Retina

A retinal tear occurs when a gel-like clear substance in the center of the eye shrinks and tugs on the retina to cause a break in the tissue. When a crack develops in this thin tissue, it’s known as a tear. Retinal tears occur spontaneously in most cases, prior eye surgery or trauma, can also cause retinal tears.

Symptoms

• Black spots or ‘floaters’ in the vision field
• Photopsia(flashes of light) in one or both eyes
• Blurred vision
• Gradually decreased peripheral (side) vision
• A curtain-like shadow over the visual field

Treatment

• Laser surgery (photocoagulation)

The surgeon directs a laser beam into the eye through the pupil. The laser makes burns around the retinal tear, creating scarring that usually “welds” the retina to underlying tissue.

• Freezing (Cryopexy)

After giving you a local anesthetic to numb your eye, the surgeon applies a freezing probe to the outer surface of the eye directly over the tear. The freezing causes a scar that helps secure the retina to the eye wall.

Most retinal surgery is performed while you are awake. Retinal surgery is usually painless and performed while you remain awake and comfortable. Advances in technology have decreased the length of surgery making outpatient eye surgery possible. After your procedure, you’ll likely be advised to avoid activities that might jar the eyes — such as running — for a couple of weeks or so.

A retina detached from its place can cause the fluid inside the eye to leak underneath and separate the retina from its underlying tissue. This condition is known as retinal detachment. The ophthalmologist will suggest what procedure is best for you after diagnosing the retina. The type of surgery your surgeon recommends will depend on several factors, including how severe the detachment is.

Symptoms

Retinal detachment takes place without warning, and it does not hurt the patient. Due to this, the patient is not able to detect, although there are a few symptoms that a patient would be able to notice.

• Flashes of light
• Floaters (small flecks or threads in vision)
• Darkness or a “curtain” over vision, including the middle or the sides

Treatment

• Laser surgery (photocoagulation)

The surgeon directs a laser beam into the eye through the pupil. The laser makes burns around the retinal tear, creating scarring that usually “welds” the retina to underlying tissue.

• Freezing (Cryopexy)

After giving you a local anesthetic to numb your eye, the surgeon applies a freezing probe to the outer surface of the eye directly over the tear. The freezing causes a scar that helps secure the retina to the eye wall.

• Pneumatic Retinopexy

The surgeon injects a bubble of air or gas into the center part of the eye (the vitreous cavity). If positioned properly, the bubble pushes the area of the retina containing the hole or holes against the wall of the eye, stopping the flow of fluid into the space behind the retina. Your doctor also uses cryopexy during the procedure to repair the retinal break.

Fluid that had collected under the retina is absorbed by itself, and the retina can then adhere to the wall of your eye. You may need to hold your head in a certain position for up to several days to keep the bubble in the proper position. The bubble eventually will reabsorb on its own.

• Vitrectomy surgery

The surgeon removes the vitreous along with any tissue that is tugging on the retina. Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina. Eventually the air, gas or liquid will be absorbed, and the vitreous space will refill with body fluid. If silicone oil was used, it may be surgically removed months later.

Vitrectomy may be combined with a scleral buckling procedure.

• Scleral Buckle

Scleral buckling, involves the surgeon sewing (suturing) a piece of silicone material to the white of your eye (sclera) over the affected area. This procedure indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina.

If you have several tears or holes or an extensive detachment, your surgeon may create a scleral buckle that encircles your entire eye like a belt. The buckle is placed in a way that doesn’t block your vision, and it usually remains in place permanently.

• Internal limiting membrane – ILM Peel

Internal limiting membrane peeling has been used to treat a variety of retinal pathologies, including full-thickness macular hole, epiretinal membrane, macular edema, vitreomacular traction syndrome, and Terson syndrome, among others.

ILM peeling begins with vitrectomy and posterior hyaloid removal. Following these steps, adjuvant dyes are used to stain the translucent ILM to improve visualization and ensure complete removal in a technique called chromovitrectomy. Following dye injection, the ILM is grasped directly with forceps or a flap of the ILM is created and vitreoretinal forceps are used to grasp the flap. Pulling with the forceps in a circular motion parallel to the retinal surface, the ILM flap is extended, peeled from the retinal surface, and removed.

Diabetic retinopathy is a type of complication that affects the eye. This condition takes place when the damage done to the blood vessels of the retina causes them to swell. Due to this, the vision may become distorted or blur. Patients diagnosed with diabetic retinopathy may not notice any symptoms except for mild vision problems.

Worldwide, one-third of the estimated 285 million people with diabetes show signs of diabetic retinopathy.

Symptoms

Diabetic retinopathy typically presents no symptoms during the early stages. Signs and symptoms of diabetic retinopathy may include:

• Blurred vision
• Impairment of color vision
• Floaters, or transparent and colorless spots and dark strings that float in the patient’s field of vision
• Poor night vision
• Sudden and total loss of vision (blindness)

Causes and risk factors

Anybody with diabetes is at risk of developing diabetic retinopathy. However, there is a greater risk if the person:

• Does not correctly control blood sugar levels
• Experiences high blood pressure
• High cholesterol
• Pregnant
• Smoker
• Diabetic

Treatments

• Injections of anti-VEGF drugs

Your ophthalmologist may treat your wet AMD or other disease of the retina with a drug called anti-VEGF. Anti-VEGF treatment improves vision in about one third (1 out of 3) people who take it. For a vast majority (9 out of 10), it at least stabilizes vision.

Vascular endothelial growth factor is a protein produced by cells in your body. VEGF produces new blood vessels when your body needs them.

• Laser surgery (photocoagulation)

The surgeon directs a laser beam into the eye through the pupil. The laser makes burns around the retinal tear, creating scarring that usually “welds” the retina to underlying tissue.

• Vitrectomy surgery

The surgeon removes the vitreous along with any tissue that is tugging on the retina. Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina. Eventually the air, gas or liquid will be absorbed, and the vitreous space will refill with body fluid. If silicone oil was used, it may be surgically removed months later.

Vitrectomy may be combined with a scleral buckling procedure.

The only way people with diabetes can prevent Diabetic retinopathy is to attend every eye examination scheduled by their doctor. At Hashmanis, we highly recommend to get your OCT test done for early diagnose before visiting the consultant.

An epiretinal membrane is a condition where a very thin layer of scar tissue forms on the surface of the retina in an area that is responsible for our sharpest vision. The part of the eye affected by an epiretinal membrane is called the macula. In this, the membrane distorts one’s vision by pulling up on the retina.

Epiretinal membranes (ERMs) most often occur in people over age 50. According to The American Society of Retina Specialists (ASRS), at least 2 percent of people over 50 years old and 20 percent over age 75 have ERMs, but most do not need treatment.

Up to 20 percent of people with ERMS have them in both eyes, but symptoms and severity for each eye differ.

Symptoms

ERMs are severe when they affect the central part of the retina responsible for seeing fine details, for example, when reading or recognizing faces.

In the severest cases, vision is blurred and distorted, similarly to a distorted view through an unadjusted pair of binoculars.

Straight lines, such as those from a doorway, might appear wavy to someone with an ERM. ERM vision loss starts out unnoticeable and becomes increasingly severe.

A person should report any of the following symptoms to their doctor or an eye specialist:

Decreased vision or loss of central vision. Central vision allows the eyes to see ahead to read or drive or see fine details.

• Distorted or blurred vision.
• Double vision.
• Wavy vision.
• Problems reading small print.

Treatment

• Vitrectomy surgery

The surgeon removes the vitreous along with any tissue that is tugging on the retina. Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina. Eventually the air, gas or liquid will be absorbed, and the vitreous space will refill with body fluid. If silicone oil was used, it may be surgically removed months later.

Vitrectomy may be combined with a scleral buckling procedure.

The macula is in the center of the retina responsible for the sharp vision for reading, driving, and for looking at fine details. A small defect found in the center of the retina is known as a macular hole, which affects the vision to be blurry or distorted.

Symptoms

• Distorted or blurred vision
• Wavy vision

Treatment

Some macular holes can repair themselves over time. However, in most cases, a doctor will recommend a surgical procedure called a vitrectomy.

• Vitrectomy surgery

The surgeon removes the vitreous along with any tissue that is tugging on the retina. Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina. Eventually the air, gas or liquid will be absorbed, and the vitreous space will refill with body fluid. If silicone oil was used, it may be surgically removed months later.

Vitrectomy may be combined with a scleral buckling procedure.

Age-related macular degeneration (AMD) is an eye condition that causes permanent vision loss in people aged over 60. In this condition, the macula situated in the center of the retina begins to deteriorate. Symptoms in AMD have blurred central vision or a blind spot in the center of the visual field. There are two types of macular degeneration

• Wet macular degeneration

Blood vessels grow from underneath your macula. These blood vessels leak blood and fluid into your retina. Your vision is distorted so that straight lines look wavy. You may also have blind spots and loss of central vision. These blood vessels and their bleeding eventually form a scar, leading to permanent loss of central vision.

• Dry macular degeneration.

People with this may have yellow deposits, called drusen, in their macula. A few small drusen may not cause changes in your vision. But as they get bigger and more numerous, they might dim or distort your vision, especially when you read. As the condition gets worse, the light-sensitive cells in your macula get thinner and eventually die. In the atrophic form, you may have blind spots in the center of your vision. As that gets worse, you might lose central vision.

Most people with macular degeneration have the dry form, but the dry form can lead to the wet form. Only about 10% of people with macular degeneration get the wet form.

Symptoms

Early on, you might not have any noticeable signs of macular degeneration. It might not be diagnosed until it gets worse or affects both eyes.

Symptoms of macular degeneration may include:

• Worse or less clear vision. Your vision might be blurry, and it may be hard to read fine print or drive.
• Dark, blurry areas in the center of your vision
• Rarely, worse or different color perception

If you have any of these symptoms, go to an eye doctor as soon as possible.

Treatments

• Anti-angiogenic drugs

These medications -aflibercept (Eylea), bevacizumab (Avastin), pegaptanib (Macugen), and ranibizumab (Lucentis) — block the creation of blood vessels and leaking from the vessels in your eye that cause wet macular degeneration. Many people who’ve taken these drugs got back vision that was lost. You might need to have this treatment multiple times.

• Laser surgery (photocoagulation)

The surgeon directs a laser beam into the eye through the pupil. The laser makes burns around the retinal tear, creating scarring that usually “welds” the retina to underlying tissue.

Retinitis pigmentosa is a term for a group of eye conditions that all cause an unusual coloring that your doctor can see when he looks at your retina, the tissue at the back of your eye. The cells in the retina don’t work the way they’re supposed to, and over time, you lose your sight.

Symptoms

• Difficulty in reading or seeing details in the dark
• Difficulty in looking at central visionor side (peripheral) vision.
• Hard time figuring out detailed images
• Extra sensitivity to glare

Treatments

• Retinal implant

A retinal implant, an electronic device a surgeon puts in and around your eye, paired with special glasses allows some people with late-stage retinitis pigmentosa to read large letters and get around without a cane or guide dog.