The retina is the film in the back of the eye that light rays and images are focused on. Tiny photoreceptor cells pick up those images and transmit them to electrical impulses that are sent via the optic nerve to the brain, where visual images are interpreted.
The center of the retina is called the macula. This is the most sensitive area of the retina used for our fine central vision. Retinal and specifically macular diseases can cause clouding and distortion of vision, loss of peripheral vision and eventually blindness. There are many types of retinal diseases which can significantly impair the vision. If you experience any visual disturbance, including flashes, floaters, a curtain over your eye or the sudden or gradual onset of blurred vision, you should have an ophthalmic exam.
Symptoms of retinal disease
Any condition that disturbs the center of the retina, called the macula, will result in the onset of blurred central vision. Sometimes subtle vision loss is difficult to detect unless you happen to close the unaffected eye.
You may also experience:
Waviness or distortion when looking at straight lines
A curtain coming over your vision, from above, below or either side
Flashes of light in your side vision, especially noticeable at night
Floaters, cobwebs, or worm-like shadows that move as you move your eye, especially noticeable against a solid blue or white background
Age: Aging processes can affect the macula, causing diseases like macular degeneration and epiretinal membranes
Disease: Certain systemic diseases, like diabetes or hypertension
Heredity: There are inherited conditions such as retinal dystrophies that cause night vision loss, color vision loss, light sensitivity or generalized blur from a young age. These conditions are often progressive
Eye trauma: A retinal tear may occur as a result of an eye injury or trauma to the retina
Your eye doctor can check for retinal conditions like macular degeneration and diabetic eye changes (retinopathy) by doing a thorough eye exam, which includes dilation and examination using special magnifying instruments. We can also take photographs and perform optical coherence tomography, and fluorescein angiography to help diagnose retinal disease.
The following tests may be done to determine the location and extent of the disease:
Amsler grid test. Your doctor may use an Amsler grid to test the clarity of your central vision. If you have macular degeneration, he or she might also ask you to use this test to self-monitor your condition at home.
Optical coherence tomography (OCT). This test is an excellent technique for capturing precise images of the retina to diagnose epiretinal membranes, macular holes and macular swelling (edema), to monitor the extent of age-related wet macular degeneration, and to monitor responses to treatment.
Fundus autofluorescence (FAF). FAF may be used to determine the advancement of retinal diseases, including macular degeneration.
Fluorescein angiography. This test uses a dye that causes blood vessels in the retina to stand out under a special light.
Indocyanine green angiography. This test uses a dye that lights up when exposed to infrared light. The resulting images show retinal blood vessels and the deeper, harder-to-see blood vessels behind the retina in a tissue called the choroid.
Ultrasound. This test uses high-frequency sound waves (ultrasonography) to help view the retina and other structures in the eye. It can also identify certain tissue characteristics that can help in the diagnosis and treatment of eye tumors.
CT and MRI. In rare instances, these imaging methods can be used to help evaluate eye injuries or tumors.
An intravitreal injection is a procedure to place medication directly into the cavity in the back of the eye. The cavity in the back of the eye is filled with a fluid called the vitreous humor.
The most common and effective treatment for wet macular degeneration is an intravitreal injection of medications called anti-vascular endothelial growth factors (anti-VEGF).
In macular degeneration, vascular endothelial growth factors promote the growth of abnormal blood vessels, which leak into the retina, causing damage. The anti-VEGF drugs inhibit the formation of these new abnormal blood vessels and can decrease retinal swelling.
These injections are usually given on a monthly or bimonthly basis until the retina has stabilized.
Commonly used anti-VEGF medications are:
Retinal surgery (vitrectomy)
We remove the vitrectomy – the gel-like fluid inside your eyes, called vitreous, and inject gas or liquid into the space. This allows your ophthalmologist better access to your retina, or the back of your eye. We may also use this treatment if blood in your vitreous gel does not clear on its own. It can be used as part of your treatment if you have a retinal tear, a macular hole, diabetic retinopathy, eye infections, eye trauma or a retinal detachment.
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Dr. Bennett Chotiner is the founder and medical director of Memorial Eye Institute. A noted innovator, in 1977 he established his clinical practice, the Pennsylvania Eye Associates. In 1984, he established the Pennsylvania Eye Surgery Center, Pennsylvania’s first …
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Erik Chotiner, M.D. diagnoses and treats a wide range of medical eye conditions. He is a Phi Beta Kappa graduate of Franklin and Marshall College. Dr. Chotiner attended Jefferson Medical College in Philadelphia where he received multiple awards including the Physiology Prize for …
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