Retinal Care

Understanding the Retina
The retina is the light-sensitive tissue lining the back of our eye. Think of it like film in a camera. Images are captured on the Retina, encoded, and then sent to the brain via the optic nerve. Attached to certain areas of the retina is the vitreous, a gel-like substance that fills the inside of the eye, giving it shape and volume.. A healthy retina is key for clear vision.

Distortions of vision, such as blurred words on a page, a dark spot that appears in the center of vision, or straight lines that appear wavy, can all be signs of a retinal issue.

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Overview

At Visionary Eye Doctors, we are dedicated to helping patients in the diagnosis and treatment for of a wide variety of common retina eye conditions including:

Diabetic Retinopathy
Macular Degeneration
Flashes and Floaters

How we Diagnose Retina Conditions

Our physicians will perform comprehensive dilated eye examinations. We have the latest in-office diagnostic tests and treatments including: high definition OCT, digital fundus photography, fluorescein angiography, digital ultrasound of the eye and adnexa, laser treatments, and intravitreal injections of medications.

Your First Visit:

Due to the specialized nature of retinal eye exams, please consider the following:

Your first visit may take approximately 2 to 3 hours due to the complex nature of some retinal diseases. and will include a comprehensive examination and evaluation of your retina. Prior to seeing your physician, you will first meet with an experienced ophthalmic technician who will take your medical history, check vision and screening tests, and administer drops to dilate your pupils. Please bring a list of your medications for us to review. You may also need to have a retinal photography such as an OCT or a fluorescein angiogram to aid your diagnosis and monitor changes in your condition. This may require additional time in the office.

Following a diagnosis and a thorough explanation of your condition and treatment options, you may require medical treatment on your first visit for some urgent retinal conditions.

Diabetic Retinopathy

What is Diabetic Eye Disease?

Diabetic Mellitus is the leading cause of vision loss in adults aged 20–74 years. Diabetic retinopathy occurs when the blood vessels in the back of the eye become weakened and damaged, causing swelling or leakage of blood in the eye. There are two types: nonproliferative and proliferative.

Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. In the early stages of the disease (nonproliferative retinopathy), these blood vessels leak fluid and distort sight. In the more advanced stage (proliferative retinopathy), fragile new blood vessels grow around the retina and in the vitreous humor (a clear substance inside the eye). If these blood vessels are not treated, they may bleed and blur vision, or may scar and detach (disconnect) the retina.

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How common is Diabetic Retinopathy or Proliferative Diabetic Retinopathy?

An estimated 30.3 million people of all ages have diabetes, with over a third showing signs of retinopathy. Unfortunately, these numbers are expected to rise, due to the increasing prevalence of Diabetes, our aging population, and increasing of life expectancy.

Anyone with diabetes (Type 1 or Type 2) is at risk of developing diabetic retinopathy. The factors that affect risk include:

The type of diabetes a person has (Type 1 or 2);
How well-controlled the blood glucose is; and,
How long a person has had diabetes.

Damaged blood vessels and close-up of leaking vessel

What are the Signs and Symptoms of Diabetic Retinopathy?

Usually, there are no symptoms of early diabetic retinopathy, and the person’s sight may not be affected until the condition is severe.

Symptoms of diabetic retinopathy include:

The loss of central vision, for example, when reading or driving;
Loss of the ability to see color;
Blurred or distorted vision;
Small spots (floaters).

Because retinopathy develops over time, it is important to have an eye exam each year, or more often if you have more than mild retinopathy. Call your doctor right away if you have any of these symptoms.

What is the Treatment to Diabetic Retinopathy?

The management of Diabetic Eye Disease depends on where and what part of the eye is affected. Patients with Diabetic Retinopathy and Proliferative Diabetic retinopathy are managed with ocular intravitreal injections and/or retinal laser surgery. Depending on the specific issues with your retina, options may include:

Focal laser treatment. This laser treatment, also known as photocoagulation, can stop or slow the leakage of blood and fluid in the eye. It’s painless and is done in our office.
Scatter laser treatment. This laser treatment, also known as panretinal photocoagulation, can shrink the abnormal blood vessels. It’s also done in your eye doctor’s office or eye clinic.
Intravitreal injections. Intravitreal injections are commonly used to treat retinal diseases such as diabetic retinopathy, macular degeneration, macular edema and retinal vein occlusion. This procedure is performed in our office and requires only a local anesthetic. Before the medication is injected, the eye is numbed with anesthetic eye drops to help minimize discomfort.

How do I prevent Diabetic Retinopathy?

Control your blood sugar (glucose levels)
Tightly control your blood pressure
Control your cholesterol levels
Diet. Healthy weight maintenance, regular exercise and giving up smoking are all important to good Diabetes control. Smoking increases your blood pressure and raises your blood sugar level which makes it harder to control your Diabetes. In addition, Nerve damage, kidney and cardiovascular disease are more likely in smokers with Diabetes
Regular dilated eye examination. The most effective thing you can do to prevent vision loss is early detection through yearly eye examinations.

Macular Degeneration (AMD)

Macular degeneration is a progressive eye condition affecting as many as 10 million Americans and millions more around the world. AMD usually occurs in people over 60 and attacks the macula of the eye, where our sharpest central vision occurs. Although it rarely results in complete blindness, it robs the individual of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision.

There are two forms of AMD: Dry and Wet. 80% of people diagnosed with AMD have Dry AMD. This typically begins with the retina thinning and tiny yellow deposits, called drusen, form at the retina base. Patients typically have slow progressive vision loss. In about 10 to 20% of AMD patients, retina damage can progress to Wet AMD. This is where the base of the retina has thinned and degenerated to a degree causing delicate abnormal blood vessels to form and leak, causing more rapid and significant vision loss.

The Effects of Macular Degeneration

Macular degeneration affects the area of the retina called the macula, the part of the eye responsible for central vision. A person with this condition has difficulty seeing detailed objects such as small print, faces, or street signs. The affected areas of the macula often cause scotomas, or small central areas of vision loss. These areas may cause objects to appear faded, disappear, or look distorted. Straight lines may look wavy. Peripheral vision is not affected and macular degeneration does not cause total blindness.

Possible Causes and Risk Factors

The exact cause of age-related macular degeneration (ARMD) is unknown. What is known by macular degeneration doctors is that there are many risk factors associated with AMD, including:

Age. As we age our risk of developing AMD increases. The risk of AMD at age 50 is only 2%. That rate jumps to 37% by age 75.
Family History. One’s risk of developing AMD is 300% higher if an immediate family member has the condition.
Genetics. A strong association between development of AMD and presence of variant genes including complement factor H (CFH) and complement factor B.
Smoking. Patients who smoke are 5 to 8x more likely to develop AMD compared to nonsmokers
Racial predisposition. Caucasians and patients with light-colored skin and eyes are more likely to develop AMD than darker pigmented patients.
Obesity. High Blood Pressure and High Cholesterol
UV exposure. It is important to protect your eyes by wearing Sunglasses with 100% UV protection
Diet. Diets high in saturated fats (ie meat, butter, cheese) and low in Vitamin C, E and lutein increase one’s risk factor for AMD

How We Diagnose Macular Degeneration

Routine and yearly dilated ocular examination is important for early management. During your examination, which is done by the best macular degeneration doctors, imaging scans of the retina, called Optical coherence tomography (or OCT for short) is performed, providing detailed imaging of the retina and macula.

In addition, a dye test, called a Fluorescein Angiography maybe performed. A yellow dye (called Fluorescein) is injected into your vein. Travelling through the body and into the eyes where using a special camera, highlights abnormal new vascular growth or leakage helping identify Wet AMD.

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Treating Macular Degeneration

Currently, no treatment is available to manage Dry AMD. Health and diet modification including daily eye vitamin intake (called AREDS Eye Vitamins), Sunglass wear with 100% UV protection, daily intake of green leafy vegetables, daily exercise and maintaining a Mediterranean diet have been shown to slow the progression of Dry AMD.

Studies funded by the NIH (National Institute of Health) called the Age-Related Eye Disease Study (AREDS 1 and 2) sought to answer the question whether taking daily vitamins and/or minerals could prevent, treat or cure AMD. What was found:

High levels of antioxidants and zinc can reduce the risk of vision loss from advanced AMD by at least 25% (patients with Intermediate Dry AMD or Advanced Dry AMD)
Supplements do not provide significant benefit to patients with Minimal or Early Dry AMD.
These nutritional supplements do not prevent the initial development of AMD, nor do they improve vision already lost to AMD.

National Eye Institute Recommended Formula

AREDS 2 formulation contains: Vitamin C, Vitamin E, Zinc, Copper, Lutein and Zeaxanthin.

Fortunately, the best eye doctor for macular degeneration finds that there are ways to manage Wet AMD. Intravitreal Anti-VEGF injections, such as Avastin (Bevacizumab), Leucentis and Eylea have been proven to reduce macular leakage and abnormal vascular growth, slowing vision loss and at times even improving it (in about 50% of patients).

In wet macular degeneration, new blood vessels growing near the macula may leak or bleed. If this type is present, laser treatment can help to seal the leaky vessels, but cannot repair damage that has already occurred. Many patients with either type of macular degeneration can benefit from low vision rehabilitation. Optical devices can be prescribed to help you use your remaining vision more effectively.

Floaters

Floaters are small abnormalities in a person’s vision. They can appear as tiny spots or small curvy lines that move along with the movement of the eye. There are many possible causes of floaters, but usually they are the result of foreign matter in the vitreous, physical injury to the eye, or another existing eye disease.

While floaters do not have major adverse effects on overall vision, it is important that people experiencing these spots monitor them closely as they could be indicative of a more serious condition.

What causes Floaters?

The back of the eye is filled with Vitreous, a gel-like substance (made of protein and water). Vitreous is important due to the fact it maintains the shape of the eye and acts as the shock absorber, providing protection to the retina. Overtime and as we age vitreous slowly shrinks.

As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina. These are floaters.

Protein CLlumping and Vitreous Gel Shrinkage

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Who is at risk for Floaters?

Floaters develop as we age. Usually the process begins after the age of 50 but in some people, can develop in their 30’s and 40’s. Floaters are more common and more likely to develop at a younger age in those who are very nearsighted (myopic), have Diabetes Mellitus, had a history of trauma or who have had a cataract operation.

How are Floaters treated?

Treatment is not recommended. On rare occasions, floaters can be so dense and numerous that they significantly affect your vision. In these cases, a pars plana vitrectomy, a surgical procedure that removes floaters from the vitreous, may be needed.

Can Floaters be dangerous?

When new floaters appear, it is important to seek care by an eye care specialist to assure no signs of retinal tears or retinal detachments are evident.

Sometimes as a section of the vitreous pulls away from the retina, it tugs on the retina causing a retinal tear or break leading to a retinal detachment. A retinal detachment is a serious condition and should always be considered an emergency. If left untreated, it can lead to permanent visual impairment within two or three days or even blindness in the eye.

Those who experience a sudden increase in floaters, flashes of light in peripheral vision, or a loss of peripheral vision, like a curtain covering part of their vision should seek care by an eye care specialist as soon as possible.

Retinal Care

Overview

How we Diagnose Retina Conditions

Your First Visit:

Diabetic Retinopathy

What is Diabetic Eye Disease?

How common is Diabetic Retinopathy or Proliferative Diabetic Retinopathy?

What are the Signs and Symptoms of Diabetic Retinopathy?

What is the Treatment to Diabetic Retinopathy?

How do I prevent Diabetic Retinopathy?

Macular Degeneration (AMD)

The Effects of Macular Degeneration

Possible Causes and Risk Factors

How We Diagnose Macular Degeneration

Treating Macular Degeneration

Floaters

What causes Floaters?

Who is at risk for Floaters?

How are Floaters treated?

Can Floaters be dangerous?

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