Retina Care & Disease Management

The retina is a thin sheet of nerve tissue in the back of the eye where light rays are focused and transmitted to the brain. The vitreous is a gel-like substance that fills the eye and is connected to the retina, optic nerve and many blood vessels. Problems with the retina and vitreous — including retinal tear, retinal detachment, severe intraocular infection (endophthalmitis) and trauma — can lead to vision loss and blindness. Surgery can correct problems before vision is lost or prevent further deterioration from occurring.

Exciting new advances in the surgical and medical treatment of retinal and vitreous diseases has improved the outlook for helping many of these previously untreatable conditions.

Macular Degeneration Treatment

The macula is a part of the retina in the back of the eye that ensures that our central vision is clear and sharp. Age-related macular degeneration (AMD) occurs when the arteries that nourish the retina harden. Deprived of nutrients, the retinal tissues begin to weaken and die, causing vision loss. Patients may experience anything from a blurry, gray or distorted area to a blind spot in the center of vision.

AMD is the number-one cause of vision loss in the U.S. Macular degeneration doesn’t cause total blindness because it doesn’t affect the peripheral vision. Possible risk factors include genetics, age, diet, smoking and sunlight exposure. Regular eye exams are highly recommended to detect macular degeneration early and prevent permanent vision loss.

Symptoms of macular degeneration include:

• A gradual loss of ability to see objects clearly
• A gradual loss of color vision
• Distorted or blurry vision
• A dark or empty area appearing in the center of vision

There are two kinds of AMD: wet (neovascular/exudative) and dry (non-neovascular). About 10-15% of people with AMD have the wet form. "Neovascular" means "new vessels." Accordingly, wet AMD occurs when new blood vessels grow into the retina as the eye attempts to compensate for the blocked arteries. These new vessels are very fragile, and often leak blood and fluid between the layers of the retina. Not only does this leakage distort vision, but when the blood dries, scar tissue forms on the retina as well. This creates a dark spot in the patient’s vision.

Dry AMD is much more common than wet AMD. Patients with this type of macular degeneration do not experience new vessel growth. Instead, symptoms include thinning of the retina, loss of retinal pigment and the formation of small, round particles inside the retina called drusen. Vision loss with dry AMD is slower and often less severe than with wet AMD.

Effective management of AMD can often be achieved through intravitreal injections, which can stop abnormal blood vessel growth in wet macular degeneration. These FDA-approved medications, including Avastin® and Lucentis, are injected into the vitreous of the eye on a monthly basis to control the damaging effects of this condition.

Diabetic Eye Disease

Patients with diabetes are at an increased risk of developing eye diseases that can lead to vision loss and blindness, such as diabetic retinopathy, cataracts and glaucoma. In fact, diabetes is actually the leading cause of blindness in the United States.

Diabetic eye conditions often develop without any noticeable vision loss or pain, so significant damage may already be done to the eye by the time patients notice any symptoms. For this reason, it is important for diabetic patients to have their eyes examined at least once a year. Early detection of eye disease can help prevent permanent damage.

Diabetic-related eye problems develop from high blood sugar levels, which can cause damage to blood vessels in the eye. Over 40 percent of diabetic patients will develop some form of eye disease in their life. The risk of developing eye problems can be reduced through regular eye exams and by keeping blood sugar levels under control through a healthy diet and regular exercise.

Cause of Diabetic Eye Disease

Diabetic eye conditions develop in the retina as a result of microvascular abnormalities. The tiny blood vessels within the retina develop microaneurysms and begin to leak blood. As new blood vessels develop, they also leak blood and can cause hemorrhages and permanent damage to the retina.

While diabetics struggle with a high sugar count in the blood along with insufficient insulin production, it is actually the lack of oxygen in the blood that causes eye problems and leads to vision loss.

Diabetic Retinopathy

Diabetic retinopathy is the most common type of diabetic eye disease and the leading cause of blindness in the US. This condition is caused by blood vessel changes within the retina that lead to swelling and leaking of fluid. It can also cause growth of abnormal new blood vessels on the surface of the retina. There are four stages of diabetic retinopathy that begin with the occurrence of microaneurysms and eventually lead to abnormal blood vessels on the surface of the retina that can easily leak fluid and cause severe vision loss and even blindness.

The fluid can also leak into the center of the macula and cause swelling and blurred vision, a condition known as macular edema. The risk of developing macular edema increases as diabetic retinopathy progresses.

Treatment of Diabetic Eye Disease

Treatment for early stages of diabetic retinopathy and other conditions usually focuses on maintaining levels of blood sugar, blood pressure and blood cholesterol, in order to prevent any permanent damage from occurring. For more advanced stages of the condition, laser surgery is often effective in shrinking the abnormal blood vessels through over 1,000 laser burns in the area of the retina. This procedure, known as scatter laser treatment, usually requires two or more sessions in order to fully remove the blood vessels.

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