What is Diabetic Retinopathy?
Diabetic retinopathy is a potentially blinding complication of diabetes affecting over half of Americans diagnosed with the disease. As a result of the body’s inability to use and store sugars, the tiny blood vessels that nourish the retina are affected. Damage to the retina, the light sensitive tissue lining the back portion of the eye that transmits visual images to the brain, can result in severe loss of vision and ultimately blindness. Diabetes is the leading cause of blindness in people under the age of 65. A diabetic is 10-15 times more apt to go blind than a nondiabetic.
What Causes Diabetic Retinopathy?
Fluctuation in blood sugar levels in diabetic patients leads to an increased risk in diabetic retinopathy. In the early stages, vessels in the retina swell and begin to leak into surrounding tissue. Vision is rarely affected during this stage. In the more advanced stages, new blood vessels begin to grow on the retina. These abnormal blood vessels cause blurred vision, resulting in the formation of scar tissue which can lead to permanent vision loss.
What are the Symptoms?
Symptoms range from none at all in the early stages, to blurry or fluctuating vision affecting both side and central vision. Spots, which are small specks of blood, often appear in your vision. As the leakage progresses, vision becomes cloudy and blind spots can occur. If left untreated, diabetic retinopathy can cause blindness.
How is Diabetic Retinopathy Diagnosed?
Diabetic retinopathy can be detected during a comprehensive eye examination during which your eye doctor
examines the health of your retina using specialized instruments and lenses. Once detected, your doctor may recommend additional testing to assess the progression of the disease and determine treatment. Individuals who have been diagnosed with diabetes or have a family history of the disease should have their eyes examined on a regular basis to prevent loss of vision.
What are the Treatment Options?
There are two very effective treatment options for patients diagnosed with diabetic retinopathy: laser therapy and vitrectomy surgery. Treatment with the laser, known as photocoagulation, seals leaking blood vessels and removes new growth. The vitrectomy procedure removes the cloudy vitreous replacing it with a saline solution.
Although these surgical modalities do not cure diabetic retinopathy, if treatment is performed before the retina is severely damaged, patients have a 90 percent chance of maintaining their vision. Early detection and management is important because once damage has occurred, the effects are usually permanent.
Long-term, uncontrolled diabetes can cause progressive damage to the eye’s retina, resulting in vision loss.
In its early stages, diabetic retinopathy is painless and often produces no symptoms. If this non-proliferative or background retinopathy leads to macular edema, you may notice a gradual blurring of your vision. Reading and other close work may become more difficult.
If the abnormal blood vessels bleed, vision may become spotty, hazy or disappear completely.
But because diabetic retinopathy often causes no symptoms, even in advanced cases, it is very important to have a yearly dilated eye exam.
The disease can be treated and vision loss prevent, if diagnosed early enough.
To better see inside the eye, we may dilate (widen) your pupil with eye drops. Your eyes will be more sensitive to light for a brief time after a dilated eye exam, so bring sunglasses to your exam or have someone drive you home.
Age-Related Macular Degeneration
What is Age-Related Macular Degeneration?
Age-Related Macular Degeneration (AMD) is a common eye disease that affects a tiny area in the center of the retina known as the macula. The macula is made up of millions of light-sensing cells that help to produce sharp central vision. AMD breaks down these cells gradually destroying central vision.
It is estimated that over 13 million Americans over the age of 40 show early signs of AMD, and it is the leading cause of legal blindness and vision impairment in the senior population.
AMD occurs in two forms – wet and dry – with women being at a higher risk for developing one type than men. Smokers, people with light colored eyes, and individuals with a family history of AMD are also at risk for developing this condition.
Dry AMD – 90 percent of individuals diagnosed with AMD have the dry form. Light sensitive cells in the macula slowly break down, affecting central vision over time. Dry AMD often occurs in just one eye at first, and doctors have no way of knowing when or if both eyes will be affected.
Wet AMD – Although only ten percent of all people with AMD have this type, it accounts for 90 percent of all blindness. New blood vessels behind the retina begin to grow toward the macula. These vessels are very fragile and often leak blood and fluid under the macula, rapidly causing the damage that leads to loss of central vision.
What Causes AMD?
Both genetic predisposition and environmental insults are responsible for development of AMD. We know that smoking makes it worse and exposure to UV radiation may also play a role in some patients; therefore we encourage patients to stop smoking and to wear UV blocking sunglasses
What are the Symptoms?
The most common symptoms of dry AMD are slightly blurred vision. As the disease progresses, a blurred spot forms in the center of your vision gradually becoming larger and darker, reducing central vision. Straight lines that appear wavy are an early sign of wet AMD. This is often followed by rapid loss of central vision. As in AMD, you may also notice a blind spot. Neither dry nor wet AMD causes any pain.
How is AMD Diagnosed?
AMD is detected during a comprehensive eye examination during which your doctor will examine the health of your retina. Once detected, your doctor may recommend additional testing to assess the type and progression of the disease to determine treatment.
What are the Treatment Options?
Currently, there is no treatment for dry AMD, but this does not mean you will lose your vision. Dry AMD develops very slowly over many years and most people are able to lead normal, active lives, especially if the disease affects only one eye. Wet AMD is treated with intraocular injections of anti-VEGF, a chemical mediator that helps to "dry up" the leaking blood vessels.
Macular degeneration is the physical disturbance of the center of the retina known as the macula. The macula is the part of the retina which enables acute and detailed vision. The macula is used for reading, driving, recognizing faces and watching television. Macular degeneration is the leading cause of legal blindness in people over age 55. Surgery to remove the scar produced by macular degeneration has been successful in younger patients but less successful in older patients.
What is a Retinal Detachment?
The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual images through the optic nerve to the brain. A detached retina occurs when this layer of tissue is lifted or pulled away from its underlying support. The retina cannot properly function when these layers detach and if not promptly treated, permanent vision loss may occur. Individuals with certain eye conditions such as extreme myopia, diabetes and sickle cell anemia have an increased risk for retinal detachment.
What Causes a Retinal Detachment?
There are several causes of retinal detachment. In some cases, tissue detachment occurs as a result of increased pressure in the eye during surgery. Fluid movement or new vessels growing under the retina, as in the case of diabetic retinopathy, can push the retina away from its supporting network of tissue. Small, torn areas called retinal tears or retinal breaks can lead to detachment. Injuries or a sudden blow to the head can also cause the retina tissue to detach.
What are the Symptoms?
Common symptoms include a sudden or gradual increase in the number of floaters and/or light flashes in the eye. Your vision might become blurry, or a shadow or curtain appears to falls over the field of vision typically from the top or side of your eye. A retinal detachment does not cause pain yet is considered a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.
How is a Retinal Detachment Diagnosed?
Small retinal tears and holes are diagnosed during a comprehensive eye examination.
What are the Treatment Options?
Retinal detachments are treated with surgery. In some cases, a tiny synthetic band, known as a scleral buckle, is attached to the outside of the eyeball to gently push the wall in place. In some cases, silicone oil and intraocular gas are used to reattach the retina. Smaller holes and tears in the retina are treated with laser surgery or with a freezing treatment called cryopexy, typically performed in the doctor’s office to bond the tissue in place.
A retinal detachment occurs when the retina’s sensory and pigment layers separate. Because it can cause devastating damage to the vision if left untreated, retinal detachment is considered an ocular emergency that requires immediate medical attention and surgery. It is a problem that occurs most frequently in the middle-aged and elderly.
There are three types of retinal detachments. The most common type occurs when there is a break in the sensory layer of the retina, and fluid seeps underneath, causing the layers of the retina to separate. Those who are very nearsighted, have undergone eye surgery, or have experienced a serious eye injury are at great risk for this type of detachment. Nearsighted people are more susceptible because their eyes are longer than average from front to back, causing the retina to be thinner and more fragile.
Floaters and Flashes
What are Floaters and Flashes?
Floaters and flashes of light are common eye symptoms that may or may not indicate a serious vision problem. Many people describe floaters as specks, clouds or cobwebs floating around in their central or side vision, and describe flashes as brief, bright spots of light or seeing stars.
What Causes Floaters and Flashes?
Floaters are small particles of protein or other matter trapped within the jelly-like fluid that fills the inside of the eye, called the vitreous humor. These can form at birth or as the vitreous begins to change from a gel to a liquid as part of the aging process. Certain eye diseases or injury can cause floaters to appear. Floaters are very common in individuals who are nearsighted or have undergone eye surgery.
Flashes of light may occur when the vitreous humor thickens and begins to tug on the retina causing small tears or holes. Flashes of light that appear in waves or as jagged lines in one or both eyes lasting as long as 20 minutes may be caused by spasm of blood vessels in the brain, known as an ocular migraine.
What are the Symptom?
Floaters appear as specks of various shapes and sizes, as individual spots or threadlike strands. Most floaters are not harmful and rarely limit your vision. However, a sudden increase in floaters can indicate a serious vision problem.
The onset of new flashes of light can be an indicator of serious vision threatening problems such as the beginning of a retinal detachment. Your ophthalmologist should be contacted immediately.
How is it Diagnosed?
Floaters and flashes are detected during a comprehensive eye examination with your ophthalmologist. Your eye doctor will determine if what you are seeing is harmless or if your symptoms indicate a more serious problem.