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Retina/Vitreous

Conditions - Click for more details
Physicians

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 small detailed 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. If 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 to help slow formation of new blood vessels.

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Implantable telescope for macular degeneration
The cornea specialists, in conjunction with our retina specialists, at the Gavin Herbert Eye Institute are excited to be a “center of excellence” for the CentraSight implantable telescope. This new technology allows for improved vision and quality of life. Click HERE for more information on CentraSight.

 

 

 

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Diabetic retinopathy
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 bleeding 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 easily leading 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 seeing at night and areas of shadows obscuring vision.

Those with non-proliferative diabetic retinopathy may not require treatment. They should be closely monitored by an ophthalmologist 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 techniques called photocoagulation can be used to treat the retina, keep blood vessels from leaking and eliminate fragile blood vessels.

Picture of non-proliferative diabetic retinopathy

Picture of proliferative diabetic retinopathy with some laser treatment

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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.

People 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 mixture 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, which 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 lost 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.

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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 disease.

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 .

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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.

Due 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 develop 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 the retina ( pan retinal photocoagulation) should be initiated because it may decrease vitreous hemorrhages and prevent neovascular glaucoma.

Patients with diagnosis of CRVO should be advised to optimize systemic disease control.

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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.

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Floaters
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 inflammation.

If floaters begin to drastically affect vision, a vitrectomy may be recommended. During this surgical procedure, the vitreous 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.

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Flashes
Flashes 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.

Flashes (photopsia) 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.

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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.

Symptoms include 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 six months. Over time, they adapt to having floaters in their field of vision and overall visual acuity remains the same. Very few patients with posterior vitreous detachment develop the much rarer retinal tearing or detachment conditions.

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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 the retina, causing small tears as it shrinks. These peripheral retinal tears do not affect vision but if left untreated, seepage from 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.

Symptoms 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 be repaired, preventing further loss of sight and possibly restoring sight.

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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 surgery
  • Diabetes
  • A stroke in the eye causing blockage in the small arteries or veins of the retina (branch or central retina vein occlusion)
  • 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 (or OCT).

Only your Eye M.D. can recommend the right treatment for CME. Treatment options vary depending on the degree of retinal swelling, 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

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Hypertensive Retinopathy
Hypertensive 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

The 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. The 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.

Controlling high blood pressure prevents changes in the blood vessels of the eye, as well as in other organs like the heart, kidneys, and brain.

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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 affected eye causing double vision, or swelling of the macula causing decreased vision.

The definite treatment for severe cases of ERMs is vitrectomy with membrane peel. Surgery is not usually recommend unless 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

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Macular Hole
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.

Symptoms 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 some of the vitreous gel from the interior of the eye to prevent pulling on the retina. The removed gel is replaced with a bubble containing 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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For ophthalmology appointments, please call:

UC Irvine Medical Center
714-456-7183

Gavin Herbert Eye Institute Building
949-824-2020

Laser Refractive Surgery
949-824-9970

 

 

CATARACT SURGERY
Anand Bhatt, M.D.
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Sameh Mosaed, M.D.
Roger Steinert, M.D.
Matthew Wade, M.D.

COMPREHENSIVE
M. Cristina Kenney, M.D., Ph.D.
Linda Lippa, M.D.

CORNEA SURGERY
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Roger Steinert, M.D.
Matthew Wade, M.D.

GLAUCOMA
Anand Bhatt, M.D.
Sameh Mosaed, M.D.

NEURO-OPHTHALMOLOGY
R. Wade Crow, M.D.

OPHTHALMIC PATHOLOGY
Donald S. Minckler M.D.

OPHTHALMIC PLASTIC & RECONSTRUCTIVE SURGERY/
OCULOFACIAL COSMETIC SURGERY

Jeremiah Tao, M.D.

PEDIATRIC OPHTHALMOLOGY
Robert Lingua, M.D.
Jennifer Simpson, M.D.

REFRACTIVE SURGERY
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Robert Lingua, M.D.
Roger Steinert, M.D.
Matthew Wade, M.D.

RESEARCH
Lbachir BenMohamed, Ph.D.
Donald Brown, Ph.D.
James Jester, Ph.D.
Tibor Juhasz, Ph.D.
M. Cristina Kenney, M.D., Ph.D.
Henry Klassen, M.D., Ph.D.
Anthony Nesburn, M.D.
Steven Wechsler, Ph.D.

RETINA/VITREOUS
Stephanie Lu, M.D.
Baruch Kuppermann, M.D., Ph.D.

For ophthalmology
appointments, please call:

UC Irvine Medical Center
714-456-7183

UC Irvine Gavin Herbert Eye Institute Building
949-824-2020

Laser Refractive Surgery
949-824-9970

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