Age-Related Macular Degeneration

Your macula is the central part of the retina and is devoted to your fine central vision. Age-Related Macular Degeneration (AMD) damages the macula, causing blurry central vision, wavy lines and distortion. It is the leading cause of severe vision loss in the elderly Caucasian population in the United States.

There are two forms of AMD - a "dry" form and a "wet" form. Most people have the "dry" form of AMD. This form causes a gradual decline in central vision and worsening distortion. There is no pain. The treatments for this form may include using vitamin supplements that are available over the counter. These vitamins, known as AREDS, should be taken under the close supervision of your eye care specialists. Additionally, controlling your cholesterol and blood pressure levels, and not smoking are recommended. Routinely checking your each eye with an Amsler Grid can also help you pick up changes in between your follow up visits.

The "wet" form of AMD can occur at any time in either eye. This form causes a very sudden, rapid and severe loss of central vision. Abnormal blood vessels grow into your macula, causing bleeding and swelling. The damage to your macula can cause permanent loss of central vision. Fortunately, "wet" AMD can now be treated. In the past, lasers were used to treat "wet" AMD. However, these laser treatments have now been replaced by more effective therapies that include medicines that are repeatedly injected directly into the eye. Each injection treatment may indeed sound quite frightening and painful. In reality, the treatments are not as bad as one would think. The thought of the injection and the anticipation are usually worse than the actual procedure. There are several medicines that can be administered into the eye. Your retina specialist will discuss with you the one most appropriate for you. With the injections, continued loss of vision can be halted, thereby maintaining your vision. A good percentage of people do enjoy an improvement in vision as well.

Diabetic Retinopathy

Diabetic retinopathy (DR) is the diabetic-related disease that damages your retina, causing permanent loss of vision. DR is the leading cause of vision loss across all age groups in the United States. The longer you have diabetes mellitus, either type I or type II, the higher the chances you’ll have some form of diabetic retinopathy.

Diabetic retinopathy causes damage to your retina in several ways. It can cause Diabetic Macular Edema (DME), or swelling in your macula. Your macula is the part of your retina devoted to your central vision. You do not feel this swelling; rather, it causes blurry vision. The damage leads to leakage of fluid and lipids, and this leads to painless vision loss. DME can be treated with a light laser treatment to your macula, or by medicines that are administered by injection into the affected eye, similar to the treatments for “wet” age-related macular degeneration. Sometimes, your retina specialist may use a combination of treatments.

Diabetic retinopathy can also cause a vitreous hemorrhage, or a bleed into the middle part of the eye. This can cause a painless loss of vision, associated with lots of floaters and cobwebs in your vision. This hemorrhage develops when abnormal blood vessels develop in your eye in response to severe damage to your retina (Proliferative Diabetic Retinopathy). This is treated with a different laser and can also be helped by medicines that are administered by injection into the affected eye. In some cases, surgery is necessary to clear the blood and stabilize the eye.

The best way to manage diabetic retinopathy is to control your blood sugars, cholesterol and lipid levels and your blood pressure. This should be done in conjunction with your primary care physician or your endocrinologist. Additionally, close monitoring by your retina specialist allows early changes to be detected, and thus early treatments can be initiated.

Retinal Vein Occlusion

Your retina has arteries and veins that transport blood and oxygen. Your veins can be occluded, or blocked, leading to painless vision loss. Depending on which veins are blocked, your vision loss may be mild to severe. When there is blockage of the retinal vein, the retina suffers hemorrhaging, and can develop macular edema (swelling in the central vision area). By treating the macular edema, your vision may stabilize and possibly improve. The treatment involves laser treatments and / or medicines that are administered by injection into the affected eye, similar to the treatments for “wet” age-related macular degeneration. Your retina specialist can determine which treatment is best for you.

Flashes and Floaters

Flashes and floaters are a very common complaint in the eye. If you think of your eye as a camera, the retina is analogous to the Kodak film. The retina lines the inside wall of the eye, like wallpaper. There is vitreous gel in front of the retina that can undergo aging changes that may cause flashes and floaters. Most of the time, these flashes and floaters are harmless and can be followed. However, sometimes, these flashes and floaters are associated with a retinal tear, or a retinal detachment. These are potentially blinding problems and need prompt treatments. For this reason, flashes and floaters need to be promptly evaluated by an eye care specialist.

Retinal Tears

Retinal tears can result from aging changes in the vitreous gel. They can present without any symptoms, or with flashes and floaters (See Flashes and Floaters). These tears need to be evaluated by a retina specialist and usually need laser treatment or cryotherapy (freezing) treatment. If left untreated, they may progress to a retinal detachment and permanent blindness.

Retinal Detachment

Retinal detachments can occur at any time, at any age. Most of these detachments occur spontaneously, without any inciting event. Retinal detachments inevitably proceed to blindness without treatment. They can present without any symptoms, with flashes or floaters (See Flashes and Floaters) or with a dark shadow that starts in your peripheral vision and slowly advances to the center part of your vision. Retinal detachments need surgical repair by a retina specialist. The procedures include pneumatic retinopexy, vitrectomy, scleral buckle, or a combination.

A pneumatic retinopexy is performed in the office. A gas bubble is injected into the eye to flatten out your retina. Cryotherapy (freezing) treatment or laser treatment is also used to keep the retina attached. You may have to position your head in a certain position after the procedure.

A vitrectomy is performed in the operating room. The vitreous gel is removed and your retina is reattached. After the surgery, a gas bubble is left in your eye to push on the retina while it heals. You may have to position your head in a certain way (face down, on one side, etc.) for a week or so after surgery.

A scleral buckle is performed in the operating room. A silicone plastic band that acts like a belt is placed around the wall of the eye and tightened, to provide your retina some support. Then, Cryotherapy (freezing) treatment is used to keep the retina attached.

Your retinal specialist will determine which procedure is most appropriate for your retinal detachment.

Macular Hole

A macular hole can develop in your macula, the central part of your retina devoted to your central vision. This usually occurs spontaneously, though sometimes can occur after significant trauma. The macular hole can cause painless loss of central vision. Patients usually complain of a blurry circle in their central vision or severe distortion. Macular holes can be fixed with a vitrectomy, a surgery that is performed by a retina specialist in the operating room. During the surgery, a gas bubble will be injected into the eye. After the surgery, you will have to maintain a face down position for approximately 1 week. This includes sleeping on your stomach. This surgery can lead to a gradual improvement in central vision.

Macular Pucker or Epiretinal Membrane

A macular pucker, or epiretinal membrane, is a piece of scar tissue that forms on the surface of your macula, the central part of the retina devoted to your central vision. This usually occurs spontaneously with age, though it may be related to diabetes or intraocular inflammation. The macular pucker can cause painless loss of central vision. Patients usually complain of a blurry spot in their central vision or distortion or wavy lines. Macular puckers can be fixed with a vitrectomy, a surgery that is performed by a retina specialist in the operating room. Surgical intervention may lead to a gradual improvement in central vision and a decrease in distortion.