Your Eye Health

What are vitreo-retinal diseases?
What are the macula and the fovea?
What is diabetic retinopathy?
What is the macula?
What are retinal detachments and retinal tears?
What is uveitis?
What are flashes and floaters?

At Wagner Macula & Retina Center, we want all of our patients as well as those who simply want information about diseases of the eye to have it readily available.  That is the purpose of this page.  Consult a qualified ophthalmologist however for a complete diagnosis of any medical issues affecting you or a loved one.

What are vitreo-retinal diseases?
Because the vitreous and retina lie on the back part of the eye, certain conditions can develop that are difficult to observe. They include retinal detachments or tears, eye cancer, macular holes, diabetic retinopathy, macular degeneration, retinoblastoma, uveitis, flashes and floaters and retinitis pigmentosa.
What are the retina and vitreous?

The retina forms the interior lining of the eye and contains millions of light-sensitive nerve endings. Light enters the eye though the cornea, then passes through the pupil, lens and vitreous. The retina receives the light and transmits nerve impulses through the optic nerve to the brain, where a visual image is created.

A clear, gel-like substance, vitreous fills the cavity between the lens and the retina and supports the shape of the eye to enable vision. 

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What are the macula and the fovea?
At the center of the retina is the macula, which provides central vision. The cones, which are part of the macula, allow us to see in bright light, to distinguish color, and to discern fine detail in reading. The rods, also part of the macula, are more sensitive to dim light and allow for night vision. They do not distinguish either color or fine detail very well. 

In the center of the macula is the fovea, an area smaller than a pinpoint and composed entirely of cones.

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What is diabetic retinopathy?
Diabetic retinopathy is the leading cause of blindness in young and middle-aged adults.  There are two types of diabetic retinopathy:

• non-proliferative diabetic retinopathy (NPDR)
• proliferative diabetic retinopathy (PDR)

NPDR, also known as background retinopathy, is an early stage and occurs when the tiny blood vessels of the retina are damaged and begin to bleed or leak fluid into the retina.  Swelling results, and deposits known as exudates form.  Many people with diabetes develop mild NPDR often without any symptoms.
PDR occurs when blood vessels on the retina or optic nerve become blocked, starving the retina of necessary nutrients. In response, the retina grows more blood vessels but they are abnormal and cannot restore normal blood flow to the retina.
PDR may lead to:

1. Vitreous hemorrhage - proliferating retinal blood vessels grow into the vitreous cavity and break down. Both the hemorrhaging and resultant scar tissue may interfere with vision.
2. Traditional retinal detachment - scar tissue in the vitreous and on the retina cause the retina to detach.
3. Tractional and rhegmatogenous retinal detachment - scar tissue creates a hole or tear in the retina causing it to detach.
4. Neovascular glaucoma - abnormal blood vessel growth on the iris blocks the flow of fluid out of the eye causing the pressure to increase and damaging the optic nerve.

What are the symptoms of diabetic retinopathy?
For those who fear they have NPDR, the best way to detect problems inside the eye before there is loss of vision is through a dilated eye exam. People with diabetes should have an eye examination at least once a year. More frequent exams may be necessary after diabetic retinopathy is diagnosed.
Symptoms of PDR include:

• floaters
• loss of central or peripheral vision
• visual distortions or blurriness
• visual distortions or blurriness
• loss of central or peripheral vision
  

How is diabetic retinopathy diagnosed?
The physician dilates the pupil and then looks inside the eye through an ophthalmoscope. He may also conduct a test called fluorescein angiography, during which a dye is injected into the arm and then throughout the blood system. Once the dye reaches the blood vessels of the retina, a photograph is taken of the eye and the ophthalmologist can then detect damaged blood vessels.

Can diabetic retinopathy be prevented?
Strict control of blood sugar levels will significantly reduce the long-term loss of vision from retinopathy. With improved diagnosis and treatment, only a small percentage of people with retinopathy develop serious vision problems.

What are treatment options for a person with diabetic retinopathy?
Some cardiologists utilize intraocular corticosteroids, which are injected into the vitreous cavity using topical (drops) anesthesia. This may reduce retinal swelling and improve visual acuity in some patients for up to six months after treatment. Other clinical trials that rely on corticosteroids include a sustained-release device surgically implanted inside the eye that permits constant release of the drug.

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What is the macula?
The macula is an oval area in the retina on the back of the eye. It is responsible for the central (or reading) vision. When the eye is directed at an object, the part of the image that is focused on the fovea or center of the macula is the image most accurately seen.



What is macular degeneration?
Dry macular degeneration (atrophic AMD) progresses slowly and most people usually maintain some central vision in at least one eye. The progress of this disease, the most common form, can be retarded with vitamin supplementation. Green leafy vegetables may be beneficial.  Patients with AMD should avoid smoking.

"Wet" macular degeneration (exudative or neovascular AMD) is caused by blood vessels growing under the retina in the macula. If not treated, scar tissue forms under the macula and central vision is lost.

The most common symptom of dry AMD is slightly blurred or fuzzy vision requiring more light to see detail as well as a loss of ability to see faces at a distance. Over time, a blurred spot forms in the center of sight.  Also, an inability to recognize faces at a distance may develop.

How is macular degeneration diagnosed?
Options include:

• performing a visual acuity test to measure vision at a distance
• dilating the pupil to see the inside of the eye with an ophthalmoscope to check for deposits on the retina, often an early sign of AMD.
• performing a fluorescein angiography (see above under diabetic retinopathy for description of test)

What is a macular hole?
Over time, the vitreous gel in the eye shrinks and pulls away from the retina. In some cases, this can result in the formation of a macular hole. Fluid may leak under the edges, causing a small retinal detachment and subsequent blurring and vision distortion.
An ophthalmologist who suspects a macular hole may perform the same tests as he would for macular degeneration.

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What are retinal detachments and retinal tears?
A detachment occurs when the retina is lifted or pulled from its normal position. A retinal tear occurs when the vitreous shrinks, pulling a tear, or rip, in the retina. Although most tears have little effect on vision, they can lead to an accumulation of fluid under the retina, which results in retinal detachment and sight loss.

Retinal detachment is usually accompanied by a dramatic loss of vision.   Some people see flashes of light, floaters or the appearance of a dark or gray curtain moving across the field of vision.   Although these symptoms do not always mean there has been a detachment, it’s wise to consult an ophthalmologist immediately.  He will diagnose a detachment or tear using a dilated pupil examination.

What is the treatment for retinal detachments and tears?
Surgery is the most frequent treatment for detachments.  Most retinal tears are treated with cryo-therapy (use of a freezing probe) or laser therapy.  The key to restoring vision is early treatment, although some detachments are often beyond repair.


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What is uveitis?
Uveitis is an inflammation of the uvea, the layer of the eye that lies between the retina and the sclera. Since the uvea borders many important parts of the eye, inflammation may be sight threatening.

Uveitis may develop following eye surgery or trauma. It may result from a virus, a fungus, or a parasite or as a result of an injury to the eye.
Symptoms can include pain, blurred vision, redness, floaters or sensitivity to light.

What is the treatment for uveitis?
Ophthalmologists most often treat uveitis with eyedrops, injections or oral medication.

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What are flashes and floaters?
Flashes are a brief sense of light in the field of vision. Floaters are optical debris that are perceived as small spots or circles. Some sufferers report a sudden decrease of vision

accompanied by floaters and flashes.

In most cases, surgery is not recommended and the patient learns to ignore flashes and floaters although more serious cases can require a procedure called vitrectomy.