Retina Care

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What is the Retina?

The retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical events that ultimately trigger nerve impulses. These are sent to various visual centers of the brain through the fibers of the optic nerve. Certain conditions can cause the retina can become damaged, resulting in blurred or reduced vision.

Macular Degeneration

Macular degeneration is a breakdown of the retinal tissue in the macula of an affected eye. The macula is a small area in the back of the eye that allows a person to see fine detail. The breakdown of the macula causes decreased central vision, which can affect our distance and near vision. Many studies have revealed that the frequency of this disease increases dramatically after age 60, and there is currently no cure available.

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.

Macular Degeneration

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

Recently, studies have shown that a specific combination of vitamins, known as the AREDS vitamin formula, can be useful in reducing the severity of 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 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.

Defining success in treatment is also important. 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.

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.

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 eyeglasses. 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.

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Retinal Detachments/Tears

Retinal laser surgery by Dr. Alan Downie is performed as a treatment for a variety of retinal problems including Diabetic Retinopathy, Age-related Macular Degeneration and tearing of the retina. Laser surgery is virtually painless and performed in our office while you remain awake and comfortable. If you or someone in your family suffers from vitreo-retinal diseases of the eye we can provide the care needed to appropriately treat this condition.

Retinal Detachment

The retina is the light-sensitive inner surface of the eye. It is responsible for gathering light that enters the eye and sending it to the brain via the optic nerve. The “red eye” effect we sometimes see in photographs is caused by bright light reflecting off the retina.

Retinal detachment is a condition in which the retina pulls away from the wall of the eye. Initially, most retinal detachments begin small, but can grow worse rapidly if left untreated. It is most common in people with high levels of nearsightedness (myopia) and the elderly.

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.

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:

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.

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Alan A. Downie, M.D.

Vitreo-retinal Surgery, Laser Surgery, Cataract Surgery

Dr. Downie joined Associated Eye Care in 1995. He completed his undergraduate studies at Carleton College in Northfield, MN. He received his medical degree from The Ohio State University College of Medicine and remained there for ophthalmic residency. Dr. Downie completed fellowship training in vitreo-retinal surgery at the Charles Retina Institute in Memphis, TN. Dr. Downie’s practice emphasizes medical and surgical management of diseases of the retina and vitreous humor,...

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