The retina can be thought of as a screen in which you can view the world. Diseases like diabetes and high blood pressure can affect the health of your retina.
Macular degeneration, diabetic retinopathy, flashes and floaters, retinal detachments and horseshoe tears can become of particular concern. The Harman Eye Clinic doctors are here to help diagnose and treat moderate retina disorders.
Macular degeneration is an age-related disease which negatively impacts the retina. The macula, which is the center of vision in the retina, is the damaged as this disease takes course. Macular degeneration is categorized into “wet” and “dry” forms. The dry form of macular degeneration may involve calcifications forming in the retina, and the retinal cells may begin to decrease through a process call atrophy. The wet form of macular degeneration involves new blood vessels growing under the retina, causing scarring and swelling on the retinal tissues.
Macular degeneration is the leading cause of poor vision in senior age patients. The condition involves the macula breaking down. It causes vision to become gray or hazy and in some areas vision is lost. The exact cause of the breakdown of the retina is unknown but studies have shown a relationship between smoking, high cholesterol, or genetics causing a person to develop macular degeneration.
Decreased function of the central retina is a direct result of macular degeneration. The retina is the most important part of the vision process. As the retina becomes worse, a patient notices objects not appearing as colorful as they once had. Progressively, the disease causes more damage to the retina and objects may appear to be missing pieces. Lines that were straight may suddenly be blurry or wavy.
Currently there is no cure for macular degeneration but there are a number of treatments available that may slow the process or halt the disease. Studies are always underway to determine the exact cause and develop a cure. Most macular degeneration patients will only experience mild to moderate visual loss over time. If wet macular degeneration occurs, vision loss may occur much more rapidly and can be severe. Patients may gain a little vision with treatments but once vision is lost it is hard to restore.
Diabetic retinopathy is a complication of diabetes that causes blood vessels to be damaged in the retina because of high levels of blood sugar. The condition is serious and can threaten vision because of the importance of the retina for good vision. Patients who are able to control their diabetes reduce the chance of diabetic retinopathy. Laser treatment is used to seal blood vessels in minor cases. In more severe cases the vitreous gel may have to be surgically removed.
Flashers and Floaters
Floaters may appear in your vision as a variety of different shapes. Often they are noticed when looking at plain background, like looking into the sky or at a wall. The vitreous gel develops clumps or strands which make shadows on the retina, then you spot the floaters in your vision.
Floaters may be caused by a tear in the retina which is a serious problem. If a retinal tear is not treated then the retina may become detached from the back of the eye. The only treatment for a detached retina is surgery. Other floaters are harmless and will disappear over time and not require any treatment. If you are familiar with floaters because you have suffered from them for years, you should still see your doctor if suddenly new ones develop
Floaters are more common when people reach middle age. The vitreous gel becomes thicker or shrinks as we age, forming stands or clumps within the eye. The vitreous gel can begin to pull away from the back of the eye, causing a posterior vitreous detachment, a common cause of floaters.
Flashes appear as flashing lights or lightning streaks. They can appear on and off for multiple weeks, and become more common as the eye ages. Some people experience the flashes of light appearing as jagged lines in both eyes at once, lasting from 10 to 20 minutes. These flashes are usually caused by a spasm of blood vessels in the brain, which is a migraine.
As we grow older, it is more common to experience flashes. They can appear off and on for several weeks or months. If you notice the sudden appearance of light flashes, you should contact your eye doctor immediately in case the retina has been torn.
Your eye doctor may dilate your pupil with eye drops to do a full examination. The exam is painless, your doctor will examine all the areas of your eye including the retina and vitreous gel. If your eyes have been dilated, you may require a ride home after your appointment.
A retinal detachment is a condition that involves the retina separating from the supporting structures of the back of the eye. The most common cause of a retinal detachment is because one or more small holes have been formed on the retina. The eye fluid then can enter the hole(s) and start to peel the retina off of the back of the eye. The holes can form because of trauma, degenerations of the retina or after an eye surgery.
The symptoms of a retinal detachment may include the sudden development of floaters and flashes. Bleeding from the tear in the retina can cause the floaters, and pull from the vitreous jelly causes the flashes. If the retina starts to become detached a patient may see a blurry image in the edge of their vision, as progression increases the blurriness may enter the center. If the retina fully detaches, the macula also becomes detached, the vision becomes rapidly worse. Patients experiencing these symptoms should see an eye doctor immediately.
There are treatment options for a retinal detachment. If the retina has only experienced small tears then treatment with a laser usually can fix the tear, close monitoring will follow. If the retina becomes fully detached then a silicone band, called a scleral buckle, may be placed behind the eyelids to help the retina become reattached. A vitrectomy, a surgical procedure where the vitreous gel is removed may be needed to help repair the retina. If a retinal detachment involves only the peripheral retina, then surgical repair usually helps maintain excellent vision. If the detachment has progressed to involve the center of vision, the macula, then some vision may be lost, even after surgical reattachment of the retina.
Fluorescein Angiogram (FA) & Retinal Photography
Fluorescein angiography (fluorescein – the type of dye that is used; angiogram – a study of the blood vessels) is an extremely valuable test that provides information about the circulatory system and the condition of the back of the eye. FAs are useful for evaluating many eye diseases that affect the retina.
The test is performed by injecting a special dye, called fluorescein, into a vein in the arm. In just seconds, the dye travels to the blood vessels inside the eye. A camera equipped with special filters that highlight the dye is used to photograph the fluorescein as it circulates though the blood vessels in the back of the eye. If there are any circulation problems, swelling, leaking or abnormal blood vessels, the dye and its patterns will reveal these in the photographs. Your Doctor can then make a determination as to the diagnosis, and possible treatment options for the patient.
Retinal Photography (Routine Photography, Without Angiography.)
For this your pupils will need to be dilated with eye drops, so you should not drive. If you do drive, staff may have to refuse to put drops in your eye and cancel the procedure.
Dilating your pupils stops you from the ability to read and lights become very bright, especially sunlight. Some people do drive, especially if they wait an hour or two after the drops are put in, so they wear off a little, but this is not ideal.
Very occasionally the drops last 3 days, but usually they last 1 hour with maximum effect, and are 80% better after 3 hours. Reading or close work may still be slightly difficult after this. Using sunglasses while your pupils are dilated is very helpful indeed.
What is Fluorescein Angiography?
This is a test which allows the blood vessels at the back of the eye to be photographed as a fluorescent dye is injected into the bloodstream via your hand or arm.
Why is the Procedure Necessary?
- To help the doctor confirm a diagnosis.
- To provide guidelines for treatment.
- To keep a permanent record of the vessels at the back of the eye.
How is the Test Performed?
Your pupils will be dilated with eye drops. An injection of yellow dye is given into a vein in your arm. A series of photographs is taken as the dye enters the vessels at the back of your eye.
Are There Any Side-Effects?
During the injection you may feel warm or experience a hot flush. This only lasts seconds then disappears. Your skin will be pale yellow and your urine colored fluorescent green. This is entirely normal and may take two days to wear off.
Can I eat or drink before the test?
Yes. It is advisable to eat a light meal before the test. If you have diabetes you must ensure you have had enough to eat.
Should I Take My Normal Medication?
Yes, all your regular medication should be continued. You will be asked before the test what medication you are taking.
Should I inform you of my past medical history?
Yes, this is very important. Also inform us of any allergies that you may have. If you think that you may be pregnant, please inform the medical staff.
When will I get the results of the test?
You will hear from Dr. Ballon right after your test is completed. He will explain his findings.
Can I drive Home?
No. The drops and bright light from the camera will blur your vision for a short time. Please arrange for another adult to collect you from our clinic and escort you home.