The retina is the layer of tissue that lines the back of the inside of the eye. It plays a crucial role in your vision by sending signals to the optic nerve, which communicates with the brain what images the eye is seeing. Having a healthy retina is important in maintaining clear vision. When the retina becomes damaged or diseased, it's important to see an ophthalmologist or retina specialist to help prevent vision loss from occurring or worsening.
There are a number of eye conditions that can cause damage to the retina including the following:
People diagnosed with diabetes are at risk of developing a condition called diabetic retinopathy. A leading cause of blindness, diabetic retinopathy is caused by high blood sugar levels and causes damage to the blood vessels in the retina. The longer you have diabetes, the more likely you are to develop diabetic retinopathy.
There may not be symptoms in the early stages of diabetic retinopathy. For this reason, if you have diabetes, getting annual eye exams is imperative so the eye doctor is able to detect any signs of the disease as early as possible. However, as diabetic retinopathy progresses, symptoms may appear including:
- Seeing floaters
- Blurry vision
- Cloudy, dark vision
- Vision loss
Depending on the severity of the diabetic retinopathy, treatment may be necessary. Treatment options include medications, laser treatments, and surgery such as vitrectomy.
Macular degeneration is a leading cause of blindness in people over the age of 50. It is characterized by the deterioration of the macula, the central part of the retina. The macula is responsible for your central vision, allowing you to see fine details and essential for activities such as reading or driving.
There are two types of macular degenerations:
- Dry macular degeneration- This type is the most common, responsible for approximately 90% of macular degeneration cases. It is a result of thinning retinal tissue and loss of retinal pigment. Small, yellow deposits called drusen may form. Dry macular degeneration may lead to gradual vision loss.
- Wet macular degeneration- This is a more rare form of macular degeneration but it is also more severe. Abnormal blood vessels grow beneath the retina which then leak blood and fluid. This causes damage to the macula and can lead to quick and more serious vision loss.
In the early stages of macular degeneration, there may not be any noticeable symptoms. However, if the disease progresses, symptoms may include distorted lines, blurry central vision, and faded colors. It's important to get regular eye exams so the ophthalmologist can monitor the disease and notice any change in vision.
There is currently no cure for macular degeneration. Nonetheless, some studies have shown that a healthy diet, exercise, not smoking, and avoiding exposure to sunlight may help slow the progression of the disease. Nutritional supplements following the AREDS 2 study guidelines may be recommended. For wet macular degeneration, treatments available include eye injections, photodynamic therapy, and laser treatments.
Retinal Tears and Detachments
The inside of the eye, between the lens and the retina, contains a gel-like substance called vitreous. The vitreous is attached to the retina. As we age, the vitreous becomes thinner and can pull away from the retina. This can result in the appearance of floaters and flashes. In most cases, floaters and flashes are not problematic. However, if the vitreous pulls away hard enough, the floaters and flashes can be a sign that a retinal tear has occurred. If a tear in the retina develops, fluid can get behind the retina and lead to a retinal detachment, which is when the retina separates from the back of the eye entirely.
Symptoms of a retinal tear or detachment include:
- Sudden increase in floaters
- Sudden onset of flashes
- Dark side vision
- Seeing a gray curtain move across your vision.
Retinal tears are usually treated with laser treatment or cryotherapy (freezing). These treatments are performed in-office and help seal the retina on to the back of the eye which prevents a retinal detachment from occurring. Retinal detachments will require surgery to return the retina back to its normal position. The type of surgery performed will depend on the severity of the detachment but the options include scleral buckle, pneumatic retinopexy, and vitrectomy.
Macular holes occur as we age and primarily affect those over the age of 60. A macular hole is a tear in the macula, the small area in the center of the retina responsible for central vision. A macular hole occurs when the vitreous pulls away from the retina and tears off a piece of the macula with it, leaving a hole in the macula.
Symptoms of a macular hole include blurriness, distorted vision, and a blind spot in the central vision. The extent to which vision is affected will depend on the size and stage of the macular hole. If it is left untreated, macular holes can worsen over time and cause worsening vision. Oftentimes, surgery is required to repair the macular hole and a vitrectomy is the primary surgery recommended. A vitrectomy involves removing the vitreous from the eye and replacing it with a gas bubble to hold the edges of the macula in place while it heals.
A macular pucker is scar tissue that develops on the retina. This scar tissue forms when the vitreous pulls away from the retina and damages the retina as a result. As the scar tissue contracts, it causes the retina to wrinkle, or pucker. Symptoms of a macular pucker include
- Distorted vision
- Straight lines appear wavy
- Gray area in central vision
- Blind spot in central vision
If the macular pucker causes mild vision impairments, then treatment may not be necessary. Rather, prescription glasses or contact lenses may be recommended. However, if vision loss is severe, then vitrectomy surgery can be beneficial.
Lattice degeneration is the thinning of the peripheral, or outer edge, of the retina and usually develops in both eyes. Though the cause of lattice degeneration is unknown, there are some contributing risk factors. These include being nearsighted and having a family history of lattice degeneration.
Lattice degeneration does not have symptoms so it requires a comprehensive eye exam to be diagnosed. However, in some cases, it may lead to a retinal tear or detachment which do have symptoms, including the sudden appearance of flashes and floaters and loss of peripheral vision.
Treatment for lattice degeneration is usually not necessary but your retina specialist will monitor it for any changes.
Retinal Vein Occlusions
There is one main central vein that carries blood from the retina to the heart. There are also smaller veins that branch off of the central vein. When one of these veins become blocked, a retinal vein occlusion occurs. Essentially, this is considered an eye stroke. There are two types of retinal vein occlusions:
- Central retinal vein occlusion (CRVO) - The blockage occurs in the main central vein.
- Branch retinal vein occlusion (BRVO)- The blockage occurs in one of the small veins that branch off the central vein.
When the vein becomes blocked, blood is unable to leave the retina and may cause bleeding, swelling, and leaking of fluid. The most common symptom is blurry vision or loss of vision. Other symptoms may include floaters, pain, or pressure in the eye. There is no treatment available to clear the blockage in the vein. Rather, treatment involves the complications of the blockage and preventing or reducing vision loss. Treatments include injections in the eye, focal laser therapy, and photocoagulation laser therapy.
Uveitis and Iritis
Uveitis is the inflammation of the uvea. The uvea is the middle layer of the eye containing the iris, ciliary body, and choroid. Uveitis is most common in people age 20-60. It does not always have a known cause but eye infection, eye injury, and autoimmune disorders are all potential causes.
One of the most common types of uveitis is iritis. Iritis, also known as anterior uveitis, is the inflammation of the iris, the colored part of the eye.
Symptoms of uveitis include:
- Red eyes Eye pain
- Sensitivity to light
- Decreased vision
- Blurred vision
- Increase in floaters
Treatment for uveitis will vary depending on the type of uveitis. Anti-inflammatory and antibiotic eye drops may be used to help reduce inflammation and fight infection. If the uveitis is severe, surgery may be necessary to help manage the disease.
A choroidal nevus is a benign pigmented area that grows underneath the retina in the choroid layer of the eye. Similar to how a freckle can grow on skin, a freckle can also grow in the eye. Most people don't realize they even have a choroidal nevus because they don't typically cause symptoms. A choroidal nevus is discovered when your eye doctor performs a comprehensive eye exam. Because it is benign, a choroidal nevus only requires monitoring, using imaging tests to notice any changes. In rare cases, it may develop into melanoma.
Retinopathy of Prematurity
Premature babies are at risk for developing retinopathy of prematurity, or ROP. Because the baby is born too early, the retina has not fully developed and abnormal blood vessels grow. These blood vessels may leak or bleed causing damage to the retina. As a result, vision loss or impairment may occur, potentially leading to lifelong vision problems.
ROP can only be detected with an eye exam. A pediatric ophthalmologist or retina specialist should perform an exam soon after the baby is born for initial diagnosis and then as needed to monitor for any changes in the disease. Oftentimes, ROP can resolve itself without needing treatment. However, if the ROP progresses, surgery may be required. Surgery options include photocoagulation therapy and cryotherapy. For more severe cases, scleral buckling or vitrectomy may be performed.