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  • Retinal conditions can affect the retina (including the macula) and the vitreous – some of the main conditions are mentioned below.

    Macular degeneration and diabetic retinopathy

    Retinal vein occlusion: This occurs when the veins in the retina are blocked and the build-up of pressure causes smaller downstream blood vessels to leak. The blockage can occur in a branch vein with vision loss restricted to part of the visual field (branch vein retinal occlusion) or a central vein with the entire visual field affected (central vein retinal occlusion).

    Retinal detachment: A retinal detachment is a serious condition in which the retina lining the back of the eye separates from the wall of the eye. If not treated, it can lead to permanent blindness. Surgery under local anaesthesia is needed to reattach the retina.

    Retinal tears: A retinal tear is not usually as serious as a retinal detachment, but it can develop into a retinal detachment if untreated. Retinal laser treatment is an effective treatment for retinal tears.

    Macular hole: A macular hole is a small tear in the macula that usually forms gradually. The first sign is usually distortion of central vision. A vitrectomy may be recommended.

    Retinitis pigmentosa: This is the name for a range of genetic diseases that damage the retinal rod and/or cone cells (photoreceptors), causing vision loss. Unfortunately, there is no known treatment. An ophthalmologist can give you advice on what to expect and how to manage the disease.

    Epiretinal membrane: Also known as macular pucker, epiretinal membrane occurs when a thin sheet of scar-like tissue grows on the surface of the macula and interferes with central vision. Your doctor will monitor progression using an OCT scan and fluorescein angiogram. Vitrectomy may be recommended.

  • These will vary depending on the exact condition, for example:

    • Sudden loss of vision (retinal vein occlusion, retinal migraine)
    • Flashing lights (retinal detachment, retinal migraine)
    • Shadow-like objects in your field of view (retinal detachment, diabetic retinopathy)
    • Cloudy vision (diabetic retinopathy)
    • Blurring or loss of central vision (epiretinal membrane, macular degeneration)
    • Tunnel vision (retinitis pigmentosa)
  • Why is the retina so important?

    The retina acts like the ‘film’ of a camera, sending information about shapes, colours, patterns and movement via the optic nerve to the brain, where the information is processed. If the retina is damaged, this will cause visual disturbances or loss of vision.

    Can I check my retina or macula for signs of damage myself?

    No. Your retina lines the inside of the back of your eye and must be examined by an optometrist or ophthalmologist using special equipment. Eye drops are used to dilate the pupil to allow proper examination. However, you may be able to use an Amsler Grid to identify signs of change to your central vision. Any concerns should be investigated immediately.

    Why do I need surgery for a detached retina?

    If surgery to reattach your retina is not performed, there is a high chance you will lose your vision. The eye may also become painful later.

    What are floaters and are they harmful?

    Floaters are particles within the eye that float around like specks or smudges in your field of vision. They occur when the vitreous – the clear, jelly-like fluid that fills your eye – degenerates with age. Floaters can be harmless (e.g. a sign of posterior vitreous detachment). But they may also be a sign of more serious retinal conditions, including retinal detachment and diabetic retinopathy, so make sure you have your eyes checked.

Diagnosing retinal conditions

Retinal examination

The examination usually begins with an ophthalmoscope to look inside the eye and directly visualise the back of the eye. This is followed by more detailed examination that requires your pupils to be dilated using eye drops. It’s important to note that your eyes will remain dilated for approximately 4 to 6 hours and your vision will be blurry, meaning that you won’t be able to drive home – please make other arrangements.

After dilating your pupils, your ophthalmologist will use a special condensing lens and a bright light, usually mounted on their forehead, to evaluate the retina, the optic nerve and tiny blood vessels. A retinal tear or retinal detachment can often be detected during this type of examination.

Other tests may be necessary to assess the severity of your condition, diagnose other retinal conditions and guide treatment.

Digital retinal photography

State-of-the-art equipment is used to produce high-resolution photographs of your retina, optic nerve and blood vessels. The photographs help your ophthalmologist detect changes in these areas, as well as in the macula (in the centre of the retina). Your retinal photographs will be kept in your medical records and used as a comparison if more are taken at a later stage.

Fluorescein angiography

A fluorescein angiography (sometimes called retinal photography or eye angiography) uses a fluorescent dye to show any blockages or leaks in the tiny blood vessels supplying the retina. The dye is usually injected into a vein in your arm and flows through the blood system to the vessels at the back of the eye. Your ophthalmologist can detect any blockages or leaks and will use a special camera to take photographs. Your vision will be blurred for up to 12 hours after the test.

Optical coherence tomography (OCT)

OCT is a non-invasive test that captures detailed images of the retina. This scan allows your doctor to identify areas of retinal thinning, thickening or swelling caused by fluid build-up and leaking blood vessels. The OCT scans your eyes without making direct contact. The procedure takes less than 10 minutes.

Amsler Grid

This is a simple test you can do at home to alert you to any vision changes that may indicate the presence of macular degeneration or epiretinal membrane. The Amsler Grid contains a series of horizontal and vertical lines with a dot in the middle. If the lines appear wavy or lines are missing, have your eyes checked immediately.

Treating retinal conditions

Retinal laser treatments

  • Retinal laser: The three most common diseases treated with laser are retinal holes (to seal the retinal layers together), diabetic retinopathy (to stop leakage from small blood vessels that cause swelling or stop new blood vessels from growing) and macular degeneration (to shrink and seal abnormal blood vessels).
  • Laser capsulotomy: After cataract or refractive lens exchange surgery, some people develop a wrinkling of the back membrane of the natural lens (this can occur over months or years). If this interferes with vision, your ophthalmologist might suggest a procedure using a YAG laser, which removes the cloudy part of the lens capsule to allow light to pass through.
  • Argon laser: This is used for retinal phototherapy, particularly when treating diabetes, retinal tears, membranes or some tumours.
  • Laser photocoagulation: Used in the treatment of diabetic retinopathy and age-related macular degeneration, this procedure uses a laser to cauterise/seal retinal blood vessels and sometimes retinal tissue. The aim is to lower the risk of further vision loss – it is unlikely that lost vision will be recovered.

Vitrectomy

A vitrectomy involves removing the vitreous gel (the clear, jelly-like fluid inside your eye) using keyhole surgery so that stitches are not needed. It is performed in the day surgery – the procedure itself takes around 30 to 45 minutes.

Once the vitreous is removed, it is replaced with a bubble of gas or with sterile saline. Silicone oil may be used if the retina has been detached for a long time or retinal scarring is present.

Laser or freezing treatment is used to seal the retinal holes.

Because gas and oil bubbles float upwards, you will need to keep your head in a certain position for a number of day after the surgery to place the bubble in the correct position, while the retina is healing. The silicone may remain in the eye for months, or it can be removed after the retina has healed.

A protective eye patch is necessary for about 24 hours afterwards, followed by eye drops and ointment. Generally, patients can resume their regular activities after a day or so, although this can vary from person to person. A vitrectomy may be needed to treat:

  • Epiretinal membrane (macular pucker)
  • Vitreous haemorrhage
  • Retinal detachment
  • Macular hole
  • Macular oedema
  • Severe cases of floaters.

Eye injections

These injections are also called intravitreal injections. They are administered in the clinic or day surgery, after your eye is numbed with a local anaesthetic to stop any pain. Ongoing treatment is necessary for many of the disorders.

  • Anti-VEGF injections: Vascular Endothelial Growth Factor (VEGF) is a protein secreted by oxygen-deprived cells. Low levels of VEGF are normal; however when there are high levels of this protein, abnormal blood vessels will grow. Anti-VEGF drugs (e.g. Lucentis, Avastin and Macugen) block the protein and the corresponding abnormal blood vessel growth – they are given as eye injections. These drugs are used in the treatment of macular degeneration and diabetic retinopathy.
  • Steroid injections: These work mainly by reducing inflammation caused by many retinal conditions, particularly those causing macular oedema (including diabetic retinopathy, central retinal vein occlusion and postoperative macular oedema).

Other retinal treatments

  • Pneumatic retinopexy: A gas bubble is injected into the eye and stops fluid from passing through the hole or tear in the retina, allowing it to reattach. Laser or freezing treatment is performed between 1 to 3 days after the gas injection to seal the retinal tear.
  • Cryo–buckle surgery. A band of solid silicone rubber is stitched to the surface of the white of the eye (sclera) under the conjunctiva (transparent layer covering the sclera), where it can’t be seen. This material ‘buckles’ the sclera (wall) of the eye inwards against a small internal layer of tissue known as the retinal pigment epithelium (RPE), which in turn pushes the detached retina against the wall of eye. Freezing treatment (cryo) is used to scar the tissue around the retina, which creates a seal between the retina and the wall of the eye and closes up the tear or hole.
  • Photodynamic therapy. Photodynamic therapy (PDT) is a treatment for wet age-related macular degeneration. A light-sensitive medicine is injected into the bloodstream, and a laser light shone into the eye, activating the medicine and causing it to create blood clots that block abnormal blood vessels.
  • Transpupillary thermotherapy. A diode laser delivers heat (infrared radiation) to the affected area of the retina and destroys the abnormal cells. It is usually performed under local anaesthetic to treat tumours inside the eye, such as retinoblastoma and choroidal melanoma.
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