Vitreo-Retinal and Macular Degeneration Frequently Asked Questions

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1 Vitreo-Retinal and Macular Degeneration Frequently Asked Questions What is a Vitreo-Retinal specialist? Retinal specialists are eye physicians and surgeons who focus on diseases in the back of the eye such as macular degeneration, diabetic disease, retinal detachment trauma and intraocular infection. Our Center For Sight vitreo-retinal specialist, William J. Mestrezat, M.D. is a medical doctor who has completed his training in eye surgery and disease. This includes a residency and fellowship specific to vitreo-retinal disease. What is the retina? The retina is the delicate, light-sensitive tissue that covers the interior wall of the eye. Like the film of a camera, it receives images projected through the lens of the eye and sends these images to your brain through the optic nerve. When the retina is damaged in any way, your vision becomes impaired. Damage to the retina may be caused by injury, illness or as a result of aging. What is the vitreous? The vitreous is a gel-like substance that fills the back of the eye and is loosely attached to the retina. What are floaters? Some people experience cobwebs, strings, or speck-like floaters in their field of vision. They are usually black and can float in and out of view. Floaters can be an indicator that the gel-like vitreous is liquefying, which is a normal ageing process but can also occur at an early age for those that are nearsighted or after an eye trauma. What is a post vitreous detachment (PVD)? The liquefaction usually continues until the vitreous separates from the retina to which it is loosely attached. The vast majority of PVDs do not cause problems except annoying floaters and sometimes brief flashes of light. Improvement in symptoms is usually seen within a few months. Occasionally retinal tears can occur with PVD. Retinal tears can lead to a detached retina if the retina tear is not treated. There is no way to tell if a PVD caused a retinal tear so if someone has symptoms of a PVD they need a prompt dilated retinal exam. What is retinal detachment? When the retina detaches, it separates or pulls from its normal position, this can occur for retina holes, tears or traction from scar tissue. If not promptly treated, retinal detachment can cause permanent vision loss.

2 What are the symptoms of retinal detachment? Symptoms include new floaters or a sudden or gradual increase in either the number and or severity of floaters, which are like cobwebs, strings or specks that float about in your field of vision, and/or light flashes in the eye. Another symptom is the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately. Who is at risk for retinal detachment? A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women and Caucasians more than African Americans. A retinal detachment is also more likely to occur in people who are nearsighted or have had a retinal detachment in the other eye, a family history of retinal detachment, cataract surgery, an eye injury or systemic eye diseases. How can vitreo-retinal problems be treated? Problems with the retina and vitreous including retinal tear, retinal detachment, severe intraocular infection, eye disease and trauma can lead to vision loss and even blindness. Surgery, lasers and injections can correct problems before vision is lost or prevent further deterioration from occurring. What is diabetic retinopathy? Diabetic retinopathy is a complication of diabetes that weakens the blood vessels that supply nourishment to the retina. When the weak vessels leak, swell or develop thin branches, vision loss occurs. In its advanced stages, the disease can cause blurred or cloudy vision, floaters and blind spots and eventually, blindness. Can diabetic retinopathy be prevented? Yes. People with diabetes are most susceptible to developing it, but your risk is reduced if you follow your prescribed diet and medications, exercise regularly, control your high blood pressure and avoid alcohol and cigarettes. Regular eye exams are an integral part of making sure your eyes are healthy. Can diabetic retinopathy be treated? Yes. Many of the problems caused by diabetic retinopathy such as swelling of the retina, bleeding in vitreous and scar tissue can be treated with modern techniques such as injections, laser or surgery. The earlier problems are found the easier they are to treat before vision loss becomes irreversible. Early and periodic dilated eye exams are very important.

3 What is macular degeneration? Macular Degeneration is a group of diseases characterized by a breakdown of the macula. The macula is the center portion of the retina that makes central distance vision and reading vision possible. The retina is the delicate innermost layer of tissue that lines the back of the eye. It contains layers of light receiving cells called photoreceptors that are connected to the brain by the optic nerve. If you think of the eye as a camera, the retina is the film on which images are recorded and the macula is the small, central part of the retina. What are the two main forms of macular degeneration? Dry macular degeneration involves degeneration of the pigment cells under the macula, these cells are vital to the retina so when the cells are lost the overlying retina stops functioning and blind spots may occur. Sometimes abnormal substances called drusen can accumulate under the macula in dry form of macular degeneration and can cause distortion and blind spots. Wet macular degeneration has abnormal blood vessel growth under the macula which can cause swelling and or bleeding. The vision loss with the wet form of macular degeneration is usually more rapid and severe then the dry form. What causes macular degeneration? Macular degeneration is the leading cause of vision loss in adults over the age of 55. Studies have found that both genetic and environmental risk factors influence the disease. Rarer forms of macular degeneration can occur in younger people and can be inherited or associated with trauma, infection or systemic disease. What are the symptoms of macular degeneration? Blurring of central vision Difficulty seeing detail up close and at a distance Distortion of lines and shapes Diminished color vision Are there special tests to diagnose macular degeneration? Yes. Your doctor will examine your eyes with special lenses to view the interior of the eye through the pupil. Other tests for macular degeneration include: Acuity Tests: this test measures the accuracy of your central vision at specific distances in specific lighting situations. Amsler Grid Test: this test checks for blind spots, loss of sight and distortion. Color Testing: this can help determine the status of your cone cells which are the cells located in the macula and are the retinal cells that interpret color. Fluorescein Angiogram Test: a dye is injected in the vein of your arm and then photos are taken of the retina and the macula in order to identify new blood vessel growth and leakage from blood vessels.

4 Optical Coherence Tonography (OCT): this test takes a cross section photo of the layers in the back of the eye. It is very beneficial to see if there is swelling, abnormal blood vessels or scar tissue in the macula. Can macular degeneration lead to total blindness? Most people with macular degeneration retain peripheral vision and learn to optimize the use of their remaining vision. Low vision aides can sometimes be helpful too. Can macular degeneration be prevented? No, the most important thing to do is to have regular eye exams, which may allow early detection and diagnosis. This is particularly important if a close relative has been diagnosed with macular degeneration. Even though it can t be prevented, its progress and severity can sometimes be reduced with certain vitamins, minerals and Omega III fatty acids. Controlling high blood pressure and quitting smoking can be helpful. What treatment options are available for macular degeneration? Thermal Laser was the first treatment used to treat wet macular degeneration and is still occasionally used today. It uses a light beam focused on the blood vessels to canalize them. Photodynamic therapy (PDT) uses a low intensity laser to stimulate a light sensitive drug that is injected intravenously to cause shrinking of abnormal blood vessels of the macula. Anti-VEGF Injections are the newest treatment involving a series of injections of a small quantity of drugs called anti-vegf into the eye. These drugs block chemicals that allow the abnormal blood vessels to grow. Treatment for wet macular degeneration can involve combining these types of treatments and treatments may take many months to complete. What are the risk factors associated with macular degeneration? History of hypertension History of cardiovascular disease Smoking Sun Exposure Hyperopia (farsightedness) Light skin & eye color Lens opacities (cataracts) Is macular degeneration curable? No, but treatment can slow or even stop the progression of the disease or in some cases reverse some of the damage. The earlier you're diagnosed, the better.

5 What is a macula pucker? A macula pucker is when wrinkles, creases or bulges form in the macula as the vitreous pulls away from the retina. Symptoms include blurred central vision, distorted or wavy vision, difficulty reading or performing tasks that require detail vision, gray and/or cloudy area in the central vision. Treatment may only be necessary if there is significant vision loss in which vitrectomy surgery may be recommended to remove the scar tissue. What is a macula hole? A macula hole occurs when the shrinking vitreous gel adheres to the macula. This causes the macular tissue to stretch and after several weeks or months the macula tears, forming a hole. As the hole progresses, a blind spot develops in your central vision and impairs the ability to see at both distant and close ranges. Vitrectomy surgery is the most effective treatment option to repair a macula hole. How do I schedule an appointment? Go to centerforsight.net and click schedule an appointment or call