Retina

Your eyes are extremely complex. Everything works together seamlessly to provide you with clear, functional vision. One of the most important structures inside of your eye is the retina.

The retina is a thin tissue that lines the back interior of the eye. The retina is actually an extension of the brain, formed from neural tissue and connected to the brain by the optic nerve. The retina is made up of several layers, one of which contains light-sensitive photoreceptor cells. There are two types of photoreceptor cells in the retina – rods, which detect light intensity, and cones, which provide detail and color vision.

The retinal cells are stimulated by light, and responsible for translating light into neural signals that then travel along the optic nerve to the brain. The brain processes this information and constructs an image.

The retina is important for a number of reasons. It creates the image, and transmits that information to the brain for us to be able to see. A healthy retina is the basis for all good vision.

Unfortunately, the retina is susceptible to many different conditions, both preventable and not. To compound the danger, once sustained, damage to the retina is irreversible. If retinal cells die, there is no amount of treatment that can bring them back. This is why Advanced Valley Eye Associates believe proactive retinal health care is so important!

Common Retinal Conditions

Flashers & Floaters

Flashes and floaters are extremely common and relatively harmless. Flashes, which appear as sudden flashes of light (almost like a “lightning strike”) in the visual field, are common with age. Floaters, which appear as specks floating around in the visual field, are common in people of all ages, but become more prominent with age.

Flashes are most often a result of the vitreous body (the substance that fills the center of the eyeball) shrinking and pulling away from the optic nerve head. This is common with age, as the vitreous begins to become less liquid-like and more gel-like, causing shrinkage.

Floaters may appear like specks on the surface of the eye, but they are actually floating around on the inside. As you age, the pieces of vitreous humor begin to clump together and form little specks. These specks float around inside of your eye and cast a shadow on the retina, which is why you can see them in your vision.

Flashes and floaters themselves are harmless. Often, they are just a symptom of age and nothing to worry about. Still, if there is a sudden change in your symptoms of flashers or floaters, an urgent visit to the ophthalmologist is in order! While usually no more than the vitreous body detaching from the optic nerve (a normal event) the sudden onset of new symptoms CAN be a symptom of a retinal tear, a serious condition which can lead to a retinal detachment, which is considered a medical emergency.

Flashes do not have a treatment, and with time, tend to reduce. Floaters do not need to be treated most of the time. However, if your floaters are significantly bothersome, and interfere with vision, there are now newer laser techniques available. Ask Dr. Miller if you might be a candidate for Laser Floater Removal at Advanced Valley Eye Associates.

The Laser Floater Ablation Procedure

The most efficient and painless method is YAG laser ablation to obliterate the floaters. It is much safer and less expensive than vitrectomy.

• The Ellex Laser, the laser used by Dr. Miller, is the only FDA-approved laser specially designed for this purpose.
• Removes the floaters, not the vitreous.
• Effective in 92% of cases.
• Non-invasive.
• Pain-free procedure that can eliminate the visual disturbance caused by floaters.
• Typically takes 20-60 minutes per treatment session.
• On average, patients will require two treatment sessions to achieve a satisfactory result.

Diabetic Retinopathy

Diabetic retinopathy is a common eye condition that occurs in patients with uncontrolled diabetes (both type 1 and 2). Your chance of getting diabetic retinopathy increases the longer you’ve had diabetes, the frequency in which your blood glucose changes, and the type of diabetes you have.

Diabetic retinopathy is caused by high blood glucose levels for a prolonged period of time. Over time, high blood glucose levels can cause small blood vessels in the retina to become blocked. Your eye will then try to grow new blood vessels to make up for the lack of blood flow, but these blood vessels are abnormal and prone swelling and leaking. The fluid leaked into the retina can cause another condition called macular edema, when the central portion of the retina begins to swell. This causes problems with central vision.

Diabetic retinopathy occurs in stages. Over time, as the condition progresses, fluid and blood can be leaked into the eye uncontrollably. This causes blind spots and swelling in the eye, which can severely affect vision. Certain types of diabetic retinopathy also makes glaucoma development more likely, as pressure inside of the eye is elevated.

Many people don’t realize they have diabetic retinopathy until vision changes occur. It is important to get this condition diagnosed early to prevent vision loss and damage to the retina. The symptoms of diabetic retinopathy often include loss of central vision when you read or drive, loss of color vision, blurry vision, and blind spots in vision.

Regulating blood glucose levels, especially in the early stages, can control diabetic retinopathy. As the condition worsens, laser therapy and medications may be necessary to stop the growth of abnormal blood vessels. A surgical procedure called a vitrectomy can be performed to remove blood from the inner eye, which can restore some vision.

Age-Related Macular Degeneration (AMD)

The central portion of the retina, called the macula, is responsible for sharp central vision. Macular degeneration is the leading cause of vision loss, and affects more people than cataracts and glaucoma combined.

Macular degeneration occurs when the macula begins to deteriorate. This is an age-related condition, although there are forms that affect younger people. There are two types of macular degeneration: dry AMD and wet AMD. The vast majority of cases of AMD are the dry form (about 85-90%). Wet AMD makes up for about 10-15% of AMD cases.

There are three stages of dry AMD:

Early AMD is diagnosed by the presence of medium-sized drusen (yellow deposits beneath the retina). Most people with early AMD do not have vision loss. This condition is typically only diagnosed during eye exams.

Intermediate AMD is diagnosed by the presence of larger drusen or pigment changes in the retina. During this stage, there may be some vision loss, but some people may not notice changes.

Late-stage AMD is accompanied by noticeable vision loss.

Dry and wet AMD are treated differently. Early dry AMD cannot be treated directly, but progression may be slowed by nutritional therapy. The vitamin supplements studied in the Age Related Eye Disease Study (AREDS) can be used to reduce the progression of dry AMD by up to 25%, and often are recommended by Dr. Miller to our patients. These can be purchased commercially as “Ocuvites Preservision”, or obtained in our office as “Retinavites”, both of which have the same vitamin formula.

Wet AMD is accompanied by leaking blood vessels, which is why it’s referred to as “wet”. These blood vessels can leak blood under the retina, causing scarring and vision loss. Wet AMD is typically treated with either laser therapy or injectable anti-VEGF medication therapy. Both of these treatments are aimed at stopping the growth of weak blood vessels, and preventing leakage.

If you have symptoms or questions about your retina, or about retinal disease, we’re happy to evaluate your situation at Advanced Valley Eye Associates!