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Retina

Posterior Vitreous Detachment “Floater”

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A Posterior Vitreous Detachment (PVD) is a condition in which the vitreous gel (gel that fills the cavity of the eye) liquefies and separates from the retina (the inside layer of back of the eye).

Causes and Risk Factors

The vitreous is thicker where it attaches to the optic nerve. When the vitreous separates, this thickening, along with other opacities, will float in the center of the eye. When light enters the eye, these opacities cast a shadow on the retina. These are “floaters” and will usually be more obvious in brighter light. As the vitreous peels from the retina, it may stimulate the retina causing flashing lights. Rarely, it may pull a piece of retina with it, causing a retinal hole or tear. This may lead to a retinal detachment. This is usually a sudden event, but may also occur slowly over months.

Increasing age and nearsightedness play a role in determining the onset of posterior vitreous detachment. Broadly speaking, the condition is common for older adults and over 75% of those over the age of 65 develop it.

Posterior vitreous detachment does not directly threaten vision and most of the time is benign. Occasionally, a PVD may cause a membrane to form on the retina (epiretinal membrane), which may affect vision to varying degrees.

PVD may also occur with trauma or around the time of cataract surgery (within weeks or months of the surgery).

Symptoms

When a Posterior Vitreous Detachment occurs there is a characteristic pattern of symptoms:
  • Flashes of light (photopsia)
  • A sudden dramatic increase in the number of floaters
  • A ring of floaters, “cobwebs” or “hairs” in the central vision
The flashes usually subside in the first few weeks. Sometimes, an occasional flash, especially when going from light to dark, may persist for a while, but will almost always resolve completely. The floaters will always be present, but, with time become a non-issue, showing up occasionally, especially in brighter light.

Treatment

A dilated exam is recommended at the time of new symptoms of flashes and/or floaters. Therapy is not required or indicated for posterior vitreous detachment, unless there are associated retinal tears and/or detachment which need to be repaired.

Epiretinal Membrane or “Macular Pucker”

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Epiretinal membrane, is the technical name for “macular pucker or wrinkle.” The macula is the portion of the retina responsible for central, straight-ahead vision. Sometimes, a membrane resembling scar tissue grows on the macula. This membrane shrinks and contracts (puckers) the retina, distorting and/or reducing central vision.

Some causes of this condition include previous retinal surgery, retinal detachment, a blockage of a blood vessel in the eye, vitreous detachment, or ocular inflammation.

A macular pucker can sometimes be treated with membrane peeling surgery. If your condition progresses to the point that this type of procedure is required, we would refer you to a retinal surgeon.

Retinal Detachment

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When light enters the eye and makes its way to the retina that lines its back interior, it passes through a gel-like substance (sometimes called “vitreous” or “vitreous gel”) that fills the center of the eye. Sometimes this vitreous gel shrinks and pulls away from the retina, causing a posterior retinal detachment (“PVD”). PVD is not necessarily an emergency. However, the tugging that occurs as the vitreous gel pulls away sometimes causes the retina to tear or detach from the inside. The tear may allow vitreous gel to move behind the retina and interfere with its access to the blood and oxygen it needs to function properly. Permanent loss of vision may result unless the retina is reattached promptly.

Common Symptoms of Retinal Detachment: Floaters & Flashes

Vitreous gel often develops clumps that are perceived as dark spots, specks, or string-like shapes that float across the visual field. These “floaters” are most often the normal result of the gel aging and breaking down and are not necessarily an indication that there is a problem, but they can be caused by blood or other debris released into the vitreous when the retina is torn.

Brief flashes or sparks of light that appear suddenly at the edge of the visual field can be a sign that the retina is becoming detached.

Floaters and flashes are often the first signs of the risk of retinal detachment. However, a detachment can take place without warning.

Don’t ignore these symptoms!
 
Call our office immediately if you experience:
  • More floaters than usual, particularly if you notice the sudden appearance of many small dark dots
  • Brief flashes or sparks of light at the edge of your vision
  • A shadow (sometimes described as a “curtain”) across a portion of your vision that does not go away
  • Any new, sudden loss of a portion of your vision
Macular Degeneration

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The inside layer of the back of the eye is called the retina. The retina is like the film of a camera. The central 10% of the retina is called the macula. The macula is responsible for sharp, central vision required for “straight ahead” vision activities, such as driving, reading, recognizing faces, and performing close up work.

Age Related Macular Degeneration (AMD) is a deterioration or breakdown of the macula and is one of the most common causes of poor vision in people over age 60. The visual symptoms of AMD involve the loss of central vision (reading, recognizing faces, etc.), while peripheral vision is unaffected. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors.

While AMD is one disease, it may be categorized into two forms.

“Dry” AMD

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The most common form of AMD is the dry form (called atrophic or non-exudative). Dry AMD is associated with thinning and slow deterioration of the retinal cells in the macula. It is usually slowly progressive and may take many years to develop. You may hear terms like drusen (white or yellow deposits), retinal pigment epithelial changes, and atrophy. These terms describe the appearance of the macula in dry AMD.

Some factors involved in the degenerative process of the macula, such as our gender and genetics, are beyond our control. However, clinical studies have shown that the effect of one important factor, free radicals, can be reduced to some extent.

Every day, our eyes are exposed to blue light waves that generate “free radicals” that can damage DNA and the light-sensing structures of the eye’s retina. Vitamins E and C, minerals zinc, copper, and selenium, and plant pigments lutein and zeaxanthin appear to have some protective value. Lutein and zeaxanthin, in particular, have been shown to be effective in reducing the effects of free radicals by helping the macula to filter out blue light.

Egg yolks and dark green, leafy vegetables such as spinach are rich in these minerals. Taking a nutritional supplement that contains these vitamins, minerals, and pigments can make it easier to include the proper amounts in your everyday diet. Use common sense and consult your physician before adding nutritional supplement to your diet, particularly if you are pregnant, breastfeeding, have a medical condition, or are taking a conflicting medications. Be aware that the concentration of zinc in these supplements has been shown to be effective in protecting eye health but may not be appropriate for everyone.

Steps to take:
  • Ensure proper diet and nutritional supplement
  • Protect your eyes from sunlight (sunglasses, hat, etc.)
  • Don’t smoke
  • If diagnosed with macular degeneration, monitor your vision with an Amsler grid.

Directions for Use of Amsler Grid

img_amslergrid

Click here to download the Amsler Grid

1. With your reading glasses on, test ONE eye at a time while holding grid at normal reading distance.
2. Look at the dot in the center of the page for three seconds with each eye.
3. All the lines should be straight.
4. If the lines become wavy, or if part of the grid is missing, notify our office immediately.
5. Test each eye for three seconds, once per week.

“Wet” AMD

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The wet form of AMD (called exudative) is much less common, but can produce rapid visual distortion and loss, and can be much more serious. This is not a separate condition, but is a complication of dry AMD. All patients with dry AMD should be monitored for the development of the wet form.

In this condition, abnormal blood vessels may grow into the macula from a layer beneath the retina, leaking fluid and blood, creating distortion or a large blind spot in the center of your vision.

Treatment of “Wet” AMD

If the blood vessels are not growing beneath the center of the macula, laser treatment is sometimes effective. In many cases, the location of the blood vessels make laser treatment unsafe. In these cases, treatment with anti-VEGF (vascular endothelial growth factor) intravitreal injections may be appropriate. These injections have shown a significant benefit in the treatment of wet AMD.

Low-vision high intensity reading lamps, magnifiers, iPads or other readers, and other low-vision aids help people with AMD make the most of limited vision. Also, consider large print reading materials and books on tape.

Diabetic Retinopathy

Diabetes affects blood vessels throughout the body, particularly in the kidneys and the eyes. Diabetic retinopathy is the name we give to adverse effects of diabetes on the blood vessels in the eye. In the United States, diabetic retinopathy is the leading cause of blindness among adults.

Risk of developing diabetic retinopathy increases over time. An adult who has had diabetes for 15 years or longer has an 80% chance of experiencing damage to retinal blood vessels.

When diabetes affects the ocular blood vessels, they may develop leaks or contribute to the formation of scar tissue; these problems reduce the retina’s ability to detect and transmit images.

There are two main types of diabetic retinopathy: background (BDR) and proliferative (PDR). Treatment is available for both types.

There are many diagnostic tools that are used to diagnose diabetic retinopathy including OCT imaging, fluorescein angiography, and fundus photography. Various treatment options are available including intravitreal injections targeting leaky blood vessels and panretinal as well as focal laser treatment.