Category Archives: Ocular disorders

Retinal Arteriolar Macroaneurysm

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is a retinal macroaneurysm?

A retinal macroaneurysm is an abnormal out-pouching in a retinal blood vessel (arteriole) where the arteriolar wall has been weakened. It looks like a tiny balloon in the blood vessel. The retina in your eye is like the film inside a camera. The retina “takes the picture” of objects you look at and sends the message to the brain. The retina is a living tissue, which requires blood supplied by tiny vessels. Retinal arterioles are blood vessels that bring blood to the retina.

Retinal MA
Retinal Arteriolar Macroaneursym
Arteriolar MA
Fluorescein angiogram of macroaneursym
Retinal MA by OCT
OCT scan of retinal macroaneurysm

Who is at risk for a retinal macroaneurysm?

Retinal macroaneurysms are more common in older people who have high blood pressure or hardening of the arteries. These conditions appear to weaken the blood vessels in the eye causing a ballooning of the vessel wall. Retinal macroaneurysms are NOT related to aneurysms in the brain.

What are the symptoms of a retinal macroaneurysm?

Blurring of vision may occur if excess fluid (edema) leaks from the macroaneurysm. Bleeding (vitreous hemorrhage) from a macroaneurysm causes floaters that can look like tiny dots or cobwebs moving about in your vision.  Sometimes, bleeding under the retina causes the sudden onset of a large blind spot in the vision.

What treatment is available?

Laser may improve the vision by sealing the macroaneurysm to keep it from bleeding and leaking fluid, but the vision rarely returns completely to normal. There may be some permanent damage to the retina from the macroaneurysm. In some cases the macroaneurysm may be observed without laser to see if it will heal on its own. In other cases, medication injections may be used to improve vision.  Your doctor is going to order appropriate tests and recommend the best course of action to take at this time. The retinal macroaneurysm will not be worsened by your daily activities or by using your eyes. See your internist to keep your blood pressure under good control.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2016-2022 Designs Unlimited of Florida. All Rights Reserved.

Alkeus study for treatment of Stargardt disease

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There is currently no proven treatment for Stargardt disease (SD), an inherited eye condition that affects the retina and causes a slow loss of central vision over years. It affects about one in 10,000 people and may begin to cause symptoms early or late in life.

In Stardardt disease there is an abnormal protein that is involved with transporting vitamin A. In normal eyes Rim protein transports vitamin A from the retina to cells that recycle it for continued use. The retina requires vitamin A to process light for functional vision. Eyes with Stargardt disease have a defective Rim protein. As a result, vitamin A that has been used by the retina tends to accumulate in the retina in the form of toxic byproducts called vitamin A dimers (pronounced, “DYE-mer”). Vitamin A dimers are thought to contribute to permanent retinal damage over time.

Alkeus is a company that is researching the use of a drug that may slow the loss of vision in Stargardt disease. This pill (ALK-001) is taken by mouth once a day. In laboratory studies it appears to slow the formation of vitamin A dimers. It has been studied in the laboratory and now has been cleared by the FDA for study in humans. The study will compare the effect of ALK-001 to placebo (sugar pills) to determine the effectiveness and safety. Eligible patients are healthy individuals between 12 and 60 years of age. Candidates must undergo genetic testing to confirm the diagnosis. The study will last for 24months. If this and other studies prove the usefulness of ALK-001 it will likely be approved by the FDA for general use by ophthalmologists outside of clinical trials in the future.

UPDATE OCT 2022: The TEASE 1 Study reported very favorable results at the American Academy of Ophthalmology meeting in Chicago this month. There was slowing of the rate of vision loss and no prominent safety issues.

For further information and to find the study sites see: Clinical Trials

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2016-2022  Designs Unlimited of Florida

Posterior Capsular Opacity (secondary cataract)

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Cataract
Cataract is a foggy lens inside the eye (click image to enlarge)

 

PCO
Opacity of the posterior capsule after cataract surgery (Click to enlarge)

What is posterior capsular opacity (PCO)?

Posterior capsular opacity is a common condition in which the posterior capsule becomes hazy after cataract surgery. The posterior capsule is the clear layer of tissue that supports the intraocular lens, which is implanted into the eye at the time of cataract surgery. Over time after cataract surgery, the posterior capsule may lose its clarity.

What causes posterior capsular opacity?

The posterior capsule becomes opaque because of an abnormal growth of hazy tissue, like scar tissue, grows over the clear posterior capsule. These cells are remnants of cells from the cataract. Research is underway to determine what might be done to prevent PCO from developing.

What are the symptoms of posterior capsular opacity?

The symptoms of PCO are very similar to symptoms from cataract: blurred, cloudy, hazy vision with or without glare from oncoming lights, especially at night. These symptoms usually develop slowly, although sometimes the problem is discovered suddenly if the other eye is a clear seeing eye. In these cases, the clear eye is covered and the cloudy vision is discovered in the eye with PCO.

How is posterior capsular opacity treated?

If the vision is good and the symptoms are mild, no treatment is needed and the PCO will not harm the eye. If improvement in vision is needed, YAG laser can be performed in a brief, pain-free treatment to open the posterior capsule to allow for improvement in vision. If the vision does not improve after YAG laser, a change in glasses may be needed or further examination of the eye may disclose other problems limiting visual return.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2014-2022 Designs Unlimited of Florida. All Rights Reserved.