The light that enters the eye needs to be converted into signals that are sent to the brain for interpretation. This happens in the retina, the paper-thin tissue that lines the back of the eye. The highly specialized area in the middle of the retina we refer to as the macula. The macula is made up of millions of light-sensing cells that collectively produce central vision.
Various problems can occur with the retina and these threaten the patient’s vision. Age-related issues are diabetic retinopathy, macular degeneration, the increase of flashes and floaters, and even detachment of the retina.
The team at Longwood Eye & LASIK Center has extensive training and experience diagnosing and treating these issues with the retina. This is key because many of these conditions don’t exhibit symptoms to the patient until vision damage is already occurring. Our early diagnosis and treatment is key to preventing vision loss.
What Is the Retina of the Eye?
The retina is made up of several layers, including one that contains specialized cells called photoreceptors. The two types of photoreceptors are rods and cones. Rods detect motion, deliver black-and-white vision, and are necessary for vision in low light. Cones are responsible for central vision and color vision. Cones perform best in medium and bright light. Rods are located throughout the retina, while cones are concentrated in the macula, the small central area of the retina that produces our central vision.
At What Age May Retina Problems Begin?
There isn’t a set age when a person should really be on the lookout for problems with the retina. Diabetes can show itself in diabetic retinopathy over time, depending on how long the person has had diabetes. Macular degeneration is age-related, affecting one in 14 Americans over age 40, but a full 30 percent of seniors over age 75. A person is more likely to develop a detached retina after age 50, as the vitreous gel in the eye become more liquid and begins to pull away slightly from the back or the eye, pulling on the retina
Why Is It Important to Treat Problems with the Retina?
While there is no cure for some conditions, such as macular degeneration, early diagnosis and treatment is key to stopping the progression of vision loss. That’s why it’s so important for patients to maintain their schedule of regular eye exams — our ophthalmologists can spot these retinal diseases early on when they are just beginning and there has only been minimal or no vision damage. But if you choose to leave these problems to their own devices, they will often result in severe vision loss or blindness.
What Are the Symptoms of Retinal Problems?
Retinal disease and other problems have some general symptoms:
- Seeing a marked increase in floaters (specks, lines, or cobweb-like items)
- Blurred or distorted vision
- Defects in the side vision
- Lost vision
But not everyone experiences symptoms and the condition can progress causing vision damage.
What Are the Most Common Diseases of the Retina?
At Longwood Eye & LASIK Center, we diagnose, treat, and help our patients deal with age-related macular degeneration. Age-related macular degeneration is the leading cause of blindness in people 50 and older across the world. It is caused by the loss of retinal photoreceptor cells, particularly the cones, in the macula. This is the area of our eyes where our vision is the sharpest.
There are two forms of macular degeneration. The first is dry macular degeneration. This is the most common form of macular degeneration and it begins with small areas of vision damage in the macula. It progresses slowly and most patients retain some vision in at least one eye.
The second form of age-related macular degeneration, known as wet macular degeneration, occurs when abnormal blood vessels form underneath the retina. These blood vessels bleed and leak fluid causing significant vision loss. Eventually a scar forms under the macula and central vision is lost.
As more and more Americans develop diabetes due to obesity, diabetic retinopathy cases are dramatically increasing. Diabetic retinopathy is the leading cause of blindness in working-aged adults in the U.S. It occurs in two ways: non-proliferative and proliferative retinopathy. In non-proliferative diabetic retinopathy, the blood vessels of the retina bleed or leak fluid. This leads to swelling of the retina, small hemorrhages, and the formation of deposits on the retina.
Proliferative retinopathy is more severe. It occurs when the blood vessels in the retina or the optic nerve become blocked, starving the retina of necessary nutrients. Proliferative diabetic retinopathy can lead to vitreous hemorrhage, where profuse bleeding into the eye blocks vision; retinal detachment, where scar tissue pulls the retina, causing it to tear or detach; and neovascular glaucoma, where the abnormal blood vessels block drainage of fluid from the eye, raising pressure within the eye.
Retinal Detachments and Tears
As we age, our vitreous gel, which fills the interior of the eye, becomes more liquid and can pull away from parts of the eye. Retinal tears occur when the vitreous pulls away from the retina. Liquid that passes through the tear and settles under the retina can make the retina separate from the back wall of the eye. This is retinal detachment.
Retinal Vein Occlusion
A retinal vein occlusion is a sudden blockage of a vein draining blood from inside the eye. When this vein is blocked it leads to bleeding, swelling, and loss of blood flow to the retina. Retinal vein occlusion typically occurs in older patients with a history of high blood pressure and heart disease.
As we age, the gel-like material in the middle of the eye, the vitreous, shrinks and begins to pull away from the retina. In most people this is simply a part of aging and there are no consequences to vision. In a small number of people, however, the vitreous pulls on the retina to such a degree that it creates a hole. This hole is usually in the center of the macula and causes blurring and vision distortion.
How Are These Problems with the Retina and Vitreous Treated?
At Longwood Eye & LASIK Center, our team uses a variety of approaches when treating retinal diseases and other problems. The goal is to stop or slow the progression of the disease to improve or restore the patient’s vision. Unfortunately, damage that has already occurred usually cannot be reversed, which further stresses the importance of early detection.
We may use laser treatment, injection of certain medications into the eye, freezing (cryopexy), the injection of gas or air into the eye, evacuation and replacement of the vitreous gel in the eye, and other methods. Here are some specifics for individual conditions.
Treatment for Macular Degeneration
Because wet macular degeneration can cause significant vision loss, our goal here is to convert the wet form of this disease into the dry form. In wet age-related macular degeneration, a chemical called vascular endothelial growth factor (VEGF) causes abnormal blood vessels to grow under the retina. These blood vessels leak and bleed, damaging the central vision. Treatment for wet macular degeneration is direct injections of VEGF inhibitors into the eye. This converts wet degeneration to dry. At this time, there are no medications or treatments for dry macular degeneration, but certain lifestyle changes and vitamin therapies can slow its progress.
Treatment for Diabetic Retinopathy
For diabetic retinopathy, laser surgery is used to shrink abnormal vessels or to treat leaking blood vessels. This is called scatter laser photocoagulation. This reduces the risk of severe vision loss by around 60 percent. We may also combine injection of anti-VEGF medicines with laser surgery to further reduce retinal swelling and lessen vision loss.
Treatment for Retinal Vein Occlusion
The goal of treatment is to reduce the swelling of the blocked vessels. Retinal lasers have been shown to lessen vision loss, as have the injection of anti-leakage medicines into the eye.
Treating Retinal Detachments and Tears
When dealing with a detached or torn retina, there are three main treatment options. Each of these involves surgery.
- In pneumatic retinopexy, a gas bubble is injected into the vitreous space. The bubble pushes the retinal tear against the back of the eye, which is then treated with laser or freezing therapy to close the tear.
- A “scleral buckle” may be used. In this procedure we sew a tiny piece of silicone to the sclera, the outside eye surface. This indents the sclera and relieves some of the force caused by the vitreous tugging on the retina.
- Finally, we may use a vitrectomy, where we remove the vitreous and replace it with a gas bubble or a clear sterile solution.
Treating Macular Holes
Macular holes can be successfully treated with surgery. In this surgery, a gas bubble is injected into the eye. The gas acts as an internal temporary bandage that holds the edge of the macular hole in place as it heals. The patient must keep his or her face down for a few days after the bubble is placed. Over time, the bubble is gradually absorbed and the vitreous cavity refills with fluid.
At the Longwood Eye & LASIK Center, we offer the latest, most advanced diagnostic and laser treatment technology. This also includes optical coherence tomography for diagnosing macular edema and digital fluorescein angiography. This imaging system allows us to carefully analyze and treat diabetic retinopathy.
Are There Risks with Retinal Surgery to Treat These Conditions?
There are possible complications with these procedures, but you have to remember that doing nothing involves far more risk of vision damage or blindness. These are the possible complications of these procedures:
- Cataract formation (although this is common in people over 60 in all cases with or without surgery)
- Glaucoma (increased pressure in the eye)
- Bleeding into the vitreous cavity
- Vision loss
Will These Problems Clear up on Their Own?
These problems with the retina will not heal on their own. If you leave them untreated, they will only worsen and cause damage to your vision. This is permanent damage. If you have any signs of any of these issues, you need to call the team at Longwood Eye & LASIK Center immediately so that we can diagnose the problem and begin treatment.