Below we have outlined a number of retina conditions, their symptoms and various treatment options.
Retinal disorders often represent the most serious and challenging of eye problems to diagnose and manage. At Retina Specialists of Tampa, we provide pain free treatment in the most difficult cases. We are committed to offering our patients the most sophisticated and comprehensive diagnostic evaluations and the most current eye surgery and care treatments.
Our retina specialist, Dr. Tarabishy and his staff provide highly-specialized eye care in a personal and individualized manner, involving family members and caregivers if desired. A treatment plan is tailored to your needs after a careful discussion to help you understand your diagnosis, treatment options, and expected outcomes.
At Retina Specialists of Tampa, we have dedicated our life to your eyesight and specifically your retina health. Our principal mission is to bring your life into focus. Dr. Tarabishy is one of the area’s most respected eye surgeons, he is a Board Certified Ophthalmologist and Retina specialist. Dr. Tarabishy performs both Laser surgery and Cryotherapy, providing our patients with both the care and peace of mind they deserve. Contact us today for the complete Retina care you need, beacause your eyes deserve great care.
Below we have outlined a number of retina conditions, their symptoms and various treatment options. Yet, even with daily advancement and medical breakthroughs, early detection is critical in the treatment of Retinal conditions and diseases. So, if you or a loved one are experiencing any of these symptoms, we urge you to call us right away.
Diabetic retinopathy is a condition occurring in persons with diabetes, which causes progressive damage to the retina, the light sensitive lining at the back of the eye. It is a serious sight-threatening complication of diabetes.
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Diabetes can affect sight
Types of diabetic retinopathy
Traction retinal detachment
How is it diagnosed
How is it treated
Vision loss is preventable
When to schedule an exam
If you have diabetes mellitus, your body does not use and store sugar properly. High blood-sugar levels can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy.
Nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR, commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates.
Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected it is the result of macular edema (pronounced eh-DEEM-uh) and/or macular ischemia (pronounced ih-SKEE-mee-uh).
Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from retinal blood vessels. It is the most common cause of visual loss in diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral vision continues to function. Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly.
PDR is present when abnormal new vessels (neovascularization) begin growing on the surface of the retina or optic nerve. The main cause of PDR is widespread closure of retinal blood vessels, preventing adequate blood flow. The retina responds by growing new blood vessels in an attempt to supply blood to the area where the original vessels closed. Unfortunately, the new abnormal blood vessels do not resupply the retina with normal blood flow. The new vessels are often accompanied by scar tissue that may cause wrinkling or detachment of the retina. PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision.
Proliferative diabetic retinopathy causes visual loss in the following ways:
Vitreous hemorrhage: The fragile new vessels may bleed into the vitreous, a clear, gel-like substance that fills the center of the eye. If the vitreous hemorrhage is small, a person might see only a few new, dark floaters. A very large hemorrhage might block out all vision. It may take days, months, or even years to reabsorb the blood, depending on the amount of blood present. If the eye does not clear the vitreous blood adequately within a reasonable time, vitrectomy surgery may be recommended. Vitreous hemorrhage alone does not cause permanent vision loss. When the blood clears, vision may return to its former level unless the macula is damaged.
When PDR is present, scar tissue associated with neovascularization can shrink, wrinkling and pulling the retina from its normal position. Macular wrinkling can cause visual distortion. More severe vision loss can occur if the macula or large areas of the retina are detached.
Neovascular glaucoma: Occasionally, extensive retinal vessel closure will cause new, abnormal blood vessels to grow on the iris (colored part of the eye) and block the normal flow of fluid out of the eye. Pressure in the eye builds up, resulting in neovascular glaucoma, a severe eye disease that causes damage to the optic nerve.
A medical eye examination is the only way to detect changes inside your eye. An ophthalmologist (Eye M.D.) can often diagnose and treat serious retinopathy before you are aware of any vision problems.
The ophthalmologist dilates your pupil and looks inside of the eye with an ophthalmoscope. If your ophthalmologist finds diabetic retinopathy, he or she may order color photographs of the retina or a special test called fluorescein angiography to find out if you need treatment. In this test a dye is injected into your arm and photos of your eye are taken to detect where fluid is leaking.
The best treatment is to prevent the development of retinopathy as much as possible. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. If high blood pressure and kidney problems are present, they need to be treated.
Laser surgery: Laser surgery is often recommended for people with macular edema, PDR, and neovascular glaucoma. For macular edema, the laser is focused on the damaged retina near the macula to decrease the fluid leakage. The main goal of treatment is to prevent further loss of vision. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement. A few people may see the laser spots near the center of their vision following treatment. The spots usually fade with time but may not disappear. For PDR, the laser is focused on all parts of the retina except the macula. This panretinal photocoagulation treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.
Vitrectomy: In advanced PDR, your ophthalmologist may recommend a vitrectomy. During this microsurgical procedure, which is performed in the operating room, the blood-filled vitreous is removed and replaced with a clear solution. Your ophthalmologist may wait for several months or up to a year to see if the blood clears on its own before performing a vitrectomy. Vitrectomy often prevents further bleeding by removing the abnormal vessels that caused the bleeding. If the retina is detached, it can be repaired during the vitrectomy surgery. Surgery should usually be done early because macular distortion or traction retinal detachment will cause permanent visual loss. The longer the macula is distorted or out of place, the more serious the vision loss will be.
If you have diabetes, it is important to know that today, with improved methods of diagnosis and treatment, only a small percentage of people who develop retinopathy have serious vision problems. Early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision loss by maintaining strict control of your blood sugar and visiting your ophthalmologist regularly.
People with diabetes should schedule examinations at least once a year. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy. Pregnant women with diabetes should schedule an appointment in the first trimester, because retinopathy can progress quickly during pregnancy.
If you need to be examined for eyeglasses, it is important that your blood sugar be consistently under control for several days when you see your ophthalmologist. Eyeglasses that work well when blood sugar is out of control will not work well when blood sugar is stable.
Rapid changes in blood sugar can cause fluctuating vision in both eyes even if retinopathy is not present. You should have your eyes checked promptly if you have visual changes that:
• Affect only one eye
• Last more than a few days
• Are not associated with a change in blood sugar
When you are first diagnosed with diabetes, you should have your eyes checked:
• Within five years of the diagnosis if you are 29 years old or younger
• Within a few months of the diagnosis if you are 30 years old and older
floaters and flashes
You may sometimes see small specks or clouds moving in your field of vision. These are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear gel-like fluid that fills the inside of your eye. While these objects look like they are in front of your eye, they are actually floating inside it. What you see are the shadows they cast on the retina, the layer of cells lining the back of the eye that senses light and allows you to see. Floaters can appear as different shapes such as little dots, circles, lines, clouds, or cobwebs.
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What causes floaters
Are floaters serious
Can floaters be removed
What causes flashing lights
When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. This is a common cause of floaters.
Posterior vitreous detachment is more common in people who:
• Are nearsighted
• Have undergone cataract operations
• Have had YAG laser surgery of the eye
• Have had inflammation inside the eye
The appearance of floaters may be alarming, especially if they develop very suddenly. You should contact your ophthalmologist (Eye M.D.) right away if you develop new floaters, especially if you are over 45 years of age.
The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters. A torn retina is always a serious problem, since it can lead to a retinal detachment.
You should see your ophthalmologist at Lakeland Eye Clinic As soon as possible if:
• Even one new floater appears suddenly
• You see sudden flashes of light
If you notice other symptoms, like the loss of side vision, you should see your ophthalmologist.
Floaters may be a symptom of a tear in the retina, which is a serious problem. If a retinal tear is not treated, the retina may detach from the back of the eye. The only treatment for a detached retina is surgery. Other floaters are harmless and fade over time or become less bothersome, requiring no treatment. Even if you have had floaters for years, you should schedule an eye examination with your ophthalmologist if you suddenly notice new ones.
Some people may have particularly large or opaque vitreous floaters that can be very bothersome and interfere with regular activities. Vitrectomy can be performed to remove floaters in select patients. Your physician can tell you more about the potential benefit and risks, and if you are an appropriate candidate for the procedure.
When the vitreous gel rubs or pulls on the retina, you may see what look like flashing lights or lightning streaks. You may have experienced this same sensation if you have ever been hit in the eye and seen “stars.”
The flashes of light can appear off and on for several weeks or months. As we grow older, it is more common to experience flashes. If you notice the sudden appearance of light flashes, you should contact your ophthalmologist immediately in case the retina has been torn.
Floaters and flashes of light become more common as we grow older. While not all floaters and flashes are serious, you should always have a medical eye examination by an ophthalmologist to make sure there has been no damage to your retina.
Macular degeneration is a deterioration or breakdown of the macula. The macula is a small area in the retina at the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. When the macula does not function correctly, your central vision can be affected by blurriness, dark areas or distortion. Macular degeneration affects your ability to see near and far, and can make some activities—like threading a needle or reading—difficult or impossible.
Although macular degeneration reduces vision in the central part of the retina, it usually does not affect the eye’s side, or peripheral, vision. For example, you could see the outline of a clock but not be able to tell what time it is. Macular degeneration alone does not result in total blindness. Even in more advanced cases, people continue to have some useful vision and are often able to take care of themselves.
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Adapting to low vision
Testing your vision
Many elder people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD). Exactly why it develops is not known. Macular degeneration is the leading cause of severe vision loss in Caucasians over 65. The two most common types of AMD are “dry” (atrophic) and “wet” (exudative):
“DRY” MACULAR DEGENERATION (ATROPHIC)
Most people have the “dry” form of AMD. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.
“WET” MACULAR DEGENERATION (EXUDATIVE)
The “wet” form of macular degeneration accounts for about 10% of all AMD cases. It results when abnormal blood vessels form underneath the retina at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe. Deposits under the retina called drusen are a common feature of macular degeneration.
Drusen alone usually do not cause vision loss, but when they increase in size or number, this generally indicates an increased risk of developing advanced AMD. People at risk for developing advanced AMD have significant drusen, prominent dry AMD, or abnormal blood vessels under the macula in one eye (“wet” form).
Macular degeneration can cause different symptoms in different people. The condition may be hardly noticeable in its early stages. Sometimes only one eye loses vision while the other eye continues to see well for many years. But when both eyes are affected, the loss of central vision may be noticed more quickly.
Following are some common ways vision loss is detected:
• Words on a page look blurry
• A dark or empty area appears in the center of vision
• Straight lines look distorted, as in the following diagram
Many people do not realize that they have a macular problem until blurred vision becomes obvious. Your ophthalmologist can detect early stages of AMD during a medical eye examination that includes the following:
1. A simple vision test in which you look at a chart that resembles graph paper
2. Viewing the macula with an ophthalmoscope
3. Taking special photographs of the eye called fluorescein angiography to find abnormal blood vessels under the retina
A large scientific study found that people at risk for developing advanced stages of AMD lowered their risk by about 25% when treated with a high-dose combination of vitamin C, vitamin E, beta carotene and zinc. Among those who have either no AMD or very early AMD, the supplements did not appear to provide an apparent benefit.
It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision that you may have already lost from the disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. You should make an appointment with Dr. Tarabishy, our board certified Ophthalmologist, and retina Specialist to determine if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.
LASER SUGERY, PDT AND ANTI-VEGF TREATMENTS
Certain types of “wet” macular degeneration can be treated with laser surgery, a brief outpatient procedure that uses a focused beam of light to slow or stop leaking blood vessels that damage the macula. A treatment called photodynamic therapy (PDT) uses a combination of a special drug and laser treatment to slow or stop leaking blood vessels.
Another form of treatment targets a specific chemical in your body that is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage.
These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, many people with macular degeneration still experience some vision loss.
To help you adapt to lower vision levels, your ophthalmologist at Retina Specialists of Tampa can prescribe optical devices or refer you to a low-vision specialist or center. A wide range of support services and rehabilitation programs are also available to help people with macular degeneration maintain a satisfying lifestyle.
Because side vision is usually not affected, a person’s remaining sight is very useful. Often, people can continue with many of their favorite activities by using low-vision optical devices such as magnifying devices, closed-circuit television, large-print reading materials and talking or computerized devices.
You can check your vision daily by using an Amsler grid like the one pictured here:
DOWNLOAD THE GRID
To use the grid:
1. Wear your reading glasses and hold this grid 12–15 inches away from your face in good light.
2. Cover one eye.
3. Look directly at the center dot with the uncovered eye.
4. While looking directly at the center dot, note whether all lines of the grid are straight or if any areas are distorted, blurred or dark.
5. Repeat this procedure with the other eye.
6. If any area of the grid looks wavy, blurred or dark, contact your ophthalmologist immediately.
The retina is a nerve layer at the back of your eye that senses light and sends images to your brain. An eye is like a camera. The lens in the front of the eye focuses light onto the retina. You can think of the retina as the film that lines the back of a camera.
A retinal detachment occurs when the retina is pulled away from its normal position. The retina does not work when it is detached. Vision is blurred, just as a photographic image would be blurry if the film were loose inside the camera. A retinal detachment is a very serious problem that almost always causes blindness unless it is treated.
Almost all patients with retinal detachments require surgery to return the retina to its proper position.
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Types of surgery and risks
A clear gel called vitreous (vit-ree-us) fills the middle of the eye. As we get older, the vitreous may pull away from its attachment to the retina at the back of the eye. Usually the vitreous separates from the retina without causing problems. But sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through the retinal tear, lifting the retina off the back of the eye, much as wallpaper can peel off a wall.
The following conditions increase the chance of having a retinal detachment:
• Previous cataract surgery
• Severe injury
• Previous retinal detachment in your other eye
• Family history of retinal detachment
• Weak areas in your retina that can be seen by your ophthalmologist
These early symptoms may indicate the presence of a retinal detachment:
• Flashing lights
• New floaters
• A shadow in the periphery of your field of vision
• A gray curtain moving across your field of vision
These symptoms do not always mean a retinal detachment is present; however, you should see your ophthalmologist as soon as possible. Your ophthalmologist can diagnose retinal detachment during an eye examination in which he or she dilates (enlarges) the pupils of your eyes. Some retinal detachments are found during a routine eye examination. Only after careful examination can your ophthalmologist tell whether a retinal tear or early retinal detachment is present.
Most retinal tears need to be treated with laser surgery or cryotherapy (freezing), which seals the retina to the back wall of the eye. These treatments cause little or no discomfort and may be performed in your ophthalmologist’s office. Treatment usually prevents retinal detachment.
types of surgery
There are several ways to fix a retinal detachment. The decision about which type of surgery and anesthesia (local or general) to use depends upon the characteristics of your detachment. In each of the following methods, your ophthalmologist will locate the retinal tears and use laser surgery or cryotherapy to seal the tear.
THE RISKS OF SURGERY
Any surgery has risks; however, an untreated retinal detachment usually results in permanent severe vision loss or blindness. Some of the surgical risks include:
• High pressure in the eye
Most retinal detachment surgery is successful, although a second operation is sometimes needed. If the retina cannot be reattached, the eye will continue to lose sight and ultimately become blind. The more severe the detachment, the less vision may return.
The eye is shaped much like a tennis ball, with three different layers of tissue surrounding the central gel-filled cavity. The innermost layer is the retina, which senses light and helps to send images to your brain. The middle layer between the sclera and retina is called the uvea. The outermost layer is the sclera, the strong white wall of the eye. Uveitis (pronounced you-vee-EYE-tis) is inflammation of the uvea.
The uvea contains many blood vessels— the veins, arteries, and capillaries—that carry blood to and from the eye. Since the uvea nourishes many important parts of the eye (such as the retina), inflammation of the uvea can damage your sight
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Uveitis has many different causes:
• A virus, such as shingles, mumps, or herpes simplex;
• A fungus, such as histoplasmosis;
• A parasite, such as toxoplasmosis;
• Related disease in other parts of the body, such as arthritis, gastrointestinal disease, or collagen vascular disease such as lupus;
• A result of injury to the eye.
In most cases of uveitis, the cause of the disease remains unknown.
Uveitis may develop suddenly with redness and pain or with a painless blurring of your vision.
A case of simple “red eye” may in fact be a serious problem of uveitis. If your eye becomes red or painful, you should be examined and treated by an ophthalmologist (Eye M.D.).
Symptoms of uveitis include:
• Light sensitivity
• Blurred vision
• Redness of the eye
A careful eye examination by an ophthalmologist is extremely important when symptoms occur. Inflammation inside the eye can permanently affect sight or even lead to blindness if it is not treated.
Your ophthalmologist will examine the inside of your eye. He or she may order blood tests, skin tests, or x-rays to help make the diagnosis.
Uveitis is a serious eye condition that may scar the eye. It needs to be treated as soon as possible.
Eyedrops, especially corticosteroids and pupil dilators, can reduce inflammation and pain. For more severe inflammation, oral medication or injections may be necessary.
Uveitis can be associated with these complications:
• Glaucoma (increased pressure in the eye);
• Cataract (clouding of the eye’s natural lens);
• Neovascularization (growth of new, abnormal blood vessels);
• Damage to the retina, including retinal detachment.
These complications also may need treatment with eyedrops, conventional surgery, or laser surgery. If you have a “red eye” that does not clear up quickly, contact your ophthalmologist.
Since uveitis can be associated with disease in other parts of the body, your ophthalmologist will want to know about your overall health. He or she may want to consult with your primary care physician or other medical specialists.
If uveitis is caused by an underlying condition, treatment will focus on that specific condition. The goal of treatment is to reduce the inflammation in your eye. Several treatment options are available.
Drugs that reduce inflammation. Your doctor may first prescribe eyedrops with an anti-inflammatory medication, such as a corticosteroid. If those don't help, a corticosteroid pill or injection may be the next step.
Drugs that fight bacteria or viruses. If uveitis is caused by an infection, your doctor may prescribe antibiotics, antiviral medications or other medicines, with or without corticosteroids, to bring the infection under control.
Drugs that affect the immune system or destroy cells. You may need immunosuppressive or cytotoxic drugs if your uveitis affects both eyes, doesn't respond well to corticosteroids or becomes severe enough to threaten your vision.
Some of these medications can have serious side effects, such as glaucoma and cataracts. You may need to visit your doctor for follow-up examinations and blood tests every 1 to 3 months.
Vitrectomy. Surgery to remove some of the vitreous in your eye (vitrectomy) may be necessary to manage the condition.
Surgery that implants a device into the eye to provide a slow and sustained release of a medication. For people with difficult-to-treat posterior uveitis, a device that's implanted in the eye may be an option. This device slowly releases corticosteroid medication into the eye for two to three years. Possible side effects of this treatment include cataracts and glaucoma.
The speed of your recovery depends in part on the type of uveitis you have and the severity of your symptoms. Uveitis that affects the back of your eye (choroiditis) tends to heal more slowly than uveitis in the front of the eye (iritis). Severe inflammation takes longer to clear up than mild inflammation does.
Uveitis can return. Contact us at Retina Specilists of Tampa to make an appointment with your doctor if any of your symptoms reappear after successful treatment.
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