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Retinal & Vitreous Disorders


Diabetic Retinopathy

There are two types of diabetic retinopathy:

The first type is non proliferative or background diabetic retinopathy (BDR). This represents the early stages of diabetic damage to the blood vessels of the retina. When the damage occurs to the retinal vasculature, the blood vessels will leak fluid, blood, or both. This can then lead to either macular edema (swelling) or macular ischemia (poor blood flow). If macular edema develops, the vision will suffer.

Treatment includes local focal laser to the areas of blood vessel leakage, intraocular steroid injections and injections of anti-VEGF agents. There is no treatment for macular ischemia.

The second type of diabetic retinopathy is proliferative retinopathy (PDR). In this disorder, the blood vessels are so damaged that they occlude permanently and in order to compensate, the retina grows very delicate, new blood vessels. These new blood vessels are totally abnormal and serve no real purpose. They only cause serious problems such as spontaneous hemorrhages into the vitreous cavity and the growth of significant scar tissue, which can lead to retinal detachment. If left unchecked, blindness may be the final outcome.

Treatment includes an extensive laser treatment. If a vitreous hemorrhage occurs, vitrectomy surgery is suggested. Early treatment has the best results. See how we can help today. 

Floaters & Flashes

Floaters are particles that are located in the vitreous cavity (the inside cavity of the eye) and can appear as dots, lines, or cobwebs. They are a natural aging process to the eye, which form the vitreous (the clear, gel like substance that fills the inside of the eye) shrinks and pulls away from the natural attachments to the retina causing clumps within the eye. The clumps cast shadows on the retina, which are visualized as the shapes mentioned previously.

Flashes of light are usually noticed when the vitreous shrinks and separates from the retina. Floaters may be associated 5-10% of the time with retinal tears. When the vitreous shrinks, it pulls on the retina and may actually tear a portion of the retina in the area of traction. This may then cause the development of a retinal detachment. This is an emergency that requires immediate surgical treatment.

Retinal Tears & Retinal Detachment

With age, the vitreous tends to change in consistence and become more watery. It also tends to shrink and as it does so, it can pull away from its retinal attachments and cause a retinal tear. Retinal tears can then cause the development of a retinal detachment. The watery vitreous fluid passing through the tear lifts the retina off the posterior wall of the eye. The treatment for retinal tears is either done with a laser or cryotherapy (freezing) to reseal the tear to the posterior wall of the eye and prevent a detachment.

If the retina is detached, it must first be reattached before the tear that caused it can be permanently sealed. There are three ways to surgically reattach a retina.

  1. Pneumatic Retinopexy – A gas bubble is injected into the eye and the gas then pushes the retina posteriorly to seal the tear.
  2. Scleral Buckle Surgery – The fluid that has peeled the retina off the posterior wall must be drained and then a flexible piece of silicone is sewn on the outer eye wall through the sclera to support the tear while it heals.
  3. Vitrectomy Surgery – The vitreous gel is removed from the eye and replaced with a gas bubble, which is eventually replaced by the clear fluids produced by the eye.

Vascular Occlusive Retinal Disorders

These disorders can involve either the venous or arterial vessels of the eye. Retinal vein occlusion is a blockage of the small veins that carry blood away from the retina. The retina is the layer of tissue at the back of the inner eye that converts light images to nerve signals and sends them to the brain. Retinal vain occlusion is most often caused by hardening of the arteries (atherosclerosis) and the formation of a blood clot. Blockage of smaller veins (branch veins of BRVO) in the retina often occurs when retinal arteries that have been thickened and hardened by atherosclerosis cross over and place pressure on a retinal vein. Risk factors for BRVO include atherosclerosis, diabetes hypertension, and eye conditions such as glaucoma. Treatment include focal laser treatment and injections of anti-VEGF agents.

Retinal Artery Occlusion (BRAO) is a blockage in one of the small arteries that carry blood to the retina. The retina is a layer of tissue in the back of the eye that is able to sense light. Retinal arteries may become blocked by a blood clot or fat deposits that get stuck. These blockages are more likely due to hardening of the arteries (atherosclerosis) in the eye. Clots may travel from other parts of the body and block an artery in the retina. The most common source of clots is the carotid artery in the neck and heart. Risk factors for BRAO include carotid artery disease, diabetes, arterial fibrillation, heart valve problems, hyper lipedema, hypertension, intravenous drug use, and temporal arteritis.

Age-Related Macular Degeneration (ARMD)

ARMD is the degeneration and slow cell death of the macula, which is a very small central area of the retina that is responsible for fine detailed vision necessary for activities such as reading and driving. The main symptoms of ARMD is the loss of central vision. Peripheral vision is usually left intact.

The actual cause of Age-Related Macular Degeneration is unknown, but if definitely related to age. It is usually detected in people over 65 years old. The main risk factors in its development include family history, high blood pressure, blue eyes, cardiovascular disease, and smoking.

There are two types of Age-Related Macular Degeneration (ARMD):

  1. Dry ARMD is the most common and is present in 90% of cases. It results in a very slowly progressive degeneration of the retina in the macular region. Most people with this disease are urged to take certain vitamins and minerals to slow its progression.
  2. Wet ARMD occurs in 10% of cases and is much more devastating to the central vision. In this form of macular degeneration, abnormal blood vessels grow underneath the retina and leak blood and fluid, which will eventually cause total loss of central vision if left untreated. Treatment options include laser, and more recently, the injection of medications into vitreous cavity which cause the abnormal blood vessels to regress.

Macular Holes

Macular Holes are small round openings in the macular, which is the part of the retina responsible for central vision. This causes the loss of central vision that is necessary to perform tasks such as reading, driving, watching TV, 3or any related activity requiring the ability to see fine details. Macular holes usually occur in the elderly when the vitreous (the gel that fills the inside of the eye) shrinks due to age and pulls a piece of the macula tissue, tearing a small round hole. Injuries and chronic swelling of the macula can also lead to macular hole formation.

The only treatment is to perform a vitrectomy, which removes the vitreous gel causing the pulling on the macula. The eye is then filled with a special gas bubble that pushes the macula against the posterior wall of the eye to ultimately seal the hole. The gas bubble eventually dissolves in about two weeks, but the patient must remain in a face-down position until the hole seals completely.

Macular Pucker

A macular pucker occurs in the central part of the retina, called the macula, when scar tissue develops on the surface. It causes the macula to wrinkle and thereby distorts central vision. Macular pucker is also known as epiretinal membrane, pre-retinal membrane, surface wrinkling retinopathy, pre-macular fibrosis, and internal limiting membrane disease.

A macular pucker usually does not require any treatment. Since this does not affect daily activities, most people will usually adjust to the mild visual distortion such as reading and driving. Rarely, vision deteriorates to a point to where it affects daily routine activities and if this is the case, then surgery may be recommended. This procedure is called a vitrectomy and requires removing the vitreous gel off to prevent it from pulling on the retina. Also, the abnormal scar tissue, which causes the wrinkling, is removed off the surface of the macula.