Age Related Macular Degeneration (AMD)
If the macula of the eye, which is located in the center of the
retina, becomes damaged or stops working it becomes hard to
see fine details.
When the macula is damaged in an older patient
it is known as age-related macular degeneration and is defined
as either wet
or dry age-related macular degeneration. Symptoms for the conditions
include gradual or a rapid loss of the central area of vision.
This may include blurry central vision, black spots in the
center of vision, light sensitivity and colors may seem faded.
Dry age-related macular degeneration is the more common condition.
There are no treatments for this condition, but magnifiers
and reading aids can help patient with loss of vision and
tasks. Research has found that certain vitamins, antioxidants,
and zinc may slow progression of the disease.
In wet age-related
macular degeneration, blood vessels begin to grow behind the
retina, leading to bleeding, scarring
and possible vision loss. This condition can develop quickly.
detected in early stages before scar formation, this condition
likely to respond to some treatments.
Treatments for wet
age-related macular degeneration include pharmacological therapy
with intravitreal Lucentis or Avastin
injection to target
newly developed abnormal blood vessels, or photodynamic
therapy to break up leaking blood vessels and medications
slow formation of new blood vessels.
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cornea specialists, in conjunction with our retina specialists,
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Diabetic retinopathy is defined as damage to the blood vessels
of retina of the eye and is associated with long-term diabetes.
The retina consists of a layer of tissue that processes light
and images into a series of nerve signals as they are sent
to the brain.
There are two types of this eye condition: non-proliferative
diabetic retinopathy and proliferative diabetic retinopathy.
The non-proliferative condition begins to develop first as
blood vessels enlarge in certain areas, these are known as microaneurysms.
This can lead to blocked blood vessels and small amounts of
or retinal hemorrhages causing fluid to leak into the retina
and vision issues.
Proliferative retinopathy is a more advanced
and severe condition. New blood vessels begin to develop and
grow in the eye, but
because they are fragile they can rupture and hemorrhage
to scaring on the retina and on other parts of the eye resulting
in vision loss and other vision issues. Diabetic retinopathy
can be prevented if blood sugar, blood pressure and cholesterol
are controlled correctly.
Unfortunately, symptoms of diabetic
retinopathy usually are not noticed until the eye damage is
severe. Some symptoms
include blurry vision, gradual vision loss, floaters, problems
at night and areas of shadows obscuring vision.
non-proliferative diabetic retinopathy may not require treatment.
They should be closely monitored by
who specializes in treating diabetic retinopathy. Although
treatment cannot reverse damage that has occurred, it
is beneficial in
helping the disease from worsening. Patients are also
advised to stop smoking.
If new blood vessels begin to grow in
the retina, a condition also known as neovascularization, or
if a macular edema
forms, treatment also may be needed. Laser surgical
photocoagulation can be used to treat the retina, keep
blood vessels from leaking and eliminate fragile blood
Picture of non-proliferative diabetic retinopathy
Picture of proliferative diabetic retinopathy with some laser
Central Retinal Artery Occlusion (CRAO)
Central retinal artery occlusion is defined as blockage of the
blood supply in the central artery of the retina (the main
trunk of the artery). Retinal arteries may become blocked by
a blood clot or substances (such as fat or plaque) that get
stuck in the arteries. These blockages may occur due to hardening
of the arteries in the eye. Also, clots may travel from other
parts of the body and block an artery in the retina. A common
source of a clot would be from the carotid artery in the neck
or from the heart lining. Most clots are caused by conditions
such as diabetes, carotid artery disease, high cholesterol,
or certain heart rhythm problem like atrail fibrillaltion.
with retinal arterial occlusion, whether it is temporary
or permanent, have a risk of stroke because clots may also move
to the brain. Retinal vessel occlusion more often affects older
people. Risk factors are related to the disorders that cause
the blockage. The symptom is a sudden blurring or loss of vision
in the eye. Breathing in (inhaling) a carbon dioxide-oxygen
has been used to treat blockages in the arteries. This treatment
causes the arteries of the retina to widen (dilate). It may
allow the clot to move down the artery and sometimes break up,
reduces the area of the retina that is affected. The use of
the clot-busting drug, tissue plasminogen activator (tPA), within
a few hours of retinal artery occlusion may be helpful. Unfortunately,
there is no treatment that can consistently restore vision
from an artery occlusion. However, if it is caught within the
first hour and treatment is initiated immediately, recovery
is possible in rare cases.
Measures used to prevent other blood
vessel (vascular) diseases, such as coronary artery disease
, may decrease the risk of
retinal artery occlusion. These include:
eating a low-fat diet ,exercising ,stopping smoking, losing weight if you
are overweight. Aspirin is commonly used to prevent the artery
from becoming blocked
again. It is also helpful to control atrial fibrillation.
Branch Retinal Artery Occlusion (BRAO)
The central retinal artery, enters the eye through the optic
nerve and divides into multiple branches to perfuse the inner
layers of the retina. A branch retinal artery occlusion (BRAO)
occurs when one of these branches of the arterial supply to
the retina becomes occluded. Most commonly, a branch retinal
artery occlusion occurs secondary to an embolus. Emboli typically
originate within vessels upstream where they dislodge and travel
within the circulatory system to ultimately become lodged downstream
in a smaller vessel. The most common include cholesterol emboli
from carotid atheromatous plaques, platelet-fibrin emboli from
thrombotic disease, and calcific emboli from cardiac valvular
Patients with branch retinal artery occlusion (BRAO)
typically present with sudden, unilateral, painless, partial
visual loss. Risk factors for BRAO include high
blood pressure, high cholesterol, diabetes, coronary artery disease, or history
of stroke .
Central Retinal Vein Occlusion (CRVO)
As the central retinal artery enter the eye trough the optic
nerve, a central VEIN, LEAVES the eye trough the same area,
and can be occluded too. Veins of the retina can become blocked
by a blood clot. Retinal vein occlusion also can occur when
the retinal arteries put pressure on the retinal vein. This
is usually caused by a condition such as blood clot, Diabetes,
Glaucoma, hardening of the arteries (atherosclerosis), high
blood pressure. Painless visual loss is usually sudden, but
it can also occur gradually over a period of days to weeks.
to the lack of oxygen in the retina, there is a risk to develop
new vessels (neovascularization) and then this new vessels
creates an occlusion on the drainage of the aqueous humor that
in high pressures in the eye (neovascular glaucoma) or they
can leak into the gel inside the eye (vitreous hemorrhage) There
is no generally accepted medical therapy for occlusion itself.
However, if neovascularization develops,laser treatment of
retina ( pan retinal photocoagulation) should be initiated
because it may decrease vitreous hemorrhages and prevent neovascular
Patients with diagnosis of CRVO should be advised
to optimize systemic disease control.
Branch Retinal Vein Occlusion (BRVO)
Blockage of one of the venous branches in the retina is called
a branch retinal vein occlusion (BRVO), and may cause vision
loss and other complications. Males and females are, in general,
affected equally. Most retinal vein occlusions occur after
the age of 50, although younger patients are sometimes seen
with this disorder. A major risk factor for branch retinal
vein occlusion is atherosclerosis. Other risk factors include
history of stroke, coronary artery disease, aging, hypertension,
elevated blood lipids, smoking, and glaucoma. Other less common
risk factors include blood clotting abnormalities, infectious
diseases, and inflammatory disorders. The symptoms of a branch
retinal vein occlusion depend on which venous branch is involved.
Common symptoms include blurred vision or changes in a portion
of the visual field (peripheral vision). Occasionally the branch
retinal vein occlusion will affect a vein draining a portion
of the retina away from the central vision and will not cause
any symptoms. The complications and treatment are the same
as in the Central Retinal Vein Occlusion.
A floater is a dark, spot, line or shape that moves or drifts
throughout the field of vision. Most people have some floaters
and are able to ignore them unless they are numerous or become
more prominent. Floaters are caused when the vitreous begins
to shrink and becomes cobweb-like or stringy, causing shadows
to reflect against the retina.
Floaters develop as a patient
ages and usually are merely annoying. However, floaters can
be symptoms of more serious vision issues
such as retinal tears, eye injury, infection, hemorrhaging and
If floaters begin to drastically affect vision,
a vitrectomy may be recommended. During this surgical procedure,
of the eye and the floaters are removed and replaced with a salt
solution. However, most surgeons are hesitant to recommend this
procedure because it poses certain risks to the patient’s
sight, including such complications as retinal detachment, retinal
tears and cataracts.
are bursts showers, spots or arcs of light in a patient’s
visual field. If a patient experiences sudden showers of floaters,
immediate medical attention is needed.
The flashes could be caused
by the vitreous of the eye pulling away from the retina or the
retina becoming detached from the
back of the eye. Flashes could be short bursts or happen continually
until the retina is repaired. Because visual flashes may be signs
of retinal detachment and can lead to vision loss, immediate
medical care is essential. Flashes and floaters also may indicate
vitreous detachment and other vision issues.
also can occur after a patient receives a blow to the head and
is sometimes referred to as "seeing
stars." Some patients see flashes of light that look like
jagged lines or waves and last approximately 10 to 20 minutes.
These flashes are typically caused by blood vessel spasm in the
brain, which are also called migraines. When a headache follows
these visual flashes, it is a migraine. If no headache develops,
the flashes are called an ophthalmic or ocular migraine.
Posterior Vitreous Detachment
About 75 percent of patients over the age of 65 experience posterior
vitreous detachment. The condition happens as the vitreous
changes and begins to pull away from the retina.
floaters and flashes of light in vision,
There are no treatments
for posterior vitreous detachment. Patients find that the floaters
and flashes subside in about
Over time, they adapt to having floaters in their field of
vision and overall visual acuity remains the same. Very
with posterior vitreous detachment develop the much rarer
retinal tearing or detachment conditions.
Retinal Tears and Retinal Detachments
A retinal tear happens when the retina detaches from the back
wall of the eye. If the retina becomes partially detached,
blood supply to the retina is reduced and the ability to process
light rays affected. If the retina is totally detached then
the images can no longer be transmitted between the eye and
brain and blindness results.
When retinal detachment has occurred,
a patient’s vision
may seem watery, wavy, shadowed or distorted. In some cases,
vision may be totally lost.
Normally, as people age the vitreous,
a clear gel-like fluid that fills the inner cavity of the
eye, begins to decrease and
pull away from the retina. This typically is not harmful to
the eye. In some cases, the vitreous material stays attached
retina, causing small tears as it shrinks. These peripheral
retinal tears do not affect vision but if left untreated, seepage
the tears can lead to retinal detachment. Retinal detachments
also can be caused by posterior vitreous detachment, a related
disorder, as well as trauma, diabetes or inflammatory disorders.
of retinal tears vary and may not be noticeable. As the vitreous
gel shrinks and pulls away from the retina, flashes
of light may appear in the patient’s vision. Floaters,
which can be visible as black spots or lines, can be the result
of retina vessels bleeding or from the formation of small areas
of vitreous matter. Floaters and flashes may not necessarily
indicate a retinal tear, patients should be examined to be sure.
Immediate treatment is needed for retinal tears to prevent the
retina from detaching and a loss of vision. Surgical treatments
focus on creating a scar that helps to bond the retina to the
back of the eye. These treatments are done with laser light
or freezing methods. More than 90% of retina detachments can
repaired, preventing further loss of sight and possibly restoring
Cystoid Macular Edema (CME)
Cystoid macular edema, commonly called CME, is a painless disorder
which affects the central retina or macula. The eye is often
compared to a camera, with the front of the eye containing
the lens that focuses images on the inside back layer of the
eye; this back layer is called the retina, and it is covered
with special nerve cells that react to light. When CME is present,
multiple cyst-like (cystoid) areas of fluid appear in the macula
and cause retinal swelling or edema. This swelling in the retina
in turn can cause decreased vision.
Some causes of CME include:
- Eye surgery, including cataract
- A stroke in the eye causing blockage in the small
arteries or veins of the retina (branch or central retina
- Inflammation of the eye
- Eye trauma
The first symptom of CME is blurry or "wavy" vision
in the center of your visual field. Your Eye M.D. can make this
diagnosis by carefully examing the eye and also doing a special
scan of the back of the eye, called an Ocular Coherence Tomography
Only your Eye M.D. can recommend the right treatment
for CME. Treatment options vary depending on the degree of
but some options include: eye drops, injections of steroids
or other medications inside or around the eye, and possibly surgery.
No matter what the cause of the CME, it usually takes several
months for it to go away. The patient should not get discouraged.
It is important that you keep following your Eye M.D.'s recommendations.
CME optical coherence tomography
Fluorescein Angiogram of CME
retinopathy is damage to the retina from high blood pressure.
High blood pressure can damage blood vessels in the
retina. The higher the blood pressure and the longer it has
been high, the more severe the damage is likely to be. When
you have diabetes, high cholesterol levels, or you smoke, you
have a higher risk of damage and vision loss. Most people with
hypertensive retinopathy do not have symptoms until late in
the disease. Malignant hypertension may cause the following
sudden symptoms, and should be considered a medical emergency.
The symptoms include double vision or dim vision, headaches,
and/or visual disturbances and sometimes sudden vision loss
degree of retina damage (retinopathy) is graded on a scale of
1 to 4:
- At grade 1, you may not have symptoms.
- In between grades 1
and 4, there are a number of changes in the blood vessels,
areas where blood vessels have leaked, and
other parts of the retina.
- Grade 4 hypertensive retinopathy includes swelling
of the optic nerve and of the visual center of the retina
(macula). This swelling can cause decreased vision.
Controlling high blood pressure (hypertension)
is the only
treatment for hypertensive retinopathy. Patients with grade
4 (severe hypertensive
retinopathy) often have heart and kidney complications of
high blood pressure. They are also at higher risk for stroke.
retina will generally recover if the blood pressure is controlled.
However, some patients with grade 4 hypertensive retinopathy
will have permanent damage to the optic nerve or macula.
high blood pressure prevents changes in the blood vessels of
the eye, as well as in other organs like the heart,
kidneys, and brain.
Epiretinal Membrane (ERM)
Epiretinal membrane is a translucent or semitranslucent fibrocellular
tissue formed on the surface of the retina in response to changes
in the vitreous humor. It can be associated with a wide variety
of conditions, including retinal vascular occlusions, uveitis,
trauma, intraocular surgery, and retinal breaks. Majority of
the time, there is no known cause. Both sexes are equally affected.
Contracture of ERMs produces distortion and wrinkling of the
inner surface of the retina, also called cellophane maculopathy
or macular pucker in severe cases.
Affected patients may be
asymptomatic, or they may present with symptoms of distortion,
decreased image size from the
eye causing double vision, or swelling of the macula causing
The definite treatment for severe cases
of ERMs is vitrectomy with membrane peel. Surgery is not usually
the distortions or decreased vision are severe enough to
interfere with daily living, since there are the usual
hazards of surgery,
infections, and a possibility of retinal detachment.
OCT picture of ERM
A macular hole is defined as a small hole in the macula, the
area of the eye that is responsible for the sharp, detailed
vision needed for reading, driving and small detail work. This
condition is more common in patients ages 60 and older.
of a macular hole include problems with the central area
of vision. For example, straight lines may appear wavy and
reading may be difficult. In later stages, there may be small
blank areas in the central vision.
In some cases, macular holes
close up by themselves. Other cases require a vitrectomy, a
surgical procedure to remove
the vitreous gel from the interior of the eye to prevent
pulling on the retina. The removed gel is replaced with a bubble
a combination of air and gas. This bubble acts as an internal
bandage as the macular hole heals and reseals itself.
Optical coherence tomography picture of Macular Hole
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