Vitreous Retina Macula Consultants of New York

Age-Related Macular Degeneration

Many people with macular degeneration experience minimal vision loss during the early stages of the disease. For most people, macular degeneration does not become vision impairing. During this stage, the transport of wastes and nutrients by the RPE has slowed down. As a result, waste builds up under the retina and forms yellowish deposits known as drusen. An ophthalmologist examining a patient at this stage may see drusen, although no symptoms may be present or develop later. If the doctor sees drusen, the patient will be monitored. In most cases, the disease will not progress to vision loss, although some patients do experience vision loss with drusen. Many patients over 60 have some drusen. Macular degeneration may progress into dry (atrophic) macular degeneration or wet (exudative) macular degeneration.

Diabetic Retinopathy

People with diabetes are unfortunately at a higher risk for numerous ocular complications, which can lead to severe vision loss and sometimes even blindness. One of those eye diseases is diabetic retinopathy, the leading cause of blindness among Americans. Diabetic retinopathy is an eye disease that damages the blood vessels in the retina. While what exactly causes this damage is not known, poorly controlled blood sugar levels are believed to be a contributing factor. Although diabetic retinopathy can affect persons with Type I or Type II diabetes, persons with Type I diabetes are at a greater risk of developing the disease. Over time, the risk of developing diabetic retinopathy increases.

Video: Diabetic Retinopathy

Macular Hole

The macula is the very small area in the back of the retina that is responsible for providing sharpness and clarity in our vision. This detailed vision is necessary for daily tasks such as reading, driving, and watching television. A jelly-like substance called the vitreous fills the central portion of the eye. It is composed of 99% water, some chemicals to create the gel, and long protein fibers. As we age the vitreous begins to shrink. The jelly starts to break down and the protein fibers start to aggregate. In most people the vitreous eventually separates from the retina in a process called posterior vitreous detachment. In some people the vitreous may remain adherent to the central portion of the macula and pulling by the vitreous can cause bad things to happen to the macula. Chronic pulling, or traction, on the macula can cause the macula to become distorted or stretched. In some people the force of the traction exceeds the mechanical strength of the macula and a hole can form. Macular holes are typically very small – smaller in diameter than a pin. However the macula is very important for sharp vision and even a very small hole can cause important visual problems. The vision is generally decreased and distorted. The curious aspect of macular holes is that they don’t heal themselves. If someone had their ears pierced, but didn’t wear an earring the hole would close. Only the smallest macular holes can close without surgery and even then the chance is low. The retina is really a type of brain tissue, and brain tissue doesn’t heal well. The steps naturally taken by the body to heal a macular hole can make it get larger over time.

Video: Macular Hole

Retinal Tears and Detachments

The retina can be likened to film in a camera. It is the light sensitive structure that lines the back of the eye. The part directly in the back of the eye is the macular region. Because of the structure of the macula and the cells that are there, the macula supplies sharp vision and also provides most of the color information being sent back to our brains. The rest of the retina supplies a lower resolution image that gives us the wide field of view we ordinarily have. This side vision is very important in functioning in the modern world. The retina is not connected to the back of the eye in a firm way. Under some circumstances the retina can pull away from the back of the eye. Since the retina gets much of its oxygen and nutrition from the tissue in the back of the eye, this can lead to significant harm to vision. Types of Retinal Detachments There are many different ways the retina can detach from the back of the eye. One way is that it can be pulled by force. There is no hole or tear in the retina, just brute force. A second way is the retina can tear and fluid from the middle part of the eye can go under the retina; this method combines pulling with fluid flows to cause the retina to separate from the back of the eye. The third important way is there can be an excessive amount of fluid made under the retina by disease and the rising tide of fluid floats the retina away from the back of the eye.

Video: Retinal Tears and Detachments

Vitrectomy

Vitrectomy is a microsurgical procedure used to treat certain retinal disorders such as macular hole, macular pucker, retinal detachment, proliferative diabetic retinopathy, intraocular infections, and traumatic eye injuries. Using specially designed instruments and techniques, the vitrectomy procedure involves removing the vitreous gel through a very small incision in the eye wall. The vitreous gel is replaced with a saline solution. Then, using a high intensity fiber optic light source, your surgeon will use a specially designed microscope that allows for a clear view of the vitreous cavity and retina at different magnification to perform any additional work if necessary, such as removal of scar tissue (macular pucker, tractional detachment) or close a macular hole. This same-day surgical procedure is usually performed under local anesthesia and intravenous sedation. The vitrectomy surgery has been a revolutionary advancement in technology that allows us to treat retinal diseases and prevent vision loss. Generally, a vitrectomy takes about 30 minutes to an hour depending on the type of operation, but may be significantly longer depending on the surgical indication and complexity of the case.