Sickle cell disease is the most common genetic disease, affecting about 400,000 newborns each year. It is caused by a mutation in the gene that codes for the hemoglobin protein that carries oxygen in the blood stream. Sickle hemoglobin tends to clump into a sickle shape when it gives up its oxygen molecule to the tissues it supplies. When this occurs, the red blood cells lose their flexibility and tend to block the small blood vessels in the body. 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. These blood vessels may be damaged in people with sickle cell disease.
Who is at risk of eye problems in sickle cell disease?
Although more extensive blockage of retinal blood vessels occurs in sickle cell disease, more severe complications (bleeding and retinal detachment) occur in people with a combination of sickle hemoglobin and hemoglobin C (called Hemoglobin SC disease). Some studies suggest men are more likely than women to have loss of vision.
What are the visual symptoms of sickle cell disease?
Blurring of vision may occur if excess damage occurs to the retinal blood vessels. Floaters can look like tiny dots or cobwebs moving about in your vision. They may be due to bleeding from the retina into the central gel of the eye. Retinal detachment may cause a dark shadow to appear off to the side (in the peripheral visual field) and may progress to total loss of vision. Pain is rare and may be due to high pressure in the eye (neovascular glaucoma).
What treatment is available?
There is no cure, but treatment may improve vision or keep the vision from worsening. If bleeding occurs inside the eye due to blocked blood vessels, floaters are seen by the patient. Medicine injections may help recover vision and may be applied without pain in most cases. Laser may stabilize or improve the vision. In some situations, surgery is required. The vision may not return to normal following treatment as there may be some permanent damage to the retina. The earlier retinal problems are found, the better the outcome of treatment. Therefore, annual exams are important and it is critical to report new floaters without delay.
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.
Asteroid hyalosis is a fairly rare, harmless eye condition in which calcium crystals form inside the eye. The name comes from the fact that the calcium crystals look like asteroids on the examination by the eye doctor and are seen in the vitreous gel (also known as the hyaloid) that fills the eye. These calcium crystals form slowly over time, usually in just one eye. Asteroid hyalosis is not considered an eye disease and rarely causes problems with the vision.
What causes asteroid hyalosis?
The cause is not known. Limited research has been carried out because asteroid hyalosis does not harm the eye. It is usually well-tolerated and may be observed by the eye doctor. Asteroid hyalosis is not associated with calcium-related problem outside the eye.
What symptoms may be seen?
Many patients have no symptoms at all, but sometimes floaters are seen. Floaters are small specks, fibers, or bug-shaped objects that may appear to move in front of your eye. At times they may appear like a veil or cloud moving in the vision. They are frequently seen when looking at a blank wall or blue sky. Usually, they can be ignored and tolerated.
What should be done about the symptoms?
The most important step is to have a thorough dilated eye examination. The eye doctor will check for the presence of a tear in the retina. If the retina is stable, the asteroid hyalosis may be observed without treatment. If the floaters become a problem for the patient and interfere with vision, vitrectomy surgery may be considered to remove the asteroid hyalosis.
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.
Photograph of asteroid hyalosis appearing as white clumps inside the eye (vitreous) obscuring the view of the retina in the background.
Copyright 2021-2022 Designs Unlimited of Florida. All Rights Reserved.
Birdshot chorioretinopathy (BSC) is a type of uveitis (pronounced, “you-vee-EYE-tis”), a term used to describe inflammation inside the eye. BSC mainly causes inflammation of the choroid and retina, but may affect other parts of the eye as well. The choroid is the part of the uvea that lies under the retina, which is the “film” in the back of the eye that “takes the picture” of objects you look at. BSC is fairly rare form of inflammation affecting both eyes of men and women, usually starting in middle age.
What causes birdshot chorioretinopathy?
Birdshot chorioretinopathy (BSC) is strongly related to genetics. Most people with BSC have inherited a cell protein called HLA-A29. However, most individuals with HLA-A29 do not develop BSC; it appears to be triggered by an external event, such as an infection that “awakens” the immune response, which then abnormally attacks the eyes. BSC is most common in people of European ancestry.
What are the symptoms of birdshot chorioretinopathy?
Birdshot chorioretinopathy (BSC) usually presents with the slow-onset of floaters and blurred vision in both eyes. The floaters appear as tiny floating dots, which move or “float” in the vision and are seen especially well in bright environments. Shimmering lights may also be reported. Some patients note difficulty seeing at night. Symptoms may be very bothersome despite normal vision as measured on the eye chart. Over many years without treatment, the vision deteriorates further with loss of contrast, color vision, peripheral vision, and central vision. The symptoms vary from person to person and some have more rapid and severe deterioration than others.
How is birdshot chorioretinopathy diagnosed?
The diagnosis of birdshot chorioretinopathy (BSC) may be delayed due to the slow onset of symptoms and the subtle findings on the eye exam. A retinal specialist or uveitis specialist may be needed to perform sophisticated testing and make the diagnosis. Inflammation may be detected in many different parts of the eye, but the most typical findings include numerous pale spots inside the back of the eye. Blood testing for HLA-A29 is positive in the vast majority of patients with BSC. However, not all patients with uveitis who are positive for HLA-A29 have birdshot chorioretinopathy. Therefore, it is necessary to exclude other diseases that may simulate BSC including lymphoma, sarcoidosis, tuberculosis, syphilis, and cancer medications such as pembrolizumab and others.
How is birdshot chorioretinopathy managed?
Birdshot chorioretinopathy (BSC) usually requires management by an experienced retinal or uveitis specialist. In most cases, systemic treatment (pills or injections into the skin) are needed to control the inflammation. In a small subset of patients, localized treatment to the eye is sufficient. This is more often the case in older patients at onset of symptoms. When pills are used, the eye doctor frequently coordinates medical care with the expert assistance of a rheumatologist (a medical specialist with expertise in auto-immune diseases, like rheumatoid arthritis). In BSC the rheumatologist monitors the patient for medication side-effects that may develop outside the eyes. In many cases, the uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision.
Your doctor will choose from a variety of medications. Steroids (pills, eye drops, and injections) may be used at the start of treatment to gain rapid control of inflammation. However, long-term steroid treatment in high doses is usually avoided to prevent side-effects of steroid therapy. For long-term control methotrexate (MTX) pills or skin injections may be given weekly. MTX has a long record of safety and is affordable. If MTX fails or causes side-effects (liver or bone marrow), CellCept is another suitable medication, though it may cause diarrhea. Cyclosporin has been used effectively, but is fraught with a high incidence of problems with hypertension (high blood pressure) and kidney toxicity. Humira is a new biologic treatment given as an injection into the skin every two weeks. It has been approved by the FDA for treatment of uveitis, such as BSC. All medications used to treat BSC may have adverse effects and must be monitored for effectiveness and safety in a given patient.
Birdshot chorioretinopathy is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized.
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.
Floaters are small specks, fibers, or bug-shaped objects that may appear to move in front of your eye. At times they may appear like a veil or cloud moving in the vision. Floaters differ from blind spots in the vision in that floaters have some degree of independent movement. Blind spots are missing areas in the vision that move precisely with eye movement. Although floaters do follow the movement of the eye, there is usually some degree of continued movement after the eye stops moving. They are frequently seen when looking at 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.
What does this symptom mean?
Although many people have occasional floaters, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous. Sometimes, the retina tears and may cause loss of vision from detachment of the retina. At other times, floaters may persist and chronically interfere with vision.
What causes floaters?
Floaters are usually due to degeneration of the vitreous gel in the eye from aging. Over time, the vitreous shrinks, condenses, and pulls away from the retina. The condensation causes fibers and cellular clumps to pull away from the retina and float freely inside the eye. The shadow of these opacities is what we see as floaters. Other causes of floaters include trauma, bleeding, retinal breaks and detachment, eye surgery, inflammation, and cancer (very rarely).
Vitreous floaters and haze interfering with vision after repair of retinal detachment. The vitreous opacities appear as fibers and haze in this photo. They interfere with a clear view of the retina when looking into the eye and they interfere with the vision when looking out through the haze.
What can be done about floaters?
It is important to have a thorough dilated eye examination to determine the cause of floaters. Treatment is dictated by the cause of the floaters. If there is no serious underlying cause (retinal break, retinal detachment, etc.), no treatment may be needed. New floaters often fade without treatment. It can be helpful to avoid tracking or following floaters to allow your brain to ignore them. Floaters are less obvious in a darker environment, so wearing sunglasses outdoors may help minimize symptoms of floaters. Stress and depression appear to aggravate the symptoms of floaters and may be treated separately.
YAG Laser Treatment: A special laser may be useful in some cases of persistent floaters. It is an office treatment in which the laser in used to break the floating fibers and clumps into smaller fragments in the vitreous of the eye. Although it may help, YAG laser does not eliminate floaters. Repeat treatments are frequently necessary. Complications may include bleeding, increased floaters, retinal breaks and retinal detachment, which may require surgery to prevent blindness. There is limited evidence on the safety and effectiveness of YAG laser for floaters and it may not be covered by insurance. YAG laser may result in loss of vision/loss of the eye.
Vitrectomy Surgery: Vitrectomy is a surgery performed in the operating room. It is commonly used to treat serious problems of the vitreous and retina. It is very effective at reducing or eliminating floaters. However, complications include bleeding, infection, retinal break and retinal detachment, which may require surgery to prevent blindness. Serious complications occur in 1-2% of eyes reported in most studies, although some reports suggest the risk of complications may be as high as 10%. The most common problem with vitrectomy is cataract formation. After vitrectomy, cataract may develop over months to years and often requires cataract surgery. Glaucoma has been reported years after vitrectomy, but the exact incidence is not known. Vitrectomy surgery may result in loss of vision/loss of the eye.
For most patients the best course of action is observation of floaters without treatment at first. If symptoms persist and significantly interfere with vision despite 6-12 months of observation, treatment may be helpful. Most patients report good results with vitrectomy, but the possibility of complications must be carefully considered and accepted prior to embarking on surgery.
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 2019-2022 Designs Unlimited of Florida. All Rights Reserved.
Uveitis (pronounced, “you-vee-EYE-tis”) is a general term used to describe inflammation inside the eye. The uvea is the name given to the layer of tissue in the eye that has a brown color (melanin pigment) and blood vessels, which serve to provide blood supply and protect the eye from excessive light. The uvea can be divided into separate parts, which perform different functions in the eye: the iris, the ciliary body, the pars plana, and the choroid. The part of the uvea in the front of the eye is called the iris (the round, blue or brown part of the eye that you can see in the mirror). Behind the iris is the ciliary body, which produces the fluid that fills the eye. The pars plana serves as the boundary between the ciliary body and the choroid. The back part of the uvea that lies under the retina (the “film” in the eye that “takes the picture”) is called the choroid. Therefore, in any one patient uveitis is usually given a more specific name depending on where most of the inflammation is located in the eye. In intermediate uveitis the inflammation is primarily located in the vitreous gel that fills the eye, which is located in an intermediate position between the front and the back of the eye. It is sometimes referred to as vitritis or pars planitis.
What causes intermediate uveitis?
Uveitis may be caused by an infection, an injury from trauma, a disease in the body outside the eye, or sometimes for unknown reasons. Infection by a virus, bacteria, fungus, or other parasite may cause uveitis. Infections may be limited to the eye or may involve other organs as well. In intermediate uveitis, infection may be caused by syphilis, tuberculosis, Lyme disease, cat scratch disease, Whipple’s disease, toxocariasis, human lymphotrophic virus (HTLV-1), or toxoplasmosis.
In other situations, uveitis is caused by inflammation without infection. For example, multiple sclerosis, sarcoidosis, HLA-B27, and inflammatory bowel disease may cause intermediate uveitis. Pars planitis is a sub-type of intermediate uveitis that often starts early in life during childhood. Its cause is unknown.
Uveitis commonly occurs following an injury to the eye. Very rarely, cancer or cancer-fighting drugs may cause intermediate uveitis. In some cases, no underlying cause can be found to be the cause of uveitis. Tobacco may be an aggravating factor and should be discontinued.
What are the symptoms of intermediate uveitis?
The most common symptoms include tiny floating spots which move or “float” in the vision. They are usually numerous and may cause a veil-like appearance in the vision. Sometimes blind spots, blurred vision, distortion, or loss of side vision occurs. The eye may be painful, red, tearing, and light sensitive if other parts of the eye are also inflamed. Symptoms may be mild or they may be severe and disabling.
How is intermediate uveitis managed?
To effectively treat intermediate uveitis, it is important to find the underlying cause whenever possible. Take some time to carefully review and report to your doctor any unusual or unexplained symptoms such as rashes, back and joint problems. Tell your doctor if you travel abroad, spend time in rural settings, or may be exposed to animals or infections. Heredity may also play a role. You should tell your doctor about any family members with inflammatory disorders anywhere in the body. Also, review and report your ancestry (for example, Asian, Mediterranean, or American Indian ancestry). When the doctor diagnoses uveitis, laboratory tests may be ordered to help determine its cause. Occasionally, a surgical biopsy is needed for diagnosis. If infection is found, antibiotics are prescribed. To limit the damage from inflammation, intermediate uveitis is treated with anti-inflammatory medication in the form of eye drops, injections, or pills. When pills are used, the eye doctor frequently coordinates medical care with the expert assistance of a rheumatologist. Rarely, surgery is required to treat uveitis. In some cases, intermediate uveitis may be long-lasting. In these cases, years of therapy are needed to preserve vision. Intermediate uveitis is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized.
In some cases, intermediate uveitis may go away, but return at a future date. Therefore, if you become aware of symptoms of uveitis in the future, do not hesitate to contact your doctor. Preliminary evidence suggests that tobacco use may be an aggravating factor in some cases of uveitis.
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.
Iritis (pronounced, “eye-RYE-tis”) is a general term used to describe inflammation in the front of the eye. Specifically, it means inflammation of the iris. The iris is the name given to the layer of tissue in the eye that gives it a brown or blue color and serves to protect the eye from excessive light. Iritis is also called anterior uveitis.
What causes iritis?
Iritis may be caused by systemic inflammatory disease, trauma, infection, or sometimes for unknown reasons. Infection by a virus, bacterium, fungus, or other parasite rarely causes iritis. Infections may be limited to the eye or may involve other organs as well. More commonly, iritis is caused by inflammation without infection. For example, sarcoidosis, arthritis, lupus, and inflammatory bowel disease may cause iritis. The most common type of arthritis that causes iritis is ankylosing spondylitis, a condition that causes low back stiffness in the morning. Iritis also commonly follows an injury to the eye. In some cases, no underlying cause of iritis can be found.
What are the symptoms of iritis?
The eye may be painful, red, tearing, and light sensitive. Tiny floating spots which move or “float” may be seen. Symptoms may be mild, or they may be severe and disabling. Iritis may cause glaucoma, cataract, or scarring of the iris producing a distorted pupil (the part of the eye that is normally round and black). Blurred vision is common, and blindness may occur if iritis is not treated.
How is iritis managed?
When the doctor diagnoses iritis, laboratory tests may be ordered to help determine its cause. A questionnaire may be reviewed. Occasionally, a surgical biopsy is needed. If infection is found, antibiotics are prescribed. Dilating drops are used to limit pain and scarring of the iris. To limit the damage from inflammation, iritis is treated with anti-inflammatory medication in the form of eye drops (steroid and non-steroid), injections, or prednisone pills. The eye drops must be used very frequently to break an acute attack of iritis. Sometimes, non-steroid pills (e.g. methotrexate) or biologics (e.g. Humira) maybe needed. Aggressive treatment is recommended to prevent complications and permanent injury to the eye. Surgery may be required to treat complications of iritis such as glaucoma and cataract. Iritis is a serious eye problem and may result in loss of vision or blindness. However, by seeing your eye doctor promptly and taking the medications exactly as recommended, permanent damage from iritis can be minimized. In some cases, iritis can return in either eye at a future date. Therefore, if you become aware of the return of symptoms of iritis in the future, contact your doctor without delay.
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.
Scleral buckle surgery is an advanced form of eye surgery for the repair of retinal detachment that is performed in the operating room under a microscope. Scleral buckle surgery may take thirty minutes to several hours to perform depending upon what task is being accomplished. Despite common tales, the eye is not taken out and placed on the cheek. It remains in its normal position throughout the surgery. During scleral buckle surgery a silicone band or sponge is sutured to the external eye wall (the sclera) behind the eye muscles and hidden by the covering of the eye (the conjunctiva). The surgery creates an indentation (buckle) in the sclera that offers a ledge of support for the retina inside the eye and offsets traction on the retina from the vitreous gel (a major cause of retinal break and retinal detachment).
Artistic rendition of scleral indentation (click on image to enlarge)
Below is an example of scleral buckle surgery. If you are uncomfortable watching surgery, please do not click on this video.
What type of anesthesia is available?
Although some surgeons and patients choose local anesthesia, general anesthesia is also available. With local anesthesia the patient is sedated with IV medication so there is no memory of the anesthetic injection around the eye. Surgical drapes are placed over the face leaving plenty of breathing room. During surgery the patient is awake, but generally does not feel pain. It is important to lie still on the operating room table as movement during surgery may result in damage to the eye and affect the final visual result.
General anesthesia offers some advantages over local anesthesia. With general anesthesia the patient is motionless and remembers nothing of the surgery. The anesthesiologist places a tube to hold the airway open. Which type of anesthesia is best for a patient may be determined by the health of the patient, so you may wish to ask your internist for advice. If a person cannot lie still for the surgery or if claustrophobia is a problem, general anesthesia is preferred. Although there are risks with any type of anesthesia, modern techniques offer a high degree of safety for the patient.
How can I prepare for scleral buckle surgery?
Your EyeMD will schedule an appointment with your primary care doctor if evaluation is needed prior to surgery. Please inform your doctor of any chest pain/pressure, fever, productive cough, or shortness of breath. Unless otherwise notified by your doctor, do not take aspirin-containing products or any herbal supplements for two weeks prior to surgery. Coumadin should be stopped four days prior to surgery. On the morning of surgery, take no medications for diabetes unless instructed differently by your doctor, but please do take all of your other medications with a sip of water. Otherwise, do not eat or drink anything after midnight the day before surgery. If you usually use eye drops in the morning, they may be taken on the morning of surgery. Please click on this link for further information on how to prepare for surgery.
What are the risks of scleral buckle surgery?
Although uncommon, problems such as bleeding and infection may arise from any surgery. Retinal detachment or abnormal scar tissue formation may require additional surgery. Rarely, there may be loss of vision/loss of the eye from surgery. Although serious problems are not encountered often, the risks and benefits must be weighed for each individual prior to surgery. In retinal detachment, surgery is the only way to improve vision and prevent blindness.
What can I expect after scleral buckle surgery?
A soft eye patch and a hard eye shield are placed on the eye at the end of surgery. Leave these in place until your exam on the day after surgery. You may use Tylenol or Advil for aching pain, but call the doctor for a prescription if your pain is not relieved.
Over-The-Counter Pain Medication Schedule for Maximum Effect
Dosing Schedule:
8AM
2PM
8PM
2AM
Maximum
Ipubrofen
800mg
800mg
800mg
800mg
3200mg
(200mg tablets)
4 tablets
4 tablets
4 tablets
4 tablets
Dosing Schedule:
11AM
5PM
11PM
Maximum
Tylenol Extra-Strength
1000mg
1000mg
1000mg
3,000mg
(500mg acetaminophen)
2 caplets
2 caplets
2 caplets
Note: This schedule may need to be altered if you have kidney or liver disease.
This schedule is designed not to exceed maximum dosages of these medications.
Do not take addiitonal medications that also contain ibuprofen or acetaminophen.
It is common to have moderate discomfort after scleral buckle surgery. A scratchy feeling may result from sutures on the white of the eye. These sutures dissolve in about a month. At your exam after surgery, you will be given eye drops and/or an ointment to keep the eye comfortable, to prevent infection, and to promote healing. Wearing the eye patch is optional after you are seen in the office. Be sure you understand any positioning requirements given by your surgeon and feel free to ask about special pillows and equipment available to help maintain head position. If a gas bubble is placed in your eye at the time of surgery, you may not fly on a plane or undergo nitrous oxide anesthesia until the gas has dissolved, or you could risk severe pain and blindness. You may see the gas bubble as a horizontal, dark, curved line or as a dark ball in the vision. If a gas bubble is used during surgery, please keep a MedicAlert bracelet on your wrist until the gas has disappeared. The swelling and redness slowly disappear over weeks to months. The vision usually returns slowly after surgery and may take months to years for final recovery. Sometimes, the vision does not recover completely to normal. If the center of the retina was detached, there is usually some degree of permanent blurring of vision or distortion.
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.
A break is a tear or hole in the retina. The retina is a thin layer of 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. Because the retina is very thin, breaks may develop and cause retinal detachment with loss of vision. There are two kinds of retinal breaks: holes and tears. Retinal tears cause retinal detachments more often than retinal holes.
Horseshoe-shaped retinal tear as seen in an eye with retinal detachment (Click on image to enlarge)
What are the causes and symptoms?
Retinal breaks are fairly common in near-sighted eyes because near-sightedness is usually due to an elongation of the eye. As the eye enlarges deep in the eye socket, the retina has to stretch over a larger area. This stretching causes the retina to become thinner and may result in tiny round holes. These holes may cause no symptoms and may not cause retinal detachment.
In any eye, near-sighted or not, tears can occur from abnormal pulling on the retina by the vitreous (a clear gel that fills the eye and normally helps to hold the retina in place). Usually due to degeneration from aging, the vitreous gel condenses inside the eye and pulls on the retina. When this happens, patients usually notice the sudden onset of floating spots or “cobwebs”. Sometimes, brief lightning-like flashes of light occur in the side vision. About 10-15% of the time, new floaters and flashes mean a retinal tear has developed. This event places the eye at high risk of blindness from retinal detachment.
How is a retinal break treated?
Not all retinal breaks require treatment. The doctor may recommend observation alone. If a retinal break threatens to cause retinal detachment, the break is usually treated by laser or a freezing probe (cryopexy) to seal the retina to the eye wall at the site of the break. Treatment is NOT aimed at eliminating the flashes and floaters. Flashes usually disappear over a few weeks or months. The floaters gradually fade over many months, but they rarely disappear completely.
Treatment does not always prevent retinal detachment, so the patient should always report the new onset of more floaters or, more importantly, any progressive loss of side-vision or “curtain across the vision.”
Rarely, the central vision may become blurred and distorted due to scar tissue formation from the retinal break. This problem cannot be prevented with laser or cryopexy, though the scar tissue can be removed by surgery if it interferes with vision.
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.
The retina is a “tissue-paper” thin layer of nerve tissue, which lines the inside 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.
What is retinal detachment?
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.
Horseshoe-shaped retinal tear as seen in an eye with retinal detachment (Click on image for enlargement)
What causes retinal detachment?
Retinal breaks (holes and tears in the retina) cause retinal detachment. These retinal breaks are usually caused by a degeneration of the vitreous (the clear gel that fills the eye and normally helps to hold the retina in place). Vitreous degeneration is common in aging and near-sightedness, but may also follow a direct blow to the eye, hemorrhage, infection, or inflammation inside the eye. When the vitreous degenerates and condenses, it pulls on the retina and may cause retinal tears, which often lead to retinal detachment.
What are the symptoms of retinal detachment?
Prior to retinal detachment, most people notice warning signs such as new floating spots or “cobwebs” in the vision. Sometimes, brief lightning-like flashes of light are seen in the side vision. These are the symptoms of vitreous degeneration and retinal breaks. The retinal detachment that follows usually causes a dark “curtain” or “shadow” to form in the side-vision. The “shadow” often comes from below and on the side near the nose. If it is not treated, the shadow gradually covers all of the vision resulting in blindness. There is generally no pain with retinal detachment.
How is retinal detachment treated?
The treatment of most retinal detachments requires surgery. Your doctor is skilled in a number of techniques to prevent blindness. Which type of surgery is recommended depends on the precise findings on examination. Surgery is not usually aimed at eliminating flashes and floaters. Flashes usually disappear in a few weeks or months. The floaters gradually fade over many months, but rarely disappear completely. Some retinal detachments that do not cause symptoms may be observed without initial surgery.
Laser/Cryopexy demarcation: Small areas of the retinal detachment (especially before any side vision has been lost) can sometimes be treated with laser or cryopexy to “seal down” the retinal along the edges of the detachment in an effort to prevent it from extending further. This surgery is performed in the office. If it is not successful in stopping the detachment, more extensive surgery is required.
Pneumatic retinopexy: Many retinal detachments can be repaired by this surgery performed in the office by anesthetizing the eye, sealing the break(s) with laser or a freezing probe (cryopexy), and pushing the retina into proper position with a gas bubble which is injected into the eye. Although this procedure is successful most of the time, it requires the strict cooperation of the patient to remain in proper head position for about five days. If this procedure fails, more extensive surgery in the hospital operating room is sometimes needed.
Scleral buckle surgery: Some retinal detachments require the placement of a permanent plastic supporting belt around the eye to create a “ledge of support” for the retina. This is a major surgery in which a belt is placed around the eye in the hospital operating room. The eye is often rendered more near sighted by this procedure. Rarely, permanent side effects include double vision. If this surgery is not successful, vitrectomy surgery may be recommended. Scleral buckle surgery is preferred over other methods of surgery if the retinal breaks are located in the inferior (bottom portion) of the retina, where gas bubbles may not be effective in holding the retinal in position. Scleral buckle is also preferred over vitrectomy in eyes with a clear lens, because vitrectomy surgery usually results in cataract formation. Scleral buckle surgery is often used when other attempts at surgery have failed.
The video below demonstrates scleral buckle surgery. If you are uncomfortable watching surgery, please do not click on this video:
Vitrectomy surgery: Performed in the hospital operating room as a major eye surgery, vitrectomy surgery involves making small incisions into the eye to remove floaters, dissect scar tissue, remove fluid from under the retina, apply laser, and place a gas bubble or silicone oil into the eye to hold the retina in place. Specific head positioning is sometimes needed. Sometimes a cataract or lens implant must be removed to adequately repair the retina. This surgery may be repeated if necessary to prevent blindness.
The video below demonstrates vitrectomy surgery. If you are uncomfortable watching surgery, please do not click on this video:
With one or more surgeries most retinal detachments can be repaired keeping useful vision. Vision may not return to normal, as there may be some permanent damage from the retinal detachment resulting in blurred or distorted vision. In some cases additional surgery is needed to removed scar tissue that forms after retinal reattachment surgery. There are always risks to surgery including hemorrhage, infection, scarring, glaucoma, cataract, double vision, deformity, loss of vision/loss of the eye. Sometimes despite all efforts with surgery, all vision may be lost. Surgery is recommended for retinal detachments because blindness usually results if treatment is withheld. If you have questions, please do not hesitate to ask your doctor.
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.
A posterior vitreous detachment (PVD) occurs when the vitreous gel inside the eye condenses and pulls away from the retina. The vitreous is a thick, clear gel with invisible fibers that fills the inside of the eye. From birth the vitreous gel is attached to the retina and helps to support it. The retina is a thin layer of tissue that lines the inside of the eye like film in a camera. Just like film, the retina serves to “take the picture” of objects you look at. The primary cause of PVD is a degeneration of the vitreous, in which the tiny fibers clump together causing the vitreous to pull away from the retina.
Clear vitreous gel fills the eye (click on image to enlarge)
A. Vitreous gel fills the eye at birth. B. Vitreous fibers begin to pull away from retina. C. Further separation of vitreous fibers that remain attached to the optic disc. D. Complete separation of vitreous fibers from the posterior retina.
What symptoms does posterior vitreous detachment cause?
The most common symptoms of PVD are floaters and flashes. Floaters are specks, fibers, or veils that appear to move in front of your eye. Floaters are actually tiny clumps of gel or cellular debris within the vitreous. PVD sometimes causes bleeding inside the eye. Blood in the vitreous appears as floaters described as hair-like strands or tiny round dots. Over time floaters may appear like a cloud or veil that moves across the vision. Flashes are brief streaks of light that are usually seen off to the side, especially at night, when you turn your head or eyes. Flashes are caused by vitreous gel tugging on the retina with eye movement. Although the sudden onset of new floaters is reported by almost everyone with PVD, flashes are only seen by half of all people with PVD.
Why is it important to be seen for these symptoms?
Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters, with or without flashes, is an important symptom to report to your eye doctor. In about 10-20% of people with these symptoms, the vitreous pulls on and tears the retina. A retinal tear by itself causes no pain or visual problems. However, if a retinal tear is not detected and treated, it may go on to cause blindness from retinal detachment. A retinal detachment is when the retina stops functioning because it is pulled away from the inner eye wall and floats freely inside the eye. A retinal detachment causes a progressive loss of vision appearing like a curtain or shadow that slowly moves across the vision from the side.
What causes posterior vitreous detachment?
PVD is usually due to degeneration of the vitreous gel from aging. Over time, the thick vitreous gel tends to become liquefied and the microscopic fibers in the gel tend to condense together becoming visible and causing traction on the retina. The following conditions tend to accelerate the degeneration and cause PVD to occur earlier in life: trauma, inflammation, diabetes, and myopia (near-sightedness).
How is posterior vitreous detachment managed?
The most important step is to have a thorough, dilated eye examination. 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 an attempt to repair it. If there is no retinal tear or retinal detachment found at the initial exam, another exam several weeks later may be performed to be certain that a delayed tear has not occurred. Generally, there are no restrictions to your activities.
What happens to the floaters and flashes?
There is no treatment to make the floaters and flashes go away even though they may be quite annoying. The flashes gradually subside and disappear over days to weeks without treatment. However, the floaters rarely completely disappear. They will gradually fade and become less obvious over weeks to many months. For the first few days or weeks, many people find that the floaters are less annoying if they wear sunglasses when out of doors and turn the lights down when indoors.
What to be on the lookout for?
After examination or treatment, any new floaters or loss of side vision should be reported to the doctor without delay. Sometimes, new tears or a retinal detachment can occur after the eye examination. In fact, 7% of eyes with PVD will develop a retinal break sometime after the initial eye exam; about half occur more than one year after PVD. This is more likely to occur in near-sighted eyes and eyes with lattice degeneration.
PVD may stimulate the formation of macular pucker, which may cause symptoms of distortion of vision. Treatment of a retinal tear does not prevent macular pucker.
When one eye develops a PVD, the fellow eye will usually do so at a future date. Whether the floaters and flashes are more or less severe in the second eye, they should be promptly reported to the eye doctor. If the first eye develops a torn retina, the second eye runs about a 20% chance of developing a tear as well. But even if the first eye does not have a torn retina, the second eye may still develop a tear when a PVD occurs.
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.
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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 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.
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.
