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Retinal Detachment

 

Overview of Retinal Detachment 

Retinal detachments are often associated with a tear or hole in the retina through which eye fluids may leak. This causes separation of the retina from the underlying tissues. During a retinal detachment, bleeding from small retinal blood vessels may cloud the interior of the eye, which is normally filled with vitreous fluid. Central vision becomes severely affected if the macula, the part of the retina responsible for fine vision, becomes detached.

Causes of Retinal Detachment

Retinal detachment often occurs on its own without an underlying cause. It may also be caused by trauma, diabetes, or an inflammatory disorder. It is most often caused by a related condition called posterior vitreous detachment. 

Symptoms of Retinal Detachment

The symptoms of a retinal detachment include seeing bright flashes of light, blurred vision, floaters in the eye, or blindness in a part of the visual field of one eye. 

Prognosis For Retinal Detachment

Most retinal detachment repair operations are urgent. A detached retina lacks oxygen, which causes cells in the area to die. This can lead to blindness.

Diagnosis of Retinal Detachment

A Retinal Detachment may be diagnosed using an ophthalmoscope in which the Doctor will look for a retinal hole, tear or detachment by examining your retina. Or by using an Ultrasonography this is a painless test that sends sound waves through your eye to bounce off the retina. The returning sound waves create an image of your retina and other eye structures on a video monitor.

Treatment for Retinal Detachment

Most patients with a retinal detachment will need surgery. These surgeries include: Laser surgery to seal the tears or holes in the retina, Pneumatic retinopexy (placing a gas bubble in the eye) to help the retina float back into place, More extensive detachments may require a Scleral buckle to indent the wall of the eye, or a Vitrectomy to remove gel or scar tissue pulling on the retina.

 

 

Age-related macular degeneration

(AMD) is a medical condition which usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It occurs in “dry” and “wet” forms. It is a major cause of blindness and visual impairment in older adults (>50 years). Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life.

 

In the Dry (nonexudative) form, cellular debris called drusen accumulate between the retina and the choroid, and the retina can become detached. The “dry” form of advanced AMD, results from atrophy to the retinal pigment epithelial layer below the retina, which causes vision loss in the central part of the eye. No medical or surgical treatment is available for this condition, however vitamin supplements with high doses of antioxidants, lutein and zeaxanthin, have been suggested by the National Eye Institute and others to slow the progression of dry macular degeneration.

 

In the Wet (exudative) form, which is more severe, blood vessels grow up from the choroid behind the retina, and the retina can also become detached. It can be treated with injections of medication that stops and sometimes reverses the growth of blood vessels. Until recently, no effective treatments were known for wet macular degeneration. However, new drugs, called anti-angiogenics or anti-VEGF (anti-Vascular Endothelial Growth Factor) agents, can cause regression of the abnormal blood vessels and improvement of vision when injected directly into the vitreous humor of the eye. The injections have to be repeated on a monthly or bi-monthly basis. Examples of these agents include ranibizumab (trade name Lucentis), bevacizumab (trade name Avastin, a close chemical relative of ranibizumab). Only about 10% of patients suffering from macular degeneration have the wet type.

 

Macular degeneration by itself will not lead to total blindness. For that matter, only a very small number of people with visual impairment are totally blind. In almost all cases, some vision remains. Other complicating conditions may possibly lead to such an acute condition (severe stroke or trauma, untreated glaucoma, etc.), but few macular degeneration patients experience total visual loss.

 

Diabetic Retinopathy

Overview of Diabetic Retinopathy

Diabetic retinopathy is damage to the eye's retina that occurs with long-term diabetes. There are two stages of diabetic retinopathy, non-proliferative and proliferative. Non-proliferative develops first,  and proliferative develops when the retinopathy becomes more severe.

Causes of Diabetic Retinopathy

Diabetic retinopathy is caused by damage to blood vessels of the retina. Having more severe diabetes for a longer period of time increases the chance of getting retinopathy. Retinopathy is also more likely to occur earlier and be more severe if your diabetes has been poorly controlled. 

Symptoms of Diabetic Retinopathy

The symptoms of diabetic retinopathy include blurred vision/ loss of vision over time, floaters, missing areas of vision, and trouble seeing at night. Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams. 

Prognosis for Diabetic Retinopathy

You can improve your outcome by keeping good control of your blood sugar and blood pressure. Treatments can reduce vision loss. They do not cure diabetic retinopathy or reverse the changes that have already occurred.

Once proliferative retinopathy occurs, there is always a risk for bleeding. You will need to be monitored regularly, and you may need more treatment.

Diagnosis for Diabetic Retinopathy

The doctor can diagnose Diabetic Retinopathy using a test called a fluorescein angiography, this involves the injection of a special dye into your arm. Many pictures will be taken as the dye circulates through your eyes. The doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid. Another test used to diagnose Diabetic Retinopathy is an Optical coherence tomography. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working.

Treatment for Diabetic Retinopathy

People with the earlier form, non-proliferative diabetic retinopathy may not need treatment. However, they should be closely followed by an eye doctor who is trained to treat diabetic retinopathy.Treatment usually does not reverse damage that has already occurred. However, it can help keep the disease from getting worse. Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed. Several procedures are often used to treat diabetic retinopathy. Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels. Focal laser photocoagulation is used to treat macular edema, and panretinal photocoagulation treats a large area of your retina. Often times more than one Laser treatment is needed. A surgical procedure called vitrectomy is used when there is bleeding into the eye.

 

Central Serous Retinopathy

 

Overview of Central Serous Retinopathy

Central serous retinopathy is a condition characterized by an area or multiple areas of leaking fluid in the macula, the portion of the retina responsible for your detailed vision. The circulation of the retina is supplied by 2 layers of blood vessels, a superficial layer from the retina vessels and a deeper layer from vessels of the underlying choroid. CSR is thought to arise from leakage from the deeper choroidal vessels. The result is a localized accumulation of fluid either under the retina or under the layer of pigment below the retina.

Causes of Central Serous Retinopathy

The precise cause of CSR is not completely understood; however, most clinicians believe that stress plays a role in some patients. During periods of physical or emotional stress, your body releases steroid hormones to adapt itself to the demands of stress. It follows that we also encounter CSR in patients taking steroid medications as well as during pregnancy. There is no association of CSR to systemic diseases.

Symptoms of Central Serous Retinopathy

Symptoms are usually a mild painless decrease in vision or a blind spot in the field of vision. This condition can occur in both eyes, but typically presents in one eye at a given time. The good news about CSR is that it usually will resolve on its own, often within a few months. Better than 95% of patients will improve to their previous level of vision, although some patients may still notice a persisting blind spot even if the leakage has resolved. Sometimes CSR can occur unnoticed by the patient until it happens again in an area of the macula where it is more easily noticed. About half of all patients with CSR will experience a recurrence of the condition.

Prognosis for Central Serous Retinopathy

About 5% of patients have a poorer outcome which may include significant changes to the pigment underlying the retina, the growth of abnormal new blood vessels, or the development of scar tissue. However, it should be emphasized that the vast majority of patients have complete resolution of leakage with recovery of vision at or near their previous level.

Diagnosis of Central Serous Retinopathy

CSR is often diagnosed clinically, which means it is identified by characteristic findings from your eye exam and from routine in-office imaging of the retina and its blood vessels. These studies are useful not only in diagnosing your condition but also in following its course over time.

Treatment for Central Serous Retinopathy

Laser treatment to the area of leakage is often effective in reducing the accumulation of fluid under the retina. However, since the overall prognosis is good without treatment, laser is usually reserved for special circumstances such as occupational needs, persistent leakage, or eyes with changes to the underlying pigment layer beneath the retina.

Under any circumstance it is preferable to avoid emotional stress when possible; however, it is obvious that this is not always possible. Exercise and diet have not been proven to be either helpful or harmful. Ultimately, time is your best ally, as CSR is a condition that generally resolves on its own without any intervention. Topical anti-inflammatory agents can also be used at times. Of course, careful follow up with your retina specialist will be helpful in the proper management of this condition.

 

 

For additional information regaurding conditions treated by Chesapeake Retina Center you can use these links:  

Macular Degeneration

http://webmd.com/eye-health/macular-degeneration/default.htm

Branch Retinal Vein Occlusions                             

http://medscape.com/article/1223498-overview 

Central Vein Occlusions      

http://medscape.com/article/1223746-overview

Central Serous Retinopathy                                  

http://www.medscape.com/viewarticle/582924

Cystoid Macular Edema     

http://blogs.webmd.com/eye-on-vision/labels/cataract.html

Diabetic Retinopathy   

http://www.nei.nih.gov/health/diabetic/retinopathy.asp

Retinal Detachment

http://www.nei.nih.gov/health/retinal/retinaldetach/

Macular Holes

http://www.nei.nih.gov/health/macularhole/macularhole.asp

Macular Pucker

http://www.nei.nih.gov/health/pucker/index.asp