Retina and Vitreous Diseases

The Department of Ophthalmology provides answers to frequently asked questions regarding retina and vitreous diseases.

What are the retina and vitreous?
Retina is a tissue that covers inside the eye wall and is an extension of the brain. This tissue when stimulated by light transmits the information to the brain where it is seen as an image. Vitreous has a consistency of ”gel” that fills the eye cavity.

What are vitreo-retinal diseases?
A large variety of conditions can affect the vitreous and retina that lie on the back part of the eye that is not readily visible, such as diabetic retinopathy, macular degeneration, retinal detachments or tears, macular holes, retinopathy of prematurity, retinoblastoma, uveitis, eye cancer, flashes and floaters and retinitis pigmentosa.

What is diabetic retinopathy?
A person with diabetes is at risk for developing diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness in young and middle-aged adults today. The longer a person has diabetes, the greater the chance of developing diabetic retinopathy.
There are two types of diabetic retinopathy:

  • Non-proliferative diabetic retinopathy (NPDR)
  • Proliferative diabetic retinopathy (PDR)

NPDR is an early stage of diabetic retinopathy that can lead to swelling (diabetic macular edema) and the formation of deposits known as exudates. Many people with diabetes develop mild NPDR often without any visual symptoms.

PDR is more severe form of retinopathy. These patients are at risk of losing vision due to bleeding. Also, retinal detachment can occur as a complication.

What are the symptoms of diabetic retinopathy?
Generally most patients are asymptomatic. Patients may have PDR and still have normal vision; therefore, it is important that a dilated eye examination be performed by an ophthalmologist. Other symptoms might be floaters or loss of vision.

How is diabetic retinopathy diagnosed?
Diabetic retinopathy is diagnosed during dilated eye examination. Further studies such as fluorescein angiography maybe needed.

Can diabetic retinopathy be prevented?
Good blood glucose control and blood pressure control will delay diabetic retinopathy.

What are the current treatment options for a person with diabetic retinopathy?
Depending on the severity of retinopathy, options, may include laser therapy, steroid injection inside the eye or vitrectomy.

What research is currently being conducted on diabetic retinopathy?
LY333531, a protein Kinase C-beta inhibitor (PKC-beta inhibitor) developed by Eli Lilly and Co., is a promising new medication for preventing the progression of diabetic retinopathy. Currently patients are being recruited at our institution to evaluate long-term benefits.

What is age-related macular degeneration?
Age-related macular degeneration (AMD) is the leading cause of legal, irreversible blindness among people 50 years of age and older.

Dry macular degeneration (atrophic AMD) is the most common form of macular degeneration and can progress to cause severe central vision loss. This disease progresses slowly and most people usually maintain some central vision in at least one eye.
The condition always starts as "dry" AMD. "Dry" AMD refers to the slow degenerative process that occurs without any formation of abnormal blood vessels. 
The recent Age-Related Eye Disease Study (AREDS) demonstrated that the progression of "dry" AMD could be slowed with vitamin supplementation. This study demonstrated the benefits of taking vitamin C, vitamin E, beta carotene and zinc along with copper. Several vitamin preparations containing the appropriate amounts of these vitamins are currently available, and we encourage patients with AMD to discuss these various vitamin preparations with their eye care specialist.

"Wet" macular degeneration (exudative or neovascular AMD) is caused by blood vessels growing under the retina in the macula. "Wet" AMD always arises from pre-existing "dry" AMD. These blood vessels leak fluid, protein, lipid and blood. Eventually, if untreated, scar tissue forms under the macula and central vision is destroyed. Current treatments approved for "wet" macular degeneration include thermal laser therapy and photodynamic therapy with Visudyne®.

What are the symptoms of macular degeneration?
There is no pain associated with dry or wet AMD. The most common symptom of dry AMD is slightly blurred or fuzzy vision requiring greater illumination to see greater details. Also, an inability to recognize faces at a distance may develop.
Symptoms of wet AMD may be that straight lines, such as sentences on a page appear wavy; rapid loss of central vision; and a blurred or blind spot in the center of vision.

How is macular degeneration diagnosed?
A thorough eye exam by an ophthalmologist or retinal specialist will determine the presence of macular degeneration. Fluorescein angiography may be needed to determine presence of abnormal vessels (wet AMD).

What are the current treatment options for macular degeneration?
Currently, treatments for macular degeneration are rapidly advancing and changing approximately every three months. Laser therapy, photodynamic therapy and transpupillary thermotherapy are examples.

Can wet macular degeneration be prevented?
Currently at UMMC, we are conducting a study that consists of injecting a drug around the eye (Anecortave) to try to prevent wet form of the disease if one eye has been affected by the wet form. Patients can contact our offices for screening and determination of their eligibility.

What is a macular hole?
Macular hole can cause blurred vision, the loss of central vision can occur due to loss of tissue in this area.

How is a macular hole diagnosed?
Macular hole is diagnosed during a complete eye exam, including a dilated retina exam. Optical coherence tomography aids the retina specialist in determining the extent of macular hole.

What are the treatment options for a patient with a macular hole?
Currently vitrectomy with gas injection is the treatment of macular hole with 90% success rate. The patient may be asked to maintain a face-down or an upright position to let the gas bubble close the macular hole.

What are retinal detachments and retinal tears?
Retinal tear is a rip in the retinal tissue. If fluid gets behind the retinal tissue, it will detach or separate the retinal tissue from the eye wall. This leads to loss of vision and blindness if left untreated. 

What are the symptoms of retinal detachments?
Flashes of light, floaters and loss of vision in the form of a dark curtain are symptoms of retinal detachment and tears.

What is the treatment for retinal detachments and tears?
Retinal tears without detachment can be treated with laser. Retinal detachment can be treated with pneumatic retinopexy, a procedure performed in the office, or surgery using a band (Scleral buckle) around the eye or vitrectomy. The choice of treatment depends on the severity and type of detachment.




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