Retina & Macular Degeneration
What is the Retina?
The retina is a layer of light-sensitive tissue that lines the inside of the back of your eye. Its job is to capture light and convert it into electrical signals that your brain can interpret as vision.
This thin but complex tissue contains millions of specialized cells called photoreceptors. These work together to help you see both fine detail and color in your environment.
The retina’s central portion, called the macula, is responsible for your sharp, detailed central vision that allows you to read, drive, and recognize faces. Several conditions can affect your retina and potentially impact your vision.
Early detection is key to preserving your sight, which is why it’s important to understand the signs and symptoms of common retinal problems. Here are some conditions we frequently diagnose and treat:
Diabetic Retinopathy
Diabetic retinopathy occurs when high blood sugar levels damage the delicate blood vessels in your retina. In its early stages, these blood vessels may leak, causing the retinal tissue to swell.
As the condition progresses, new, abnormal blood vessels may grow on the retina’s surface, leading to potential vision loss if left untreated. Regular eye examinations are crucial for people with diabetes, as early detection and treatment can help preserve vision.
Macular Degeneration
Age-related macular degeneration (AMD) affects the macula, causing progressive loss of central vision while peripheral vision remains intact.
What is AMD?
Age-related macular degeneration (AMD) is a disease of the retina. End-Stage AMD is the most advanced form of the disease and the leading cause of irreversible vision loss and legal blindness in individuals over the age of 65. In early, less advanced AMD, visual symptoms are generally mild and may or may not impact vision-related activities.
However, advanced stages of AMD can result in severe loss of sight in the central part of vision. This is often referred to as a central vision “blind spot.” This blind spot is different than the visual disturbances experienced with cataracts (clouding of the eye’s lens) and is not correctable by cataract surgery or glasses.
Side vision, or peripheral vision, is not affected by AMD, but is too low resolution to make up for lost central vision. At this time, there is no cure for End-Stage AMD and no way to reverse its effects.
Types of Macular Degeneration
There are two types of macular degeneration: “dry” (atrophic) and “wet” (exudative). Dry macular degeneration is the most common. It is caused by the degeneration of the retinal tissue within the macula as you age.
It is commonly referred to as AMD or ARMD, which stands for Age-Related Macular Degeneration. Approximately 10% of the population will develop dry AMD. Vision loss in dry AMD is typically gradual.
Wet AMD occurs when there is new blood vessel growth behind the macula caused by the degeneration process. These new blood vessels leak in the back of the eye. Vision loss from this type of macular degeneration is often more rapid and severe.
The wet form of AMD is much less common than the dry type and occurs in approximately 10% of patients who have the disease. However, wet AMD accounts for 90% of the severe visual loss that is associated with macular degeneration.
Treatment of Macular Degeneration
Studies have shown that a specific combination of vitamins, known as the AREDS vitamin formula slows progression of intermediate to advanced age-related macular degeneration (AMD) by providing antioxidant and mineral support to retinal tissue. The formulation specifically targets oxidative stress and zinc deficiency implicated in AMD. This combination of vitamins, named for the National Eye Institute’s Age-Related Eye Disease Study, can be purchased over the counter. Please check with your eye care professional for additional information on the use of these vitamins.
In the wet form of macular degeneration, blood vessels grow abnormally beneath the retina, damaging the macula and distorting the vision. Wet macular degeneration responds best when treated in its early stages. There are a number of treatments available, including thermal laser, which attempts to kill the new blood vessel with heat, and cold laser, which activates a light-sensitive drug in an attempt to kill the new blood vessel without additional damage to the retina.
Intraocular Drug Therapy is the newest treatment available. This treatment involves injecting a drug into the eye to neutralize the conditions causing the growth of new blood vessels. Please note that most of the treatments available are therapies requiring a number of treatments to be performed over an extended period of time to achieve success.
Associated Eye Care is proud to offer multiple FDA approved medications for this condition.
Lucentis (ranibizumab), the first intraocular injectable drug approved by the FDA for the treatment of macular degeneration. Lucentis mitigates the effects of macular degeneration by inhibiting the growth of new, weak blood vessels. The drug can potentially prevent or reverse the effects of wet macular degeneration.
Every current treatment for wet AMD is used in an attempt to maintain the patient’s vision at the level at which they present when they are first seen by the doctor. Although some success has been achieved in improving patients’ vision with treatment, the true goal of treatment is to stop vision loss.
Unfortunately, there is no known treatment at this time for dry macular degeneration.
Izervay (avacincaptad pegol) is an FDA-approved complement inhibitor used to treat advanced dry macular degeneration, specifically geographic atrophy (GA), a severe form of dry AMD that causes progressive and irreversible vision loss.
Izervay works by blocking a part of the immune system called the complement protein C5. This inhibition prevents the formation of the membrane attack complex, which contributes to retinal cell damage and death in GA. By doing so, Izervay slows the growth of the atrophic lesions in the retina, helping to preserve vision for patients at risk of severe vision loss.
Why you might be treated with Izervay:
Izervay offers a promising treatment option for advanced dry AMD with geographic atrophy by slowing vision loss through immune system modulation. However, it involves eye injections and carries some risks, so your eye doctor will weigh the benefits and risks based on your specific condition and monitor you closely during treatment.
There is also new FDA treatment option for advanced dry macular degeneration. These drugs are called complement inhibitors. Izervay is one of them.
It is important to know that treatment is to slow progression of advanced stage macular degeneration that causes anatomical changes called geographic atrophy, that causes people to have grey spots = missing spots in the central visual field that has tendency for enlargement and making that blind spot larger/more noticeable and unfortunately loose ability to drive and read. These medications slow down the progression of existing geographic atrophy, but they do not stop it or reverse it.
Prevention of Macular Degeneration
Unfortunately, macular degeneration is not wholly preventable. The use of AREDS vitamin therapy is a good start at trying to limit this disease process. Daily use of the Amsler Grid for those who have been diagnosed with AMD is a required measure to help detect early visual distortion related to wet AMD.
Individuals over 60 should receive regular eye exams and be vigilant for signs of cataracts, glaucoma, macular degeneration, and other age-related vision problems because the key to preventing vision loss is early detection and treatment.
Macular Hole and Macular Pucker
A macular hole is a small break in the macula that can cause blurred and distorted central vision. It often develops gradually and can be related to aging or eye injury. Meanwhile, a macular pucker occurs when wrinkled, scar like tissue forms on the macula, causing similar visual disturbances. Both conditions can affect your ability to perform detailed tasks and may require surgical intervention for treatment.
Central Retinal Artery Occlusion
Central retinal artery occlusion (CRAO) and branch retinal vein occlusion (BRVO) are serious conditions affecting blood flow in the retina. CRAO occurs when the main artery supplying blood to the retina becomes blocked, causing sudden and severe vision loss.
BRVO affects smaller vessels and may cause more gradual vision changes. Both conditions require immediate medical attention and can be indicators of underlying cardiovascular health issues.
Central Serous Retinopathy
Central serous retinopathy occurs when fluid builds up under the retina, causing it to detach and distort vision. This condition often affects young to middle-aged adults and can be triggered by stress, steroid use, or other factors.
While many cases resolve on their own, some require treatment to prevent chronic vision problems.
Uveitis
Uveitis is inflammation of the uvea, the middle layer of eye tissue that includes the iris, ciliary body, and choroid. This inflammation can affect the retina and may cause redness, pain, light sensitivity, and blurred vision.
The condition can develop suddenly or gradually, and may be related to autoimmune disorders, infections, or other systemic health conditions.
If left untreated, uveitis can lead to complications including retinal swelling, scarring, and permanent vision loss.
Flashes and Floaters
Flashes appear as brief sparks of light in your vision, while floaters look like small specks or dots floating in your field of view. While these phenomena are common and often harmless, sudden increases in either flashes or floaters can signal a retinal tear or detachment.
If you notice new or worsening flashes or floaters, call your eye doctor right away.
Retinal Detachment and Tears
Retinal detachment is a serious condition where the retina separates from its underlying supportive tissue. This can happen suddenly or gradually. Warning signs include sudden flashes of light, a shower of floating spots, or a curtain-like shadow moving across your vision.
Retinal detachment should be treated as a medical emergency and treated as soon as possible. An untreated retinal detachment can lead to significant vision loss and blindness. It is most common in people with high levels of nearsightedness (myopia) and the elderly.
Symptoms of Retinal Detachment
Symptoms include:
If you experience these symptoms, seek medical help immediately.
Causes of Retinal Detachment
Retinal detachments are frequently precipitated by injury, either directly to the eye or generally to the head. If you sustain a concussion or trauma to the eye, it is wise to watch for signs of a retinal detachment.
Individuals with severe nearsightedness (myopia) account for nearly 70% of retinal detachments. This is because most nearsighted people have longer eyes than people with normal vision, and the retina is stretched further. Other factors that increase the risk of retinal detachment include cataract surgery and diabetic retinopathy.
Retinal detachment is very often associated with a condition called posterior vitreous detachment. The vitreous humor is the transparent, gel-like fluid that fills the eye. It is attached to the retina, but generally shrinks as we age. In some cases, the level of shrinkage is great enough that the vitreous pulls away from the retina, leaving a gap. Because the vitreous no longer applies outward pressure to this portion of the retina, it is more prone to detachment.
Of the symptoms listed above, these are most commonly associated with posterior vitreous detachment:
Spotting signs of posterior vitreous detachment early can help prevent a subsequent retinal detachment.
In instances where retinal detachment is caused by a tear in the retina, the vitreous sometimes fills in the space behind the detachment, exacerbating the problem.
Treatment of Retinal Detachment
It is very important to seek treatment as soon as you experience symptoms of retinal detachment. Treatment for this condition depends on the severity of the detachment, whether or not there is an associated posterior vitreous detachment, general eye health and other factors. Associated Eye Care offers a range of treatments to suit all situations, including retinal laser surgery.
Treatments for Retinal Conditions
Modern medicine offers many effective ways to treat retinal conditions. Our team uses advanced technology and proven techniques to protect and restore vision for our patients. Here are the main treatment options the retinal specialists at Associated Eye Care offer for retinal conditions:
Retina Surgery
Modern retinal surgery combines sophisticated techniques with advanced technology to treat various retinal conditions. Our surgical approaches are tailored to each patient’s specific condition and needs, with the goal of preserving or improving vision while minimizing recovery time.
Retinal Detachment Surgery
The surgical repair of retinal detachment must be customized to the specific type and severity of the detachment. This may involve one or a combination of procedures, including vitrectomy or pneumatic retinopexy, all aimed at reattaching the retina and sealing any tears.
Vitrectomy
Vitrectomy is a procedure that removes the vitreous gel from the eye to access the retina. This sophisticated surgery is used to treat various conditions, including macular holes, severe diabetic retinopathy, and complicated retinal detachments.
Advanced instruments allow for precise removal of scar tissue and repair of retinal damage.
Scleral Buckle
A scleral buckle procedure involves placing a flexible band around the eye to gently push the eye wall against the detached retina. This time-tested technique can be highly effective in treating retinal detachment and may be used alone or in combination with other procedures.
Injections
Intravitreal injections deliver medication directly into the eye to treat conditions such as wet macular degeneration, diabetic retinopathy, and retinal vein occlusions. These treatments have revolutionized the management of many retinal diseases and can help preserve vision when administered appropriately.
Laser
Laser treatment can seal retinal tears, reduce abnormal blood vessel growth, and treat other retinal conditions. Laser procedures can be essential for preventing vision loss from various retinal conditions and can often be performed in an office setting.
Don’t wait until vision problems affect your daily life. Schedule a comprehensive retinal examination with our experienced specialists at Associated Eye Care today.
