Retina Diseases &
At Bethlehem Eye Associates we work to prevent, diagnose and treat diseases of the each and every day. Our eye doctors examine patients who experience floaters and flashes of light to be sure they are not experiencing retinal tears or retinal detachment as well as provide advanced diagnostic testing and evaluation for diabetic eye problems including diabetic macular edema and diabetic retinopathy. Routine eye exams provide one of the best ways to prevent vision loss in seniors through early detection, diagnosis and treatment of macular disease including age related macular degeneration (AMD) with Eyelea®, Avastin® and Lucentis® injections as well as treatment of macular hole and pucker with retinal membrane peeling surgery and vitrectomy. Bethlehem Eye Associates doctors work closely with retina specialists and cooperatively with primary care physicians to understand the causes, make the proper diagnosis and implement the necessary treatment for patients with the full range of retinal vascular disease such as retinal artery occlusion and retinal vein occlusion.
Floaters & Flashes of Light
Seeing floaters is a common occurrence and usually no cause for worry. Floaters may appear as tiny specks or “cobwebs” or as small dark shadows, “thread-like” strands or even “squiggly” lines that actually float around in your field of vision. They tend to move as your eyes move, but not necessarily in the same direction, and often just drift away when your eyes stop moving. Typically they become more noticeable when looking at a visual field with a white background such as a plain piece of paper or a clear blue sky. Floaters are a normal and expected consequence of the aging process of your eyes and, if left alone, they will “settle” or break up over time and no longer be annoying. The likelihood of experiencing floaters increases as we get older and is more common if you are very nearsighted, have diabetes or have had a blow to the head from sports or an accident. Sometimes other eye conditions or problems inside the eye may cause floaters such as infections, inflammation, hemorrhages, retinal tears or trauma to the eye.
About Flashes of Light
Occasionally, a small section of the vitreous gel inside your eye may pull away from the retina all at once instead of slowly and gradually. This can cause a noticeable and sudden increase in the number of floaters and be accompanied by flashes of light. This is called a Vitreous Detachment and it means that you should have a prompt eye exam, especially if light flashes or a distortion in your side vision accompanies it. These are signs of a possible Retinal Detachment, which is a sight threatening medical emergency.
Retinal detachment is a painless site threatening eye problem.
There are three main types of retinal detachment that include:
Rhegmatogenous Retinal Detachment is the most common type that occurs as a result of a break-usually a tear or hole-in the retina that permits fluid to pass into the space underneath the retina. Tears or holes in the retina may actually occur without causing any symptoms to occur. Therefore, it is important that you have routine eye examinations, especially if you are nearsighted or myopic, or if you play contact sports and might be subjected to eye trauma. If you are nearsighted or myopic, you may be more prone to peripheral retinal degenerations, such as lattice degeneration, which may increase your risk of retinal detachment making regular eye examinations an even more important part of your routine health care. Rhegmatogenous Retinal Detachment is the most common type of retinal detachment.
Exudative Retinal Detachment may occur due to inflammation, injury or a Retinal Vascular Disease that causes fluid accumulation underneath the retina without the presence of a retinal hole or retinal tear.
Tractional Retinal Detachment may occur when fibrous or fibrovascular scar tissue has been formed on the retina as a result of an injury, inflammatory disease or the presence of neovascularization, such as in Diabetic Retinopathy. The scar tissue actually pulls the Retina free from the underlying pigment layer it is normally attached to, causing a Retinal Detachment.
Retinal detachment causes a number of symptoms and warning signs that occur often before the actual detachment happens. The key is to preserving vision is to recognize these warning signs and symptoms and scheduling quick diagnosis and treatment. Warning signs and symptoms of retinal detachment may include:
- Flashes of light that may occur in your field of vision toward the outermost periphery.
- A sudden increase in the number of floaters in your vision and possibly even a ring of floaters or “hairs” in your vision-sometimes this is accompanied by “specks” or a “cobweb”.
- A sense of a “shadow” in your peripheral vision that may progress toward the center of your vision.
- A sensation of a “curtain” or a “veil” being drawn over your vision.
- Straight lines, such as the edge of a door or walls, appear to be curved or appear as a “bubble”.
- In extreme cases of retinal detachment you may experience a loss of central vision.
Age Related Macular Degeneration (AMD)
Age Related Macular Degeneration (AMD) is a leading cause of vision loss in seniors in which the central portion of the retina, called the macula, is damaged as a result of the hardening of the small arteries supplying oxygen and nutrients to the retinal tissue. There are two main types of Age Related Macular Degeneration: Dry Macular Degeneration and Wet Macular Degeneration. Dry Macular Degeneration is the most common type of Age Related Macular Degeneration making up 85-90% of cases, resulting in a slow progressive loss of vision. Typically, we see small, yellow colored deposits between the retinal layers, which are called drusen. Many people 50 years of age or older have some drusen as they age and may be asked to schedule eye exams more frequently in order to monitor them as there is some possibility that Dry Macular Degeneration will progress to Wet Macular Degeneration. We need to detect Wet Macular Degeneration quickly as it has far more serious consequences for vision loss. Wet Macular Degeneration is characterized by an abnormal growth of new blood vessels under the retina, called “neovascularization,” which is prone to be leaky and can easily break and bleed. If leakage occurs, the macula may actually begin to swell, bleed and scar causing severe loss of central vision, which may be irreversible.
At Bethlehem Eye Associates we are able to perform in-office Age Related Macular Degeneration (AMD) exams and diagnostic testing as well work with your primary care physician and retina specialists to be certain you have access to care you might need including non-surgical retina injection treatment with Lucentis®, Eylea®, Avastin® or other medications if needed to help maintain your vision and prevent vision loss. With regular eye exams, early detection, diagnosis and treatment, vision loss from AMD can be halted in most instances.
Diabetic Retinopathy (DR) is a complication of Diabetes Mellitus that left undetected and treated can lead to severe and catastrophic vision loss. All patients with diabetes should have regular eye exams and diagnostic testing in order to detect changes in the small blood vessels of the retina that may indicate the need for treatment-even if there is no vision loss! Damage to the small blood vessels in the retina that causes diabetic retinopathy is the most frequent cause of new blindness among adults aged 20-74 years old. However, with regular eye exams, early detection, diagnosis and treatment, vision loss can be prevented or halted in most instances. At Bethlehem Eye Associates we are able to perform in-office diabetic eye exams and diagnostic testing as well work with your primary care physician and retina specialists to be certain you have access to care you might need including non-surgical retina injection treatment with Lucentis®, Eylea® or other medications, laser treatment and surgery if needed to help maintain your vision and prevent vision loss caused by diabetic retinopathy and diabetic macular edema.
A macular hole is a condition that affects the very central portion of the retina.
A macular hole may occur for a number of reasons including eye injuries, inflammation inside the eye and most commonly, the normal aging process. As we age, the vitreous gel in the back of our eye becomes more liquefied and often results in a Vitreous Detachment with associated floaters. Sometimes, when the vitreous “pulls’ it can actually form a macular hole. Macular holes often begin slowly but usually will affect central vision depending on the severity. They can occur as partial holes only affect part of the macular layers, causing wavy, distorted, blurred vision or they can occur as full thickness holes causing a complete loss of central vision.
Signs & Symptoms of Macular Hole
The severity of the symptoms of macular holes depends on whether the hole is partial thickness or full thickness, but in general may include the following:
- Blurred Central Vision
- Distorted, “Wavy” Vision
- Difficulty reading or seeing fine detail even with glasses
- Grayish Area in Central Vision
- Central Blind Spot or “Dark Spot”
Retinal Vascular Disease
Retinal Vascular Disease is a term used to describe a number of conditions that can affect the blood vessels and circulation of the retina and result in significant tissue changes with secondary complications and vision loss. The two most common retinal vascular disorders are Retinal Artery Occlusion and Retinal Vein Occlusion. A Retinal Artery Occlusion can occur in either the Central Retinal Artery or in a Branch Retinal Artery that becomes blocked by a clot or “embolus” in the bloodstream. A Retinal Artery Occlusion is considered a medical emergency and requires immediate attention. When an artery occlusion occurs, it decreases the oxygen supply to the area causing permanent vision loss. Most patients who suffer Retinal Artery Occlusions are between the ages of 50 and 80. They notice a sudden, painless loss of vision that can be a complete loss of vision if it is a Central Retinal Artery Occlusion, or can be a partial loss of their visual field if it is a Branch Retinal Artery Occlusion. Sometimes the major loss of vision is preceded by one or more episodes of “Amaurosis Fugax” or transient loss of vision. Patients who have Retinal Artery Occlusions have other significant health problems such as high blood pressure, diabetes, heart arrhythmias or high cholesterol. In patients over the age of 60, Retinal Artery Occlusion may be due to an underlying inflammatory condition called Giant Cell Arteritis.
A Retinal Vein Occlusion can occur in the Central Retinal Vein or in a Branch Retinal Vein where a blockage causes elevated venous pressure which damages the vein, leading to hemorrhages, swelling and ischemia-a lack of oxygen-in the retina. Retinal Vein Occlusion occurs equally in women and men and mostly after the age of 60, and especially on those patients with diabetes, hypertension or cardiovascular disease. Typically, patients experience a sudden onset of blurred or a “missing area of vision” if a branch retinal vein is occluded or a severe loss of central vision if the central retinal vein has become occluded.