Retinal Disorders &
Retinal Procedures
Vitreous Detachment and Retinal Tears
Between the lens and the retina a clear jelly, known as the vitreous
body, maintains the shape of the eyeball. As a person ages, the vitreous
gradually becomes more watery and may pull away from the retina. As many
as half of all people experience this condition by the age of 50, although
most are unaware of it. A tear in the retina can occur during vitreous
detachment and is characterized by light flashes in the field of vision
at the onset of the condition, possibly progressing to spots and webs
which may gradually clear with a remaining ring-shaped floater as a continuing
annoyance.
Preventive measures are 95 percent effective; however, retinal tears
may be successfully treated by laser or cryosurgery which are both done
on an outpatient basis. Following surgery, the majority of people can
resume their normal activities with restrictions on only extreme activities.
For more information, visit the Lucentis website here.
Retinal Detachment
If you were to load film incorrectly into a camera, you would be unable
to get a good photograph. In a similar way, if the retina is not properly
positioned in the back of the eye, vision is lost. This problem occurs
with retinal detachment, in which the retina is pulled away from the back
of the eye by trauma, or more commonly, vitreous detachment. When the
retina is pulled away from the choroid, the system of blood vessels covering
the outer surface of the retina, it is deprived of nourishment and loss
of vision results.
The warning signs of retinal detachment are the appearance of flashes
of white light at the perimeter of the field of vision and the onset of
tiny floaters. Laser treatment or cryotherapy may be done at these initial
signs to avoid the more serious effects of retinal detachment. As retinal
detachment progresses, a curtain starts in the peripheral viewing field
and spreads toward the center of vision. By this time, laser or cryotherapy
treatment is no longer effective and major surgery must be performed.
The type of surgery employed depends upon the number, location
and extent of the retinal tears:
The goal of each of these, in combination with laser treatment or cryotherapy,
is to close the retinal tears, which will restore the retina
to its proper position.
This procedure is performed on an outpatient basis at our surgery center with minimal recovery time. Eye glasses may need to be changed; however, this is postponed for six to eight weeks following surgery to allow the retina and vitreous body to settle in for accurate testing.
Surgery is successful for more than 90 percent of all retinal detachment
cases. However, on a rare occasion a condition called "proliferative
vitreoretinopathy" may call for additional surgery. Retinal detachment
was once an incurable problem, but thanks to the vast improvement in surgical
procedures over the past 20 years, it may be successfully treated in the
majority of cases.
Macular Holes
The macula is the small central area of the retina responsible for our
clear direct vision, while the remainder of the retina is used for side
or peripheral vision. The vitreous body is a transparent jelly which fills
the space between the lens and the retina and maintains the shape of the
eyeball. A macular hole is frequently caused when the vitreous gel separates
from the retina, a condition which occurs most commonly as a person ages,
although, in some cases, persistent vitreous forces upon the retina can
cause a macular hole without the actual separation of the two.
Among the symptoms of a macular hole, or an impending macular hole, is
distorted vision. A straight line will look bent or wavy; signs may appear
to have letters missing. The center of an image may appear to be blurry
while the perimeter is clear. A fully developed macular hole can result
in "legal blindness."
The presence of a macular hole may be determined during a dilated eye
exam along with the use of a fluorescein angiography, a test using yellow
dye so that macular holes may be revealed photographically. Once diagnosed,
they may be surgically treated. Depending upon the patient's general physical
condition, medical history and the condition of the eye, the vitrectomy
surgery may be performed under general or local anesthesia. For most patients,
some activity is restricted for the first few days after surgery, with
usually a one-week period before returning to work.
What is Macular Degeneration?
Macular degeneration is the deterioration or breakdown of the macula. The
macula is a small area in the retina at the back of the eye that allows
you to see fine details clearly and perform activities such as reading
and driving. When the macula does not function correctly, your central
vision can be affected by blurriness, dark areas or distortion. Macular
degeneration affects your ability to see near or far, and can make some
activities - like threading a needle or reading - difficult or impossible.
Although macular degeneration reduces vision in the central part of the
retina, it does not affect the peripheral, vision. For
example, you could see the outline of a clock but not be able to tell
what time it is.
Macular degeneration alone does not result in total blindness. Even in
more advanced cases, people continue to have some useful vision and are
often able to take care of themselves. In many cases, macular degeneration's
impact on your vision can be minimal.
What Causes Macular Degeneration?
Many older people develop macular degeneration as part of the body's
natural aging process. There are different kinds of macular conditions,
but the most common is age-related macular degeneration (AMD). Exactly
why it develops is not known, and no treatment has been uniformly effective.
Macular degeneration is the leading cause of severe vision loss in Caucasians
over 65.
Age-Related Macular Degeneration (AMD)
Although there are several types of macular degeneration, the majority of people suffering from the condition developed it as part of the aging process. This is called Age-related Macular Degeneration (AMD), and is a condition people need to be aware of and monitor as the sensitive tissues in our bodies breakdown as we age.
AMD is a serious condition, and is currently the leading cause of vision loss and blindness among Americans who are age 65 and older. Currently, there are about 10 million people in America who suffer from AMD. However, this disease is a growing problem, as the baby boomer generation that represents a large portion of the U.S. population continues to age.
Wet and Dry AMD
There are two forms of AMD that a person can be diagnosed with: “wet” (neovascular) and “dry” (non-neovascular). Dry AMD is the most common form of macular degeneration, making up approximately 90% of all cases of AMD.
"Dry" Macular Degeneration (Atrophic):
As mentioned earlier, this is the most common form of AMD. It is a result of the aging deterioration of the tissue that forms the macula. As this tissue ages and breaks down, it can form debris that gathers within the macula. This debris gathering begins to gradually affect the central vision of the person suffering from the disease. The process occurs rather slowly, with the patient suffering from central vision blurriness that gradually worsens over time. Although there is no cure, treatments and healthily habits can help slow the development of Dry AMD.
"Wet" Macular Degeneration (Exudative):
In about 10% of cases, Dry AMD progresses to the more aggressive form of the disease, called Wet AMD. Wet AMD is a result of the body developing abnormal blood vessels underneath the retina in an attempt to supply more blood to the damaged tissue of the macula. The problem is that these new blood vessels usually leak fluid or blood into the retina and blur central vision. With Wet AMD, vision loss can occur very fast. One common symptom is the appearance of wavy lines where straight lines should be present. Wet AMD is a very serious disease that accounts for 90% of all blindness in the United States.
Some cases are treatable with laser surgery, and the administration of certain medications, both of which are done in the doctor's office. People suffering from the symptoms of Wet AMD should seek treatment immediately.
What Are The Symptoms Of Macular Degeneration?
Macular Degeneration affects everyone’s vision differently, so there is no one common set of symptoms. But the common thread is that since the condition affects your central vision, at some point you will notice changes in the way you visualize objects in your centralized field of vision.
Some of the more common signs of vision loss include:
- Difficulty focusing on words on a page or computer screen
- A dark spot or empty space might appear in the center of your sight
- Straight lines appear fuzzy, unclear, or wavy
Most people hardly notice any vision loss at onset, and their vision continues to gradually worsen year after year, making the condition extremely difficult to detect. AMD also tends to affect only one eye at first, making it even harder to notices changes in your vision.
Macular Degeneration alone does not result in total blindness. Even in more advanced cases, people continue to have some useful vision and are often able to take care of themselves. In many cases, Macular Degeneration's impact on your vision can be minimal.
Your physician can usually detect early signs of macular degeneration before symptoms occur. That is why it is important to maintain a healthy routine of vision checks with your primary vision provider.
How Is Macular Degeneration Diagnosed?
As mentioned earlier, most people suffering from AMD have trouble detecting any symptoms until more substantial vision loss has occurred. The good news is that your ophthalmologist (eye M.D.) can detect early stages of AMD, and begin preventative treatment before any noticeable vision loss has occurred. For people over the age of 60, a yearly eye exam is a must. Once you reach a certain age, your eye care physician will begin to administer specific tests to check for any early warning signs of AMD.
Some of these tests may include:
- An Amsler grid test, where you try and focus on special lines on a printed grid, searching for any visible areas of distortion
- Viewing your retina with an ophthalmoscope, searching for any abnormalities
- Performing a fluorescein angiography, where your doctor injects flurorescien dye into your bloodstream and then photographs the back of your eye
-An optical coherence tomography (OCT) exam, which is an imaging machine that can measure the thickness of your retina and visualize the microscopic anatomy of your retina
The greatest risk factor for AMD is definitely age, but the following groups of people have also been found to be more prone to the condition: women, whites, smokers and those whose immediate family members have had AMD.
The most important thing you can do to protect your vision from AMD is to have your eyes examined by an eye care professional at least once a year, particularly if you are age 60 or older.
How Macular Degeneration Is Treated
There is unfortunately no treatment that completely cures AMD, but several treatment options do exist that effectively slow the development of the disease. These treatments vary depend on how serious the condition is.
Treatment for Dry AMD
Research has shown that certain nutrients and supplements can slow the development of Dry AMD. If you are suffering from symptoms of Dry AMD, your eye doctor may recommend the daily use of the AREDS supplements, which is a special formula consisting of zinc, lutein and antioxidant vitamins (vitamin C, vitamin E and beta carotene). There is ample clinical evidence that shows high levels of antioxidants can slow down the progress of dry age-related Macular Degeneration. In smokers, high doses of beta keratin increase the risk for lung cancer and use of special formulations is indicated.
If you are currently suffering from Dry AMD vision deterioration, low vision devices such as high intensity lights, magnifying glasses, and other devices can help you make the most of your visual situation.
Treatment for Wet AMD
For Wet AMD, the treatment is targeted at either preventing the growth of new blood vessels, or the stoppage of leaking from the existing blood vessels.
There exist several medications that have been proven to slow the development of new blood vessels in the body. Two of the most common forms of this medication are Lucentis and Avastin.
Lucentis
Lucentis (ranibizumab) received FDA approval in late June 2006, for the treatment of advanced ‘wet’ macular degeneration. To date, it has been the most promising FDA-approved treatment for this condition that at one time meant certain blindness for patients.
Lucentis works by inhibiting proteins that stimulate the growth of new blood vessels in the body. The drug has been shown to effectively stop, and in some cases even reverse vision loss in most people with ‘wet’ AMD.
The medication is administered by direct injection into the eye. This is a painless office procedure that does require several treatments for maximum effect.
Avastin
There exists a less-expensive, non FDA-approved alternative to Lucentis, called Avastin. Avastin (bevacizumab) consists of a similar molecular makeup as Lucentis, with the only real difference being that the molecules in Lucentis are smaller than those of Avastan, which allow the drug to more effectively penetrate the retina.
Currently, Avastin is only FDA-approved for cancer treatment. But studies show similar effectiveness in the treatment of macular degeneration as Lucentis.
Avastin is available off-label, and may be a better treatment option for lower-income families.
Laser Therapy
To stop the blood vessels from leaking, a patient may have to undergo laser therapy to destroy or seal off these new blood vessels. Unfortunately, recurrences after laser treatment are common. Laser therapy also subjects a patient to potential retinal scarring that can permanently leave blind spots in that patient’s vision.
It is important to understand that none of these treatments will dramatically improve your vision should you suffer from AMD. They are simply treatment options that can potentially slow the process of vision loss. The good news is that promising AMD research is currently being done. In the meantime, routine eye examinations with your primary vision provider are the most important steps to ensuring healthy vision.
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For Post-op Instructions
To Learn More About Our Vitreo-Retinal Disorder Specialist:
Jaime Jiménez, M.D.
If you are considering a Retinal Procedure
in Hattiesburg or the surrounding Mississippi
area, please call 601-264-EYES or email
us today.
(601)264-3937
1420 S. 28th Ave
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