Category Archives: Retinal Disorders

Myopia (near-sightedness)

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

What is myopia?

A myopic eye is a near-sighted eye.  Without glasses the vision is usually quite good at near, but blurred at distance.  Myopia affects 25% of Americans and about 22% of the world population. High myopia (greater than -6.00 diopters) is less common, affecting about 2% of the world population and projected to rise to 10% by the year 2050.

What causes myopia?

Myopia is an inherited condition that usually develops in childhood or early adulthood.  The eye, which is round like a ball at birth, becomes oval like an egg.  The outer appearance of the eye is not usually changed, but the elongation of the eye changes the focus of the eye from distance to near. There is evidence to suggest that extensive near work (e.g. reading) may worsen myopia.

myopia
A myopic eye has elongated somewhat like an egg. Incoming images do not focus on the retina in the back of the eye.

Why is it important to know about myopia?

Although most people with myopia do not develop complications, highly near-sighted people are at increased risk of losing vision from glaucoma, cataract, macular degeneration, and retinal detachment. The higher the degree of near-sightedness (myopia greater than -6.00 diopters), the greater the risk of loss of vision.

Glaucoma is a condition in which the pressure inside the eye damages nerve tissue that helps you see.  This pressure usually causes no pain or discomfort and pressure measurements may be normal at times.  Over months to years, the pressure slowly takes away the side vision.  If undetected and untreated, it may cause total blindness.  The best way to diagnose glaucoma is to have regular eye exams each year with pressure measurements.  Treatment is effective in preventing vision loss through the use of eye drops.  Sometimes, laser or surgery is needed.

Myopic macular degeneration is an uncommon cause of vision loss from severe myopia. The macula is the central part of the retina in the back of the eye.  The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera.  In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.  In very near-sighted eyes, the retina becomes stretched as the eye elongates.  As a result, the central vision may become blurred or distorted even with proper glasses.  Distortion is when straight lines look wavy or crooked.  Blood vessels under the macula may bleed causing sudden blurring, blind spot, or distortion.  Any of these symptoms should be reported to the eye doctor without delay, as early treatment with medicine injections and/or laser may prevent further loss of vision.

Retinal detachment is a separation of the retina from the inside wall of the eye. When the retina detaches, it is no longer in proper position inside the eye.  Instead, it is like film that has unrolled inside a camera.  When this occurs, a camera cannot take a picture.  Similarly, when the retina detaches, the eye loses vision.  Warning symptoms prior to retinal detachment may include new floaters or brief flashes of light in the side-vision.  Later, a dark curtain or shadow slowly starts off to the side and takes away the vision as the retina detaches.  Laser or surgery repairs most retinal detachments.  It is important to diagnose a retinal detachment early in order to prevent permanent damage to the retina.  Report any new floaters, flashes, or loss of side-vision to your eye doctor without delay.

How is myopia treated?

The standard treatment of myopia is to refocus the eye with eye glasses or contact lenses. LASIK and PRK surgery flatten the cornea to focus images onto the retina. Orthokeratology is a controversial method used to flatten the cornea with contacts lenses worn overnight. Lens implants are a more aggressive measure to focus light in highly near-sighted eyes. All of these methods of treatment are simply aimed to focus the vision.  They are not designed to correct the underlying problem of elongation of the eye that leads to complications and loss of vision.  Diluted atropine eye drops appear to reduce the progression of myopia in an effort to avoid complications of severe elongation of the eye.

Will LASIK surgery help prevent these complications of myopia?

Although LASIK surgery is very effective at flattening the cornea to help eliminate the need for glasses, it does not restore the spherical shape to the eye.  Therefore, it is still necessary to be aware of the warning signs of possible complications from myopia.

What are the Do’s and Don’ts?

Using your eyes to read or work at a computer will not weaken them. Avoid intensive rubbing of your eyes.  Remember to have your eyes examined once a year.  Report the following symptoms to your eye doctor without delay:

¨     Blind spot or distortion of central vision

¨     New floaters or flashes of light

¨     Loss of side-vision

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  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

Floaters and Flashes

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vitreous gel
Vitreous gel fills the eye (Click on image to enlarge)

 

What are floaters and flashes?

Floaters are small specks, fibers, or bug-like objects that may appear to move in front of your eye.  They appear black or gray and may be few or numerous.  At times they may appear like a veil or cloud moving in the vision even after the eye is still.  They are frequently seen when looking at a brightly lit background, like a blank wall or blue sky.  Floaters are actually tiny clumps of fiber or cellular debris within the jelly-like fluid (vitreous) that fills the inside of the eye. Many dot-like floaters may be due to bleeding inside the eye, especially when they come on suddenly. Long-standing, numerous, dot-like floaters may represent inflammation in the eye.

Floaters image
Floaters as simulated in photograph (click on image to enlarge)

Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes.  They may appear curved or like a brief lightning flash and last for only a second. Flashes are caused by fibers in the vitreous gel tugging on the retina with eye movement. This type of flashing light is different from migraine.

What do these symptoms mean?

Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous.  In some instances, the retina may tear and cause blindness from detachment of the retina.

What causes floaters and flashes?

Floaters and flashes are usually due to degeneration of the vitreous gel in the eye from ageing.  Over time, the vitreous shrinks, condenses, and pulls away from the retina.  The condensation causes floaters and the pulling irritates the retina and is perceived as flashes of light. Myopia (near-sightedness) is a common cause of long-standing floaters.

What should be done about these symptoms?

The most important step is to have a thorough dilated eye examination, preferably by a retinal specialist.  The need for examination is urgent if the onset of symptoms is sudden. The eye doctor will check for the presence of a tear in the retina.  If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment.  If a retinal detachment is found, more extensive surgery is required in attempt to repair it.

Once an exam has demonstrated no retinal damage, he symptoms of flashes and floaters do not require specific treatment.  The flashes usually occur less frequently over time.  It may take days or weeks for the flashes to subside. Rarely, flashes will continue over many years.  Likewise, floaters subside with time, but take weeks to months to become less noticeable.  It is best not to concentrate on following floaters by moving your eyes as it may make them more bothersome. Depression and stress may worsen the degree in which floaters interfere with daily visual activities.

Many people have long-standing floaters that are not bothersome. In these cases, no treatment is needed after an examination to insure good eye health. Very rarely floaters will persist and interfere with vision. In these unusual cases, vitrectomy surgery may be considered. There are options to consider.

What should you be on the lookout for?

After examination or treatment, any significant new floaters (especially, many new dot-like floaters) or any loss of side vision should be reported to the doctor without delay.  An occasional flash of light in itself is not usually indicative of damage to the retina.  Sometimes, new tears or a retinal detachment can occur at a later date after the initial examination.

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.

Macular Hole

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globe anatomy
anatomy of the eye (click on image to enlarge)
normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is a macular hole?

Macular hole means there is a tiny hole in the center of the retina.  The retina is a thin layer of tissue in the back of your eye which lines the inside wall like the film inside the back of a camera.  The retina “takes a picture” of objects you look at and sends it to the brain.  The macula is the center of the retina and gives you sharp central vision for reading and seeing fine details.  When the macula is damaged, the central vision worsens.  Macular hole is not macular degeneration and does not lead to macular degeneration. Macular hole affects both eyes in only about 10% of cases.

What causes a macular hole?

A macular hole is caused when the clear gel that fills the eye (vitreous) pulls on the macula.  When you are born the vitreous gel is thick, clear, and filled with tiny, invisible fibers.  With age or trauma, the vitreous gel begins to condense and pull away from the retina.  If the attachment of the vitreous to the macula is unusually strong, the pulling may result in a macular hole.

What are the symptoms of a macular hole?

Blurring of vision is mild at first, noted especially while trying to read fine print.  It slowly worsens; often with distortion (straight lines look crooked).  Sometimes there is a small blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.

What treatment is available?

In a small number of cases, a macular hole may heal itself. In other cases the vision improves with a medicine injection (Jetrea®). If this fails or is not possible, a surgery may be performed that releases the abnormal pulling of the vitreous on the macula.  A gas bubble (pneumatic retinopexy) is then placed in the eye to close the hole in the macula.  Strict facedown positioning is recommended for several days following surgery.  Special cushions and massage tables are available to help maintain the proper head position.  The most common side effect of surgery is cataract formation.  Cataracts develop after surgery in most eyes over several months to years.  About 5% of eyes require more than one surgery to close the macular hole.  In 2-3% of eyes, the retina may detach during or soon after surgery as a result of continued pulling on the retina by vitreous fibers.  This requires additional surgery to prevent profound loss of vision.  Unommon risks of surgery include hemorrhage, infection, blindness and loss of the eye.

Surgery to close macular hole is usually successful in improving vision, though the vision rarely returns completely to normal.  Some residual distortion and central blurring of vision is common. The vision improves very slowly after surgery over several months to years.

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  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

For more information please visit Retina Vitreous Associates of Florida.

Vitreomacular Traction Syndrome

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vitreous gel
Clear vitreous gel fills the eye (click on image to enlarge)
normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is the vitreomacular traction syndrome?

The vitreomacular traction syndrome is a condition in which the vitreous gel, which fills the inside of the eye, pulls on the macula. The macula is the center of the retina and gives sharp central vision for reading and seeing fine details. The retina is a thin layer of tissue in the back of the eye that lines the inside wall like the film inside the back of a camera.  The retina “takes a picture” of objects you look at and sends it to the brain. When the macula is damaged, the central vision worsens.

What causes the vitreomacular traction syndrome?

The vitreomacular traction is caused when the clear gel that fills the eye (vitreous) pulls on the macula.  At birth the vitreous is a thick and perfectly clear gel.  With age or trauma the vitreous gel begins to condense and pull away from the retina.  If the attachment of the vitreous to the macula is unusually strong, the vitreous may pull the macula away from its normal position, distorting this normally smooth tissue.

normal OCT
Normal macula as seen on optical coherence tomography (click to enlarge)
VMT
Vitreomacular traction as seen on optical coherence tomography (click to enlarge)

What are the symptoms of the vitreomacular traction syndrome?

Blurring of vision is mild at first, noted especially while trying to read fine print.  It slowly worsens, often with distortion (straight lines look crooked).  Sometimes there is a vague blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.

What treatment is available?

If the symptoms are mild, no treatment is needed.  Medicine injection (Jetrea®) or vitrectomy surgery may help if there is significant loss of vision.  In most cases the vision improves with injection or a surgery that releases the abnormal pulling of the vitreous on the macula.  A gas bubble may be placed in the eye to smooth out the macula.  Strict facedown positioning may be recommended for one week following surgery.  Special cushions and massage tables are available to help maintain the proper head position.  The surgery is usually successful in returning vision, though the vision may not return completely to normal.

The image below shows the separation of vitreous fibers from the macula after Jetrea injection:

Jetrea VMT
Vitreomacular traction relieved by Jetrea (click to enlarge)

Below is a video that reviews the anatomy of the eye, information on vitreomacular traction, and an example of vitrectomy surgery:
https://youtu.be/r-5Az8_DU3U

Below is the case of a 70-year-old woman who had mild VMT. She was observed over several years and the traction released without surgery.

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  © 2013-2022 Designs Unlimited of Florida.  All Rights Reserved.

Diabetic Retinopathy

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Diabetes mellitus is a group of conditions characterized by abnormally high blood sugar levels.  Short-term side effects include increased thirst, frequent urination, and weight changes.  Long-term complications include numbness of the hands and feet, loss of vision, kidney failure, as well as hardening of the arteries leading to amputation, heart attack, stroke, and premature death.  Diabetes affects about one million Floridians and 16 million Americans.  It is the leading cause of blindness in America among adults.  Several studies have proven that strict control of blood sugar levels dramatically decreases the risk of blindness and other complications of diabetes.  The National Eye Institute proved that laser treatment may save vision if diabetic eye damage is detected early.  The American Diabetes Association recommends annual eye examinations for all adults with diabetes to prevent blindness.

What is the retina?

The retina is a thin layer of delicate nerve tissue, which lines the inside wall of the eye like the film in a camera.  In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.  The retina has two main areas.  The macula is the central area that gives you sharp, central vision and color vision.  The peripheral retina is the part of the retina that gives you side vision and night vision.

What is diabetic retinopathy?

Diabetic retinopathy is a condition that occurs after many years of high blood sugar.  It consists of damage to tiny blood vessels within the retina resulting in abnormal leakage of fluid and blood inside the eye.  If not detected or treated, diabetic retinopathy may cause bleeding, scar tissue formation, retinal detachment, and blindness.

Stages of diabetic retinopathy:

Non-proliferative diabetic retinopathy: The first stage of retinal damage consisting of a weakening or blockage of tiny blood vessels, which does not require treatment with laser unless macular edema develops.

Diabetic macular edema: Swelling of the central retina (the macula) due to abnormal leakage of fluid from small blood vessels weakened by diabetes.  Blurring of central vision may advance to legal blindness.

Proliferative diabetic retinopathy: The second stage of diabetic retinopathy in which abnormal, weak blood vessels begin to grow from the retina into the clear gel (vitreous) which fills the inside of the eye.  If not treated, this serious stage often results in blindness from bleeding.  Symptoms include new “floaters” or sudden loss of vision.  Retinal detachment may occur from diabetic scar tissue, which pulls the retina off the eye wall.  Retinal detachment causes a dark shadow in the vision or total loss of vision.  Laser and vitrectomy surgery best control these problems if detected early.

How is diabetic retinopathy diagnosed?

Because no symptoms may be present until severe damage to the retina has occurred, it is essential that all adults with diabetes have a complete, dilated eye examination at least once a year.  The eye doctor can see into the eye with an ophthalmoscope to diagnose retinopathy.  If significant changes are found, photographs can be taken to record the changes. A fluorescein angiogram may be performed in the office by injecting a fluorescent dye into the vein of the arm while photographs are taken of the retina.  It supplies important information about the health of the retinal blood vessels.

How is diabetic retinopathy treated?

No treatment is needed if the vision is not threatened.  If blood vessel damage is significant, painless injections of medicine (Avastin) may be required to improve vision. Laser treatment performed in the office can often prevent severe visual loss.  Laser produces heat, which serves to cauterize the damaged retinal blood vessels.  Usually there is no pain, but if extensive laser is needed, an anesthetic injection may be given around the eye.  In severe cases of bleeding and scar tissue formation, vitrectomy surgery is performed as a one-day surgery in the hospital.  With laser and vitrectomy surgery, most people can retain useful vision. However, some people lose vision despite all efforts with treatment.

What can I do to prevent diabetic damage?

Strict control of the blood sugar has been proven to reduce the rate of progression of diabetic retinopathy by about 70%.  In addition, loss of vision can be minimized by optimal control of other health problems such as physical inactivity, obesity, hypertension (<130/<80), cholesterol (<200) and triglycerides (<150), heart failure, and kidney failure.  Tobacco use is strongly discouraged.  Daily aspirin use is recommended.

PREVENT BLINDNESS THROUGH GOOD MANAGEMENT OF DIABETES AND REGULAR DILATED EYE EXAMINATIONS.

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  © 2013 Designs Unlimited of Florida.  All Rights Reserved.