- Experience visual distortions or blurriness
- Experience temporary or permanent vision loss
Can diabetic retinopathy be prevented?
Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise play important roles in the overall health of those with diabetes.
Diabetics can also greatly reduce the possibilities of eye complications by scheduling routine examinations with an ophthalmologist. Many problems can be treated with much greater success when caught early.
What is a macular hole?
A macular hole is a small break in the macula.
What is a macular pucker?
A macular pucker is when wrinkles, creases, or bugles form on the normally smooth macula due to scar tissue.
What are the symptoms of a macular hole?
In the early stages of hole formation, your central vision becomes blurred and distorted. If the hole progresses, a blind spot develops in your central vision and impairs the ability to see at both distant and close range.
What are the symptoms of a macular pucker?
Macular pucker symptoms can range from mild to severe and may involve one or both eyes. They may include:
- Blurred central vision
- Distorted or wavy vision
- Difficulty reading or performing tasks that require detail vision
- Gray and/or cloudy area in central vision
- Central blind spot
How is a macular hole treated?
Vitrectomy surgery, an outpatient procedure, is the most effective treatment to repair a macular hole and possibly improve vision. The outcome of this procedure may depend on the size of the hole and how long it was present before surgery. The amount of vision recovery can vary.
How is a macular pucker treated?
For mild symptoms, no treatment may be necessary. Updating your eyeglass prescription or wearing bifocals may improve vision. Eyedrops, medicines, or laser surgery do not improve vision.
For more severe symptoms, vitrectomy surgery is recommended to remove the wrinkled tissue. Once it’s gone, the macula flattens and vision slowly improves, though it usually does not return all the way to normal. You should consider surgery if your blurred vision is interfering with your daily activities.
What is retinoblastoma?
Retinoblastoma is a cancer that starts in the retina (back inside of the eye). It is the most common type of eye cancer in children.
How does retinoblastoma develop?
The eyes develop very early as babies grow in the womb. During the early stages of development, the eyes have cells called retinoblasts that divide into new cells and fill the retina. At a certain point, these cells stop dividing and develop into mature retinal cells.
Rarely, something goes wrong with this process. Instead of maturing into special cells that detect light, some retinoblasts continue to divide and grow out of control, forming a cancer known as retinoblastoma. There are several types of retinoblastoma.
How does retinoblastoma grow and spread?
If retinoblastoma tumors are not treated, they can grow and fill much of the eyeball. Cells might break away from the main tumor on the retina and float through the vitreous to reach other parts of the eye, where they can form more tumors. If these tumors block the channels that let fluid circulate within the eye, the pressure inside the eye can rise. This can cause glaucoma, which can lead to pain and loss of vision in the affected eye.
Most retinoblastomas are found and treated before they have spread outside the eyeball. But retinoblastoma cells can occasionally spread to other parts of the body. The cells sometimes grow along the optic nerve and reach the brain. Retinoblastoma cells can also grow through the covering layers of the eyeball and into the eye socket, eyelids, and nearby tissues. Once the cancer reaches tissues outside the eyeball, it can then spread to lymph nodes (small bean-shaped collections of immune system cells) and to other organs such as the liver, bones, and bone marrow (the soft, inner part of many bones).
How important are regular eye exams?
Early detection is key with all forms of cancer. Regular eye exams may help prevent retinoblastoma from spreading and complicating treatment or causing vision loss. Schedule an appointment at San Antonio Eye Center today.
What is a retinal detachment?
The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.
In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.
What are the different types of retinal detachment?
There are three different types of retinal detachment:
Rhegmatogenous—A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.
Tractional—In this type of detachment, scar tissue on the retina’s surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.
Exudative—Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.
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, and Caucasian more than African Americans.
A retinal detachment is also more likely to occur in people who:
- Are extremely nearsighted
- Have had a retinal detachment in the other eye
- Have a family history of retinal detachment
- Have had cataract surgery
- Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
- Have had an eye injury
What are the symptoms of retinal detachment?
- Sudden or gradual increase in either the number of floaters, which are little “cobwebs” or specks that float about in your field of vision
- Light flashes in the eye
- Appearance of a curtain over the field of vision
A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.
How is retinal detachment treated?
Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor’s office.
Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed.
With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional, such as those at San Antonio Eye Center, immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.