Vitreoretinal disease

Overview

Your eye is made up of numerous distinct components that absorb light and deliver signals to your brain. How well your eyes operate and how healthy they are reliant on each of these components working properly. If you have an infection or condition in one of your eyes, you may have discomfort and vision problems such as seeing halos. It can have an effect on your visual acuity in some situations.

 

Eye Anatomy

Parts of the Eye:

• Vitreous Gel: A transparent gel that fills the inner chamber of the eye.
• The optic nerve is a network of about one million nerve fibers that transports visual data from the retina to the brain.
• The macula is a sensitive region of the retina that provides central vision. It contains the fovea and is placed in the middle of the retina.
• The fovea is the center of the macula and provides the clearest vision.
• The light-sensitive tissue lining at the back of the eye is known as the retina. The retina turns light into electrical impulses, which are then sent to the brain through the optic nerve.
• Iris: The eye's colored part that regulates how much light enters the eye.
• Lens: A clear component of the eye located behind the iris that aids in focusing light or images on the retina.
• Pupil: The central aperture of the iris. The iris limits the quantity of light that may enter the eye by adjusting the size of the pupil.
• Cornea: The transparent outer component of the focusing apparatus of the eye, placed in front of the eye.

 

What is Vitreoretinal disease?

Vitreoretinal refers to the vitreous fluid in the eye and the retina. This part of your eye is located in the rear. The fluid is a transparent, gel-like material that aids in the form of your eye. Because the retina is the part of your eye that receives light, your optic nerve may deliver the image to your brain. The macula is located in the middle of your retina. The macula is the area of your eye that focuses light. It is in charge of making your eyesight bright and clear.

Symptoms of vitreoretinal disease include:

• Night blindness.
• Floaters in the visual field, especially the sudden onset of spots.
• Dimming in central or peripheral vision.
• Flashes of light.
• Severe eye pain.
• Sudden vision loss.
• Distortion of printed words when reading.
• Distortion in central vision, such as wavy lines.
• Extreme light sensitivity.

 

Types of Vitreoretinal Disorders

Macular degeneration, retinal tears, retinal detachment, macular holes, and diabetic retinopathy are some of the most common vitreoretinal conditions. You can have either dry or wet macular degeneration. The most frequent kind is dry macular degeneration, which produces impaired or diminished central vision. It is caused by the thinning of your macula. Wet macular degeneration, on the other hand, is caused by aberrant blood or fluid vessels in your eye. The liquid enters your macular, impairing your central vision.

Retina tears happen when the retina of the eye tears. It raises the chances of your retina fully detaching and causing significant vision loss. You can see floaters or dark patches in your eyesight. However, if you are bleeding, the symptoms will be much severe.

Retinal detachment is another possibility. This occurs when the retina separates from the supporting tissue. Because the retina is so important to your eyesight, if it detaches, you may lose your vision. There might be a rip, crack, or hole that causes separation. It might also be caused by an accident, inflammation, or anomalies. In most cases, this will not cause you any discomfort.

You might have a macular hole, which is a tiny break in the macula. You may experience blurred or distorted vision if you have this problem. Diabetic retinopathy is a disorder that diabetics suffer from. It's a condition caused by damage to your retina's blood vessels. In most situations, this affects both eyes at the same time.

 

Age-Related Macular Degeneration

Macular degeneration, also known as age-related macular degeneration (AMD), is a loss of central vision caused by damage to the macula of the retina. AMD is classified into two types: dry AMD and wet AMD.

The more prevalent of the two is dry AMD, which accounts for around 80% of AMD cases. Dry AMD is distinguished by the presence of drusen, or tiny protein bundles, in a thinned-out macula. There is no cure for Dry AMD, according to doctors. Wet AMD is less prevalent than Dry AMD, although it is more dangerous. Wet AMD is distinguished by the formation of irregular blood vessels underneath the retina. When blood vessels bleed, they might damage the macula. This illness has a rapid and profound impact on eyesight.

 

Macular Hole

The most sensitive and central area of the macula is also the thinnest section of the retina. The Fovea Centralis is utilized for fine visual skills such as reading, gazing at faces, and so on. An improper interaction between the vitreous and this region of the retina can result in forward and/or outward tugging, which can lead to the creation of a macular hole. Macular hole development is more common in women than males and often affects persons in their 60s and 70s. They obstruct center vision, resulting in a tiny blank spot wherever the user looks. If left untreated, sight loss can be irreversible; however, early surgical treatment is very effective, with over 95% of holes healing and vision improving dramatically.

 

Diabetic Retinopathy

Diabetes can cause diabetic retinopathy, which is an eye illness. When blood sugar levels are high, blood vessels in the retina are damaged. These blood vessels have the potential to enlarge and leak. They can also shut, preventing blood from going through. On the retina, aberrant new blood vessels can form. All of these changes have the potential to obstruct your eyesight.

There are two main stages of diabetic eye disease:

 

Non-Proliferative Diabetic Retinopathy (NPDR)

This is the beginning of diabetic eye disease. It is common among diabetics. Tiny blood vessels leak in NPDR, causing the retina to enlarge. Macular edema occurs when the macula expands. This is the most prevalent cause of diabetes-related visual loss.

Blood vessels in the retina can also shut because to NPDR. This is known as macular ischemia. Blood cannot reach the macula when this occurs. In the retina, small particles known as exudates can develop. These can also have an impact on your eyesight.

If you have NPDR, your vision will be blurry.

 

Proliferative Diabetic Retinopathy (PDR)

The more severe stage of diabetic eye disease is PDR. It occurs when the retina begins to develop new blood vessels. This is known as neovascularization. These delicate young arteries frequently bleed into the vitreous. If they barely bleed slightly, you may notice a few black floaters. If they bleed a lot, their eyesight may be obstructed.

These new blood vessels have the potential to create scar tissue. Scar tissue can irritate the macula or cause a detached retina. PDR is a dangerous condition that can impair both your central and peripheral (side) vision.

 

Diabetic Retinopathy Diagnosis

Drops will be inserted into your eye to dilate (enlarge) your pupil. This allows your ophthalmologist to see the interior of your eye through a specific lens. To examine the retina closely, your doctor may use optical coherence tomography (OCT). The retina is scanned by a machine, which produces detailed pictures of its thickness. This assists your doctor in locating and measuring edema in your macula.

Fluorescein angiography, also known as OCT angiography, allows your doctor to view what is going on with the blood vessels in your retina. Fluorescein angiography makes use of fluorescein, a yellow dye that is injected into a vein (usually in your arm). The color is absorbed by your blood vessels. A unique camera captures images of the retina while the dye circulates through its blood vessels. This determines whether any blood vessels are clogged or leaking fluid. It also displays whether or not any aberrant blood vessels are developing. OCT angiography is a modern method that uses no dye to examine blood arteries.

 

Vitreous Detachment

In juvenile eyes, the vitreous has a gel-like structure with a fragile framework of extremely thin collagen fibrils holding mucopolysaccharide and water molecules. The vitreous gets more liquid as the eyes age, with the fibrils clumping together to create strands and particles that throw shadows on the retina. These shadows seem to us as floaters. Floaters are generally harmless, although they can be bothersome in certain people, particularly myopes (those with short-sighted eyes). Inflammations, infections, trauma, and other factors can also cause floaters that are more bothersome than typical.

A Posterior Vitreous Detachment (PVD) is a frequent aging condition that affects the vitreous gel. This usually happens beyond the age of 50, although it can happen sooner, especially in myopes or those who have had previous eye surgery, such as cataract surgery. The vitreous humor separates from the retina and compresses forward in the eye, staying linked to the tissues immediately behind the lens in this situation. PVD symptoms include an increase in floaters and flashing lights, which are frequently seen at the peripheral borders of the eyesight in dim illumination.

While largely innocuous, vitreous separation during PVD can strain on sections of the retina, causing retinal tears or holes in a tiny number of patients. These, in turn, can allow fluid from the inside of the eye to travel through the breaches in the retina, causing it to lift off the back of the eye, resulting in a retinal detachment.

When the retina detaches, it can no longer function properly, resulting in a shadow or a curtain-like effect in vision. Retinal detachments can proceed quickly and cause total blindness if not corrected. When signs of PVD (increased floaters or flashing lights) appear, it is critical to get the eye evaluated. When retinal holes and tears are found early, before the retina has detached, they can be treated with laser, which typically prevents retinal detachment. Once the retina has begun to detach, surgery is almost usually required.

Retinal Detachment

When the retina pulls away from the back of the eye, it is said to be detached. When the retina becomes detached, vision becomes fuzzy. A detached retina is a dangerous condition. You should see an ophthalmologist soon away, or you may lose sight in that eye.

The vitreous in our eyes begins to shrink and thin as we age. The vitreous travels around on the retina without creating any difficulties as the eye moves. However, the vitreous may occasionally adhere to the retina and pull strongly enough to tear it. When this occurs, fluid can enter the tear and raise (detach) the retina.

 

Early Signs of a Detached Retina

A detached retina should be evaluated by an ophthalmologist as soon as possible. Otherwise, you risk losing sight in that eye. If you have any of the following symptoms, contact an ophthalmologist right away:

• Seeing flashing lights all of a sudden. Some people say this is like seeing stars after being hit in the eye.
• Noticing many new floaters at once. These can look like specks, lines or cobwebs in your field of vision.
• A shadow appearing in your peripheral (side) vision.
• A gray curtain covering part of your field of vision.

 

How Is a Detached Retina Diagnosed?

Drops will be placed in your eye by your ophthalmologist to dilate (widen) the pupil. Then, using a special lens, they will examine your retina for any alterations.

 

Retinitis Pigmentosa

Retinitis pigmentosa (RP) is a group of hereditary illnesses that cause retinal degeneration and visual loss. The retina is a thin tissue layer that lines the back of the eye. The retina's rod and cone photoreceptors turn light into electrical impulses that the brain interprets as vision. Because photoreceptors deteriorate, people with RP gradually lose their vision.

The severity of the symptoms is determined by whether rods or cones are initially affected. In most cases of RP, the rods are the first to be impacted. Rod degeneration impairs peripheral and night vision because rods are concentrated in the outer parts of the retina and are triggered by low light. Over time, vision gets more restricted. Visual acuity, color perception, and center vision are all impaired as the illness develops and cones become damaged.

 

Retinal Vein Occlusion

Central Retinal Vein Occlusion (CRVO) is vascular occlusion of the central retinal vein that can cause visual abnormalities and long-term complications. Age is a major risk factor for the development of central retinal vein occlusion, with 90% of patients being above the age of 50. Other main risk factors for central retinal vein occlusion include systemic arterial hypertension, open-angle glaucoma, diabetes mellitus, and hyperlipidemia.

 

Symptoms of Retinal Vein Occlusion 

Patients with CRVO frequently notice abrupt hazy or distorted vision in one eye. This loss of vision will be painless. Paresthesias, reduced extraocular movements, muscular weakness, slurred speech, ptosis, and enhanced deep tendon reflexes are neurological indications that point to a diagnosis other than central retinal vein occlusion.

The patient may have vague symptoms of visual disturbance or drastically decreased vision depending on the kind of CRVO. Similarly, they may have a reasonably normal exam or have an afferent pupillary defect, color vision decrease, and/or a decline in visual acuity in the afflicted eye. Central retinal vein occlusions are described as having a "blood and thunder" look on ocular fundus examination due to massive hemorrhages found across the retina.

Cotton wool patches, damage to the retinal nerve fiber layer, and enlargement of the optic disc are further fundus abnormalities. An ophthalmoscopy exam in non-ischemic central retinal vein occlusion often reveals tortuosity and modest dilatation of the retinal veins, as well as hemorrhages in all quadrants. Ischemic central retinal vein occlusion is characterized by significant retinal edema, venous dilatation, and widespread 4-quadrant bleeding.

 

Diagnosis Retinal Vein Occlusion 

To diagnose the etiology of a central retinal vein blockage, a comprehensive laboratory workup is required. All individuals with a central retinal vein blockage should have the following diagnostics and labs performed:

• Blood pressure
• Erythrocyte sedimentation rate
• Complete blood count
• Random blood glucose
• Random total and HDL cholesterol
• Plasma protein electrophoresis (dysproteinemias in association with multiple myeloma)
• Urea, electrolytes, and creatinine (a renal disease in association with hypertension)
• Thyroid function tests (associated with dyslipidemia)
• EKG (left ventricular hypertrophy secondary to hypertension)

In individuals under the age of 50 with bilateral retinal vein blockage and a history of prior thrombosis or a family history of thrombosis, the following tests are recommended:

• Chest x-ray (sarcoidosis, tuberculosis)
• C-reactive protein
• Thrombophilia screen (thrombin time, prothrombin time and activated partial thromboplastin time, antithrombin functional assay, protein C, protein S, activated protein C resistance, factor V Leiden mutation, prothrombin G20210A mutation; anticardiolipin antibody, lupus anticoagulant)
• Autoantibodies (rheumatoid factor, anti-nuclear antibody, anti-DNA antibody)
• Serum angiotensin-converting enzyme
• Fasting plasma homocysteine level
• Treponemal serology
• Carotid duplex imaging (exclude ocular ischemic syndrome)
  
  

Treatment of Vitreoretinal disease

Every three weeks, a retina expert will examine patients outside of our office for more complete examinations and for the convenience of our patients with more significant retina requirements. The following are some disorders that can affect the vitreous and retina:

 

Diabetic Retinopathy

A progression of retinal abnormalities marked by bleeding (dot-blot hemorrhages), swelling (macular edema), and aberrant blood vessel development (neovascularization.) This might happen if you have diabetes for a long time or if your diabetes is not well-controlled. Diabetics should undergo an eye checkup once a year to screen for these abnormalities, and a letter will be sent to your diabetic doctor to update them on the state of your eyes.

 

Age-Related Macular Degeneration

Degeneration of the macula, a particular portion of the retina crucial for crisp, clear center vision. A change in the pigmentation of the macula or the appearance of yellowish deposits right under the retina indicate the "dry" type of the illness (called drusen) In the "wet" variant, aberrant blood vessels develop underneath the retina, leaking fluid and blood and disrupting normal macula function. In this country, macular degeneration is the major cause of permanent visual loss. Physicians can discuss the use of nutritional supplements or retina therapies in the management of macular degeneration with you.

 

Macular Pucker/Epiretinal Membrane

Wrinkling of the center retina (the macula) produced by the contraction of a thin membrane on the retinal surface, causing visual distortion. To enhance eyesight, surgery to remove the membrane is occasionally indicated.

 

Posterior Vitreous Detachment

As the vitreous gel liquefies and condenses over time, it separates from the retinal surface. Usually a minor modification that causes fresh flashes of light or "floaters" in one's vision, but in severe situations can lead to a retinal detachment. To rule out a retinal detachment, any new flashes of light or "floaters" should be examined as soon as possible.

 

Retinal Tear or Detachment

A detachment of the retina from the inner layers of the eye that can cause vision to be disrupted and portions of the visual field to be lost. Frequently necessitates rapid surgical repair.

 

Conclusion

A collection of illnesses known as vitreoretinal disease impact your retina, macula, and vitreous fluid. Diabetic Retinopathy, Macular Degeneration, Retinal Detachments or Tears, Macular Holes, and Retinitis Pigmentosa are some of the Vitreoretinal Disorders. Floaters, which can range from microscopic dots to enormous clouds of "debris," haziness of the entire visual field, and severe vision loss are some of the visual symptoms of various severity.