Retina

‘Floater’ is the term given to protein-like particles that collect in the eye and tend to ‘float’ or move around with eye movements. Floaters may be seen as ‘hairs’, ‘spots’ or web-like strands.

A common cause of new floaters is Posterior Vitreous Detachment (PVD). The vitreous is the jelly-like substance that is found inside the eye. As people age, this substance begins to liquefy and begins to pull away from the retina. As the retina is tugged, it can create lightning-like ‘flashes’ in one’s vision, usually associated with floaters—annoying spots that typically move around with eye movement. Although floaters remain, the brain usually adapts in time and they become less noticeable. More importantly, floaters can also be sign of a retinal tear, or retinal detachment that is more serious and can lead to blindness without treatment. Therefore, it is very important to be evaluated by an ophthalmologist with any new onset of floaters (or flashes) to insure no other retinal problem is present.

Another cause of new floaters is bleeding inside the eye. This is referred to as a vitreous hemorrhage. Vitreous hemorrhage is the result of abnormal blood vessel formation in the eye and can be seen most commonly in diabetic eye disease. For more information on diabetic eye disease, please refer to the FAQ question ‘What is diabetic retinopathy?’.

A retinal tear is a break in the retina that is the delicate tissue lining the back of the eye.   When retinal tear is left untreated, it may progress to a more serious condition known as a retinal detachment with severe loss of vision. A retinal tear may occur spontaneously or in association with other eye conditions. People who are nearsighted (in which the eye is longer than normal) are at higher risk of retinal tears and detachments and should be examined regularly.

Posterior Vitreous Detachment or ‘PVD’, in which the jelly substance inside the eye separates from the back of the eye, can cause noticeable symptoms of flashes of light and floaters in one’s vision. Infrequently a PVD can lead to a tear in the retina. Since PVDs and their associated floaters and flashes are common, the only way to determine the presence of a retinal tear is with a thorough examination by an ophthalmologist as soon as possible. If a retinal tear is found, it can be treated immediately with laser in the office to prevent the tear from developing into a retinal detachment where the retina begins to separate from the back of the eye.

Age-related macular degeneration (AMD) is a condition that affects the central area of retina known as the macula. The macula is the most sensitive part of the retina and is made up of millions of light-sensing cells that provide sharp, and detailed central vision. AMD is more common with advancing age and is the leading cause of vision loss for people over the age of 50 in the Western world.

There are two types of AMD referred to as ‘Dry’ and ‘Wet’ forms. Dry AMD is more common and tends to be slower in onset and progression. Patients may be asymptomatic in early stages, but as the disease progresses, vision becomes blurry or distorted making it more difficult to read or see detail. While there is no clinical treatment for dry AMD, studies have shown that the use of certain vitamins can help slow its progression. Patients with a known family history of AMD may benefit from vitamin therapy. Consult your doctor before beginning a vitamin regimen, especially if you smoke or take a blood thinner medication. Patients with dry AMD should monitor their vision daily and if a change is noted, call their ophthalmologist for an immediate evaluation as dry AMD can progress into the more serious form known as ‘Wet’ AMD.

Wet AMD is the term used to describe the more aggressive type of macular degeneration. It is referred to as ‘wet’ due to the development of abnormal blood vessels under the retina that have a propensity to bleed. This onset is usually noted by the patient as a sudden decline in vision, a central ‘gray spot’ in their vision, or increased distortion of central vision. Fortunately, recent developments in AMD treatment have provided retina specialists the ability to better control this disease.   A new class of medication is now being used to treat wet macular degeneration. These drugs are based on discovery that Vascular Endothelial Growth Factor (VEGF) plays a significant role in the formation of abnormal blood vessels that damage the retina in wet macular degeneration.

The anti-VEGF drugs are injected directly into the vitreous, the gel inside the eye that overlies the retina. While it may seem intimidating to receive an injection into the eye, most patients find the experience of minimal discomfort. Once inside the eye, the medication diffuses throughout the retina. It binds strongly to the abnormal VEGF proteins, preventing the proteins from stimulating further unwanted blood vessel growth and leakage.  Most patients gain significant vision with these injections.

In cases where Anti-VEGF medications are not sufficient for treatment of wet macular degeneration, a laser treatment known as Photo Dynamic Therapy or PDT is used. PDT employs the use of a photo-reactive drug called Visudyne™ which is injected into the bloodstream and collects in the area of abnormal retinal vessels. A special laser is then directed to the site of treatment that activates the drug causing the abnormal vessels to close.

Piedmont Eye Center’s experienced retinal specialists, Dr. Robert Vogel and Dr. Golnaz Javey, offer the very latest in AMD treatment in our state-of-the-art facility. Come see why Piedmont Eye Center is a leader in advanced AMD treatment.

For additional information on AMD, please visit the following online links:

http://www.aao.org/eye-health

http://www.amdalliance.org

Diabetes is a disease in which body’s metabolism of sugar is out of balance. Diabetes affects small blood vessels throughout the body including the small vessels of retina, the delicate inner lining of the eye that allows us to see. When the retina is affected, the condition is referred to as Diabetic Retinopathy. Diabetic retinopathy is a leading cause of vision-loss globally. Of an estimated 285 million people with diabetes worldwide, approximately one third have signs of diabetic retinopathy.

Diabetic retinopathy can develop in anyone who has type 1 or type 2 diabetes. Those with poor sugar control, are more likely to develop complications of diabetic retinopathy. Over time, diabetes weakens the vessels causing them to leak fluid or blood into the surrounding tissue. This leads to a decline in vision. Diabetes can also lead to the formation of new ‘abnormal’ vessels on the retinal surface that may bleed. This can present as new ‘floaters’ in one’s vision or, in severe cases, complete vision loss.

In early stages, diabetic retinopathy may be asymptomatic and can only be detected by dilated eye examination. If left untreated, diabetic retinopathy can lead to complete blindness. It has been shown that good control of blood sugar levels and blood pressure, and cessation of smoking help to prevent the onset of diabetic retinopathy. It is recommended that all diabetic patients undergo an annual eye examination with an ophthalmologist. If Diabetic Retinopathy is detected, close monitoring and possible injection of medication, laser treatment, or surgical intervention may be necessary to preserve vision.

In some cases, injection of medication in the vitreous (the gel inside the eye that overlies the retina) may be used to treat diabetic retinopathy. Steroids or anti-VEGF medications are most commonly used for treatment of diabetic retinopathy. Anti-VEGF medications strongly bind to the abnormal VEGF (Vascular Endothelial Growth factor) that contributes to abnormal blood vessel growth in the eye. Anti-VEGF medication help reduce the unwanted blood vessel growth and leakage.  Most patients gain significant vision with these injections.

Retinal laser treatment, performed by a retinal specialist, is one method to treat abnormal vessels. In cases with severe bleeding, vitrectomy is required. This is a surgical procedure in which the collected blood is removed from the eye. In most case, laser treatment is combined with vitrectomy to help prevent future bleeding.

Dr. Robert Vogel and Dr. Golnaz Javey are experienced in managing and treating diabetic retinopathy using the very latest state-of-the-art methods.

If you have diabetes, please make sure you are keeping up with your eye examinations. Call today to schedule your appointment.

For more information visit:

www.aao.org/eye-health

A retinal vein occlusion is a condition in which a blockage occurs in one of the major veins of the retina, the innermost lining of the eye that is necessary for sight. It is most commonly associated with such systemic conditions as high blood pressure, diabetes, various blood disorders, and cardiovascular disease. It affects the elderly in most cases and can present as mild visual blurring to complete vision loss. Usually it is painless. The condition requires a thorough eye examination by an ophthalmologist and may require laser intervention by a retinal specialist. In some cases, the disease can lead to a severe type of glaucoma that can be difficult to control. If left untreated the eye can become shrunken and painful. Early intervention is crucial to preserve vision. In addition, patients with vein occlusions should be under the care of their general medical doctor.

A retinal artery occlusion is a condition in which an arterial vessel within the retina becomes blocked, leading to mild or severe vision loss. It is more common in the elderly and often associated with high blood pressure, diabetes, history of smoking, or carotid vessel disease. In some cases, warning signs of transient visual loss may precede the occlusion. This is referred to as ‘amarosis fugax’ and warrants an urgent medical evaluation. Artery occlusions, when they occur, are difficult to treat as vision loss can be permanent. Therefore, it is important for patients with known risk factors to see their medical doctor regularly.

A Fundus Fluorescein Angiogram (FFA) is a special dye study used by ophthalmic retinal specialists to view the vessels of the retina in various disease states. Often, an FFA is useful to evaluate such conditions as diabetic retinopathy, age-related macular degeneration (AMD), and retinal vascular occlusions. The study is done by injecting a special dye into a patient’s arm vein. After the dye circulates in the body, special photographs are taken of the retina to help ‘visualize’ the delicate vessels to identify problem areas that may need treatment. These photos can be used to localize laser treatment in order seal leaking blood vessels and preserve vision. As the area’s only full-time retina team, Dr. Robert Vogel and Dr. Golnaz Javey are experienced in using the very latest treatments in retinal disorders.

An OCT, which stands for ‘optical coherence tomography’, is a highly sophisticated device used to digitally image the retina of the eye. This system allows a retinal specialist to see the very intricate layers of the retina and is used to identify such things as retinal holes, overlying retinal membranes, or retinal swelling. Precise identification of these various disorders can otherwise be difficult, making it hard to determine appropriate treatment. Often found in major university eye clinics, this technology is now available locally only at Piedmont Eye Center. Trust Piedmont Eye Center to provide the very latest technology in advanced retinal diagnostics and treatment.

Piedmont Eye Center is proud to offer the latest technology available to ensure the best possible care each and every visit. Part of our commitment to technology includes the Heidelberg Spectralis OCT, which is part of the latest and most advanced OCT technology available. An OCT (Optical Coherence Tomography) machine scans the retina under a similar premise as an ultrasound or MRI, except utilizing reflected light to generate detailed cross sections and 3D rendering of the retina. This device offers your physician the most detailed and accurate information available today. The Heidelberg Spectralis is over 100x faster than technology previously available and acquires up to 40,000 single line scans per second! This increased speed and detail equates to much higher resolution and unrivaled ability to track disease progression and improvements. The Heidelberg OCT also comes equipped withTruTrack Technology, which enables active eye tracking and consistent alignment of images. This allows for a patient to rest comfortably in the machine and blink as they need to without compromising quality of scans and also a drastic reduction in artifact. Lastly, the Spectralis also came equipped with AutoRescan Technology which is responsible for providing precise follow-up scan placement to insure the exact area in question is scanned precisely each and every time. The Heidelberg Spectralis is the only SD-OCT to offer both of these technologies to complement one another to give the best scans and best information, every time!