The retina is the light sensitive tissue at the back of the eye that acts as “the film of the camera.” It converts light into nerve signals that are transmitted along the optic nerve to the vision centers in the brain. Problems with the retina are a common cause for failing vision, especially in the elderly. At EyeCare Specialists, our trained optometrists and ophthalmologists are capable of addressing a wide range of retinal problems and returning you to solid vision.
The vitreo-retinal procedures include a variety of surgical and laser procedures performed to restore, preserve, and enhance vision. Vitreo-retinal procedures treat conditions such as age-related macular degeneration (AMD), diabetic retinopathy and diabetic vitreous hemorrhage, macular hole, retinal detachment, epiretinal membrane, CMV retinitis, and many other ophthalmic conditions.
Diabetes is one of the leading causes of blindness in the United States. Leaking and bleeding blood vessels on the retina can cause severe visual loss. Effective treatments include laser photocoagulation, and vitrectomy surgery. Regular Eye exams, good medical management of blood sugar and blood pressure, along with timely treatment can significantly reduce the risk of visual loss and blindness.
Eye Care Specialists has the latest diagnostic and therapeutic equipment to fight diabetic retinopathy including the availability of 4 lasers and 5 diagnostic imaging cameras for fluorescein angiography, used to identify the presence and location of abnormal blood vessels.
Macular degeneration is the leading cause of legal blindness in the United States in persons over 60 years of age. While this condition rarely leads to total blindness, patients affected develop blurred, distorted, or patchy vision and may lose the ability to read, drive, or discern fine detail. Risk factors include:
Some macular degeneration cases may be treated with various lasers and surgical techniques.
Much like the film in a camera, the retina is responsible for creating the images one sees. When the retina detaches, it separates from the back wall of the eye and is removed from its blood supply and source of nutrition. If it remains detached, the retina will degenerate and lose its ability to function. Trauma, nearsightedness, proliferative diabetic retinopathy, and retinal tears are all causes of retinal detachment.
Symptoms often include flashes of light, new onset of floaters, and loss of peripheral vision. If a retinal tear is discovered, detachment can usually be prevented using laser treatment. Fortunately, over 90% of retinal detachments can be repaired with a single procedure. The scleral buckle procedure, vitrectomy, and pneumatic retinoplexy are three different surgical approaches for treating this condition. If you are diagnosed with retinal detachment, our doctors will discuss which option best suits you.
Fluorescein angiography is a diagnostic procedure that uses a special camera to take a series of pictures of the retina for careful study. Fluorescein is a water-soluble dye that is injected into a vein in the arm. As the dye passes through the retina’s blood vessels, the camera flashes a blue light into the eye and takes multiple pictures of the retina. If there are abnormalities in the retina blood vessels, the dye will “leak” and show your physician the trouble spots in and around the retina.
Diabetes and macular degeneration are two of the primary causes of these retina abnormalities. Fluorescein Angiography is an incredibly helpful tool in identifying the presence of damage done by such diseases. Call Eye Care Specialists for more information on how this diagnostic technique can help prevent this severe loss of vision.
Floaters and Flashes
Flashing lights and floaters at the corner of the eye are a fairly common occurrence for aging adults. Flashes and floaters can be benign and relatively harmless, or they can herald a significant danger in the back of the eye, which left unchecked can lead to loss of vision or major surgery. The only way to know if flashing light or floaters in your field of vision are benign or significant is to have a doctor dilate your eyes and examine them thoroughly.
The center of the eye is filled with a transparent gel like substance called the “vitreous”. As we age, the “vitreous” undergoes certain chemical changes. This leads to the formation of deposits of protiens which form ‘clumps and strings’ floating in the gel. When light passes through the eye, the protien clumps throw a shadow on the retina producing a sensation of “floaters.”
Floaters may be seen as strings, streaks, clouds, bugs, dots, dust, or spider webs. These objects appear to be in front of the eye, but they are really floating in this fluid, and at the same time, casting their shadows on the retina, the light sensing inner layer of the eye. The debris could be made up of blood, torn retinal tissue, inflammation, vitreous detachment, or could simply mean a normal aging change in the vitreous. Floaters could also signify retinal tears that might be threatening for vision loss.
The vitreous fluid degenerates during the middle age years, often forming minute debris within the eye. Floaters are also often noticed in people who are nearsighted (myopic), and those who have been operated on for cataract surgery or Yag laser surgery. Floaters can interfere with reading, and can be quite bothersome. Even though there is no treatment or cure, they may slowly fade out over time. One possible remedy is to move the eyes up and down when a floater appears. The vitreous fluid may shift, thus permitting the floater to move out of the line of vision.
For the most part, floaters are usually nothing to worry about, being simply a result of the normal aging development. Usually it is recommended to see an ophthalmologist within 24 hours of the onset of symptoms, as floaters could also indicate a serious eye disease such as retinal detachment. The vitreous covers the retina surface, and sometimes the retina is torn when degenerating vitreous is pulled away. This leads to a small amount of bleeding, which may be interpreted as a new cluster of floaters. A torn retina is serious, and could possibly develop into a retinal detachment. Consequently, any new floaters that appear should be seen and evaluated by a doctor.
When the vitreous gel rubs against or pulls on the retina, it can produce the illusion of flashing lights. Flashes can be perceived as a sparkle, disco light, fireflies, lightning, fire works, or sparks. The same experience can happen after being hit in the eye, giving the illusion of seeing stars. All of these flashes are generated by any abnormal stimulus to the retina.
Light flashes can happen on and off for many weeks, or even some months. This is a common occurrence during the aging process, and it is generally not cause for concern. At times, however, a significant number of new floaters will appear, accompanied by light flashes, and partial sight loss of peripheral vision could occur. If this happens, it is important to see an ophthalmologist quickly in order to evaluate whether the cause is a torn retina or retina detachment.
Migraine flashes appear as zigzag, shimmering, or even colorful, lines that may move within the visual field. They usually last from five to thirty minutes and can occur in both eyes at once. They are most likely caused by a sudden spasm of blood vessels in the brain. These flashes are often associated with headache, nausea, or dizziness, but more often occur without such symptoms.
As in the case with floaters, an eye specialist should attend to any abrupt onset of an abundance of light flashes. The exam would involve close observation of the retina and vitreous fluid.
Floaters and flashes are common visual symptoms that can be representative of normal aging changes in the eye or the onset of an eye disease that could lead to vision loss if left unattended. It is always prudent to consult an eye specialist when such vision changes occur.
A macular hole is almost always a spontaneous development that occurs predominantly in aging women. The development of a macular hole progresses through several stages, and with each progressive stage the vision may worsen. The cause of macular holes remains under investigation.
The diagnosis of macular holes in the early stages may be challenging or difficult, especially when there are concomitant disorders of the macula, such as age related macular degeneration. The ophthalmologist must rely on both the patient’s vision and the subtlest signs of the disorder, which early on may include only a faint yellow spot or ring in the macula. Fluorescein angiography may sometimes be helpful in making the diagnosis as well. This diagnostic procedure is extremely safe and entails the intravenous or oral administration of fluorescein dye, followed by retinal photography.
The likelihood of visual improvement with macular hole surgery is about 70%. However, about 90% of macular holes can be successfully closed with surgery. For patients who develop a macular hole, the risk of developing a macular hole in the opposite eye is about 10% – 20%.
Surgical procedure repair of a macular hole begins with a vitrectomy procedure. The second aspect of the procedure typically involves membrane removal (removal of a membrane on the macula). Finally, in most cases, a gas bubble is placed with the vitreous cavity to help keep the macular hole closed while the retina heals. Unfortunately, patients must maintain face down positioning for about one to two weeks in order to keep the gas bubble over the macular hole.
Retinal Artery Occlusion
If a clot (embolus) breaks free from the wall of a blood vessel leading up the neck or to the eye, it can lodge in the retinal arteries causing an obstruction of blood flow to the eye, and a loss of vision. In some cases, the clot will rapidly dislodge, and the vision will return. However, if the clot is large it may not dislodge, and the vision remains blacked-out. Usually this is painless, and the loss of vision is severe. If the blood flow to the retina is interrupted for more than 1 1/2 hours (approximately), the vision may not return even if the clot breaks free and the circulation is restored. This condition may indicate risk for cardiac disease and stroke.
If a person with this condition rapidly seeks the medical help from an ophthalmologist, sometimes it may be possible to dislodge the clot before permanent damage occurs, although often some amount of damage can occur immediately.
Retinal Vein Occlusion
The retinal blood circulation is drained by a single vein, called the central retinal vein. If this vein becomes obstructed, various problems can occur in the eye, depending on the severity of the obstruction. A person with this condition will notice blurring of vision, dimming of vision, and possibly blind spots and floaters in the vision. It usually starts fairly suddenly, but the vision may worsen over a period of time (hours to days). Rarely does this happen in both eyes at the same time. The problem is usually caused by underlying vascular disease, and sometimes abnormal clotting or blood thickness. It is not caused by clots breaking off of arteries, like an artery obstruction is.
There is no effective treatment to reverse the blockage of the vein, except to treat any underlying medical condition (diabetes, hypertension, increased cholesterol, etc.), and hope that the vein opens back up on its own. About 1/3 of cases will completely resolve with little damage to the vision. About 1/3 stay the same with some loss of vision, and 1/3 of cases worsen and develop more severe loss of vision. The worst cases may need to be treated by a laser to prevent a dangerous form of glaucoma (neovascular glaucoma), but the laser treatment will not help the vision. The retinal doctors at Eye Care Specialists are involved in an FDA Trial of a new drug that may help treat this condition more effectively than in the past.
Neovascularization is abnormal growth of blood vessels in areas of the eye including the inner back lining where images are processed (retina) and the clear front covering of the eyeball (cornea). Neovascularization in the retinal area can be associated with vision loss in diseases such as age-related macular degeneration and diabetic retinopathy. Corneal neovascularization can be linked to eye diseases causing inflammation. Corneal neovascularization also can result as a complication of wearing contact lenses.
Please contact Eye Care Specialists today to schedule a consultation with one of our experienced ophthalmologists or optometrists today. We serve patients in Scranton, Wilkes Barre, Kingston, and throughout Northeastern Pennsylvania.