RETINA

 
 
What is the Retina? Back to Top
The Retina is the back layer of the eye that contains the light-sensing cells that will receive the images that we see in the world around us, and send this information to the Optic Nerve, which will send the images to our brain where we interpret them. The retina is a very thin tissue and is loosely applied to the back of the eye.

 
How can the Doctor see my Retina
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In order to thoroughly examine the Retina, we will need to dilate your pupils. This allows us to look through them with a light and a special lens. This is called Dilated Funduscopic Exam. The more you can cooperate, the better we will be able to see all the details in the back of your eye.

 
What conditions can affect my Retina? 
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The Retina can be affected by inherent eye conditions or by systemic diseases. It can also become detached, and the communication between the cells in the retina and the optic nerve is lost, and, as a result, vision is lost as well. The symptoms of a Retinal Detachment can vary depending on the severity of the case; however, most of the time, there is a perception of a curtain  obscuring the vision in the peripheral areas of the visual field. This can be preceded by flashes of light and/or a large number of Floaters in your vision. If you experience these symptoms, contact us immediately. You might need immediate treatment.
Systemic conditions that frequently affect the retina, include autoimmune conditions, infections, high blood pressure and diabetes.
We will be able to detect early changes during your regular eye exams and determine if you need treatment.

 
How is Diabetes related to my eyes
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If you have Diabetes, your body does not use and store sugar properly. High levels of blood sugar damage the vessels throughout your body, including the vessels in your retina. When this damage occurs it is called Diabetic Retinopathy.
 
There are two types of Diabetic Retinopathy, depending on the absence or presence of growth of new vessels:
- Nonproliferative Diabetic Retinopathy
- Proliferative Diabetic Retinopathy
 
Nonproliferative Diabetic Retinopathy, also known as Background Diabetic Retinopathy, is an early stage of diabetic eye disease in which the smallest vessels of the retina are damaged and start leaking fluid or blood into the retina. This causes the retina to swell and can sometimes compromise your vision if it effects the central area of the retina. This is called Macular Edema.
Macular edema is the most common cause of vision loss due to Diabetes. Vision loss may be mild, moderate or severe, and we may be able to treat it with either a laser or an injection of medication, depending on the findings during the exam.
 
The small vessels in the Retina can also shut down and decrease the amount of blood and oxygen reaching the cells in the retina. When this happens in the area of central vision, it is called Macular Ischemia. This will cause loss of vision that sometimes cannot be treated.
 
 
Proliferative Diabetic Retinopathy is a later stage in which, because of the damaged vessels and decrease in the delivery of oxygen to the Retina, abnormal new vessels grow to try to deliver more oxygen to the retina. These are abnormally thin vessels that can grow on the surface of the retina, into the Vitreous, (the gel inside the eye), or onto the optic nerve.
 
Since these vessels are abnormal they frequently break and cause bleeding inside the eye. When they bleed into the Vitreous, it is called a Vitreous Hemorrhage. This causes multiple floaters a red brown blur or severe decrease in vision. If you experience these symptoms; you need to call us as soon as possible.
 
A vitreous hemorrhage may take days, weeks or months to reabsorb, depending on the amount of blood. A Vitreous Hemorrhage alone does not cause permanent loss of vision, but our doctor may want to treat your Retina to prevent further growth of abnormal vessels as soon as the view into your eye allows. If the eye does not clear the hemorrhage within a reasonable time, our doctor may recommend surgical intervention with a Vitrectomy.
 
Another problem that can arise from the growth of these abnormal vessels is a Traction Retinal Detachment, which happens when there is scar tissue associated with the vessel growth. This scar tissue eventually shrinks and pulls the retina towards the Vitreous, causing a Retinal Detachment, which can be localized or generalized and causes vision loss proportional to the detached area of the Retina. More severe vision loss occurs when the Macula is involved. 
 
Also occasionally, extensive retinal vessel closure causes abnormal vessels to grow on the Iris (the color of the eye), in the front of the eye and block the normal drainage of Aqueous Humor out of the eye. The pressure inside the eye builds up resulting in Neovascular Glaucoma, which causes damage to the optic nerve and may result in loss of vision.

 
How is Diabetic Retinopathy treated
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The best treatment is to prevent the development of Diabetic Retinopathy by achieving an optimal Blood Glucose control. Regular visits to your Primary Care Physician are essential. Strict control of your Blood Sugar and Blood Pressure will significantly reduce the long-term risk of vision loss due to diabetes. We recommend a hemoglobin A1c of 6.5 or lower to minimize the risk of diabetic retinopathy.
 
If you develop diabetic retinopathy that needs to be treated there are several possible treatments. Macular edema can sometimes be treated with an injection of a medication inside your eye. During your exam our doctor will determine if you are a good candidate for this treatment modality.
 
Laser Surgery is also available as a possible treatment for people with Macular Edema, Proliferative Diabetic Retinopathy or Neovascular Glaucoma.
 
The techniques differ depending of what needs to be treated: the laser treatment for Macular Edema, Focal Laser Photocoagulation, is focused on the leaking vessels adjacent to the area of swelling to stop them from leaking; while the laser for Proliferative Diabetic Retinopathy and Neovascular Glaucoma is focused on all parts of the retina except the macula, and it’s called Panretinal Photocoagulation (PRP).
 
Multiple laser treatments are sometimes necessary. The laser does not “cure” the diabetic retinopathy, and does not always prevent further loss of vision.

 
How often should I have my eyes checked if I have Diabetes
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Patients with Diabetes should schedule a complete eye exam at least once a year. If Diabetic Retinopathy is detected, the frequency of exams varies according to the severity of the disease.
 
Pregnant women with diabetes should schedule a complete eye exam during the first trimester of their pregnancy because diabetic retinopathy can progress quickly in these patients.
 
You should have your eyes checked promptly if you have visual changes:
-     Involving either or both eyes
-     Lasting more than a few days
-     Not associated with changes in your blood sugar
-     Floaters
 
If you were recently diagnosed with diabetes you should have your eyes checked:
-     Within 5 years if you are 29 or younger
-     Within a few months if you are 30 years or older.

 
What is Age Related Macular Degeneration? 
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Age Related Macular degeneration (AMD) is a deterioration or breakdown of the Macula. It can be a part of the body’s aging process.
 
When the Macula does not function well, the central vision can be affected becoming blurry, dark or distorted. This applies to near, far and all distances.
AMD affects the central vision, usually leaving the peripheral aspect of the visual field unaffected. For this reason, you could see the outline of a clock but not be able to tell what time it is. It does not result in complete blindness. Most of patients continue to have some functional vision, often remaining able to take care of themselves, and fortunately many cases actually have minimal impact in their vision.
 
 
The two types of AMD are Dry (Atrophic) or Wet (Exudative).
Dry AMD is the form that most people have. There is some thinning and aging of the tissues in the Macula and vision loss usually occurs gradually.
In Wet AMD, which accounts for approximately 10% of cases, abnormal blood vessels form underneath the Retina and leak fluid or blood in this space. Vision loss may progress rapidly to a severe stage.


 
What are the Symptoms of Age Related Macular Degeneration
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AMD can cause different symptoms of different magnitudes. It may be hardly noticeable in early stages and only detected by our doctors on a routine exam; it may involve only one eye in a severe way while the other eye preserves good vision throughout the years. 
Some noticeable changes are blurred words on a localized area of a page, dark or empty area in the center of the vision, distorted straight lines, such as a door frame, or a ruler.
 
The Amsler Grid is a useful tool for patients to detect changes in their vision when they have been diagnosed with early stages of the disease. Placing it on the refrigerator door is a good way to remember to test your vision daily. It is important to use it correctly to avoid misinterpretation of your findings:
 
- Make sure you are wearing your reading glasses if you need them
- Stand 15 inches away from the grid
- Cover one eye and test one eye at a time
- Look directly at the center dot with the uncovered eye
- While looking at the dot, pay attention to the surrounding lines that you perceive, and notice if they are all straight or if they look distorted, blurred or dark.
- Repeat the procedure with the other eye.
- If you notice any changes contact us immediately.
 
Click here to download your Amlser Grid


How is Age Related Macular Degeneration treated
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It has not been determined exactly how the Macula is affected with aging, and no treatment has been proven uniformly effective. 
 
A large scientific study was conducted to prove that the AREDS 2 formula  vitamins reduce the impact of Age Related macular Degeneration in some people. Patients with no AMD or very early stages in both eyes did not benefit from the supplements. We will be able to tell you after a thorough exam if you are a candidate for this treatment. It is very important to keep in mind that these supplements are NOT a cure for AMD, and they will not restore vision that has been lost. They are only an adjuvant to prevent further deterioration of vision in some cases.
 
Anti Vascular Endothelial Growth Factor (Anti-VEGF) Injections:
Certain types of “Wet” AMD can be treated with an intraocular injection of agents that prevent the growth and slow the leakage of abnormal vessels underneath the retina. Early detection and treatment are essential to maximizing the benefits of these injections. If you feel that there is a change in your central vision contact the office ASAP for an evaluation of the macula.
 
Despite advanced medical treatment, many people experience vision loss from AMD. If you have experienced vision loss from AMD there are devices which may help you perform your daily activities. The Foundation Fighting Blindness(770-491-1629) as well as other groups can be a helpful resource for these devices as well as support for this challenging change in lifestyle.


What is a Retinal Detachment? 
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A Retinal Detachment happens when the Retina peels away from the underlying supportive tissue. Initially it may be localized, but if rapid treatment does not happen, the entire retina may detach, leading to loss of vision and sometimes blindness. Therefore, a Retinal Detahcment is a medical emergency. Permanent damage may occur if it is not repaired in 24-72 hours.

A Retinal Detachment is commonly preceded by a Posterior Vitreous Detachment, which causes the following symptoms:
  • Flashes of light, mostly in the peripheral vision
  • Sudden dramatic increase in number of pre-existing floaters
  • Ring of "Hairs" next to the central vision
It is important that you know that most of Posterior Vitreous Detachments do not progress to Retinal Detachments, but when a Retinal Detachment occurs these are the most common symptoms:
  • A dense shadow starting in the periphery and progressing towards the center of the vision
  • The perception of a "veil" or "curtain" over your vision
  • Straight lines appear curved
  • Central visual loss
If you experience sudden flashes of light or floaters, you should consult us immediately or go to the nearest emergency room, if after hours.