Retinal Conditions

What is diabetic retinopathy?

Diabetic Retinopathy results from deterioration of the retinal blood vessels. Over time, irregular levels of blood glucose damage small vessels in the body of a diabetic. Small vessels occur in the heart, kidney, peripheral circulation, and the retina of the eye. Damage to these retinal vessels diminishes the oxygen and nutrition available to the retina. Furthermore, the defective blood vessels leak and deposits of blood, lipid and fluid bog down the neural function of the retina as well. The retina acts like the film in the camera of the eye. If the film is bad, the picture is bad. Unfortunately, the retina cannot be replaced and any damage results in permanent vision loss.

There are two types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

• NPDR is an early stage of diabetic retinopathy. NPDR occurs when the blood vessels in the retina leak which causes the retina to swell. NPDR initially does not affect vision unless edema is present in the macula, which is the area of retina responsible for central vision. As NPDR progresses, the retinal vessels can collapse and become obliterated; ischemia(lack of oxygen) results. If the ischemia is in the macula area, vision loss would be devastating and permanent.

• PDR is a more advanced stage of diabetic retinopathy occurring after retinal vessel damage and collapse in the peripheral retina. When peripheral vessels are obliterated, new vessels begin developing on the retina in response to the ischemia. Unfortunately, these new vessels are abnormal, hemorrhage easily, and form scar tissue bands that detach and further damage the retina. PDR can result in more severe vision loss, including complete blindness.

The best treatment of diabetic retinopathy is prevention. If detected early, changes in the retinal blood vessels can be treated before vision loss occurs. Finally, meticulous control of the disease of diabetes itself goes a long way in maintaining good vision.

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Macular Degeneration is a medical condition that affects the central vision. Characteristic yellow deposits called drusen result from aging and disrupt the normal architecture of the retinal tissue in the macular area. Because the macular retina is responsible for our visual detail patients can have difficulty reading, driving and recognizing faces. Peripheral vision is usually not affected. Many patients have early macular degeneration and macular drusen is the second most common finding on eye examinations over the age of 65 years. Fortunately, macular drusen or “dry” macular degeneration usually takes many years to become symptomatic and symptoms are commonly minor. However, significant loss of vision does occur for many patients and progression to bleeding or “wet” macular degeneration is a serious risk. Regular medical eye examinations are recommended to minimize the threat of vision loss.

Below is a simulation of how the progression in Macular Degeneration can affect your vision over time if left untreated.

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Macular Holes occur sporadically as a result of the natural aging process of the eye. The vitreous is the clear fluid inside the back of the eye and will shrink with age. The vitreous normally separates from the retina with no negative effect during this process. For some individuals, the vitreous does not separate seamlessly and instead continues to stick to the retina. If the vitreous remains attached to the central portion of the retina, called the macula, vision may be affected. The macular tissue will be stretched and can tear creating a macular hole. A surgical macular repair is the most effective way to treat a macular hole.

What are floaters?

Floaters are little “cobwebs” or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving. They are caused by clumps or specks of undissolved vitreous gel material floating in the dissolved gel-like fluid (vitreous) in the back of the eye, which cast shadows on the retina when light enters the eye.

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Treating Floaters

Laser Floater Removal (LFR), also known as Laser Vitreolysis, is a highly effective procedure, which involves the use of a nano-pulsed YAG laser to vaporize vitreous strands and opacities (floaters). Laser Floater Removal is well suited to the Weiss-ring type of floater caused by a PVD. Because these floaters are fibrous, they absorb the laser energy well and can be vaporized more efficiently. In addition, they are usually located safely away from the crystalline lens and the retina. If you are interested in learning more about LFR and to see if you are a candidate, give our office a call at 717-767-2000.

Retinal Vein Occlusions occur when a vein in the retina is obstructed. Retinal vein occlusions can occur for many reasons most of which are medical such as hypertension. If no medical history can account for the occlusion, a thorough medical workup for a cause would be initiated.

There are two types of vein occlusions: branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO).

• BRVO occurs when a smaller branch leading from the central vein becomes obstructed.
• CRVO occurs when the whole central vein becomes blocked.

Call 717-767-2000 to schedule your next appointment!