Detached Retina
What is the retina?
The retina is a nerve layer at the back of your eye that senses light and sends images to your brain. An eye is like a camera. The lens in the front of the eye focuses light onto the retina. You can think of the retina as the film that lines the back of a camera.
What is a retinal detachment?
A retinal detachment occurs when the retina is pulled away from its normal position. The retina does not work when it is detached. Vision is blurred, like a camera picture would be blurry if the film were loose inside the camera. A retinal detachment is a very serious problem that almost always causes blindness unless it is treated.
What causes retinal detachment?
The vitreous is a clear gel that fills the middle of the eye. As we get older, the vitreous may pull away from its attachment to the retina at the back of the eye. Usually the vitreous separates from the retina without causing problems. But sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through the retinal tear, lifting the retina off the back of the eye, like wallpaper can peel off a wall.The following conditions increase the chance that you might get a retinal detachment:
- Nearsightedness
- Previous cataract surgery
- Glaucoma
- Severe injury
- Previous retinal detachment in your other eye
- Family history of retinal detachment
- Weak areas in your retina that can be seen by your ophthalmologist.
What are the warning symptoms of a retinal detachment?
- Flashing lights
- New floaters
- A gray curtain moving across your field of vision
These symptoms do not always mean a retinal detachment is present; however, you should see your ophthalmologist as soon as possible. Your ophthalmologist (medical eye doctor) can diagnose retinal detachment during an eye examination where he or she dilates (enlarges) the pupils of your eyes. Some retinal detachments are found during routine eye examination. Only after careful examination can your ophthalmologist tell whether a retinal tear or early retinal detachment is present. What treatment is needed?
Treatment for Detached Retina
Retinal tears-Most retinal tears need to be treated with laser surgery or cryotherapy (freezing), which seals the retina to the back wall of the eye. These treatments cause little or no discomfort and may be performed in your ophthalmologist's office. Treatment usually prevents retinal detachment. In some cases retinal tears can be observed without treatment.
Retinal detachments- Almost all patients with retinal detachments require surgery to put the retina back in its proper position. Types of surgery there are several ways to fix a retinal detachment. The decision of which type of surgery and anesthesia (local or general) to use depends upon the characteristics of your detachment. In each of the following methods, your ophthalmologist will also locate any retinal tears and use laser surgery or cryotherapy around them to seal the tear.
Pneumatic retinopexy- A gas bubble is injected into the vitreous space inside the eye. The gas bubble pushes the retinal tear closed against the back wall of the eye. Your ophthalmologist will ask you to maintain a certain head position for several days. The gas bubble will gradually disappear. Sometimes this procedure can be done in the ophthalmologist's office.
Scleral buckle- A flexible band (scleral buckle) is placed around the eye to counteract the force pulling the retina out of place. The ophthalmologist often drains the fluid under the detached retina from the eye, pulling the retina to its normal position against the back wall of the eye. This procedure is performed in an operating room.
Vitrectomy- The vitreous gel, which is pulling on the retina, is removed from the eye and usually replaced with a gas bubble.Your body's own fluids will gradually replace the gas bubble. Sometimes vitrectomy is combined with a scleral buckle. After surgery you can expect some discomfort. Your ophthalmologist will prescribe any necessary medications for you and advise you when to resume normal activity. You will need to wear an eye patch for a short time. If a gas bubble was placed in your eye, your ophthalmologist may recommend that you keep your head in special positions for a time. DO NOT FLY IN AN AIRPLANE OR TRAVEL UP TO HIGH ALTITUDES UNTIL YOU ARE TOLD THE GAS BUBBLE IS GONE! A rapid increase in altitude can cause a dangerous rise in eye pressure. A change of glasses is often helpful after several months.
What are the risks of surgery?
Any surgery has risks; however, an untreated retinal detachment usually results in permanent severe vision loss or blindness. Some of the surgical risks include:
- Infection
- Bleeding
- High pressure in the eye
- Cataract
Most retinal detachment surgery is successful, although a second operation is sometimes needed. If the retina cannot be reattached, then the eye will continue to lose sight and ultimately become blind. Will your vision improve? Vision may take many months to improve and in some cases may never return fully. Unfortunately, some patients do not recover any vision. The more severe the detachment the less vision may return. For this reason, it is very important to see your ophthalmologist at the first sign of any trouble.
Dry Eye
What is dry eye?
Some people do not produce enough tears to keep the eye comfortable. This is known as dry eye. Tears are produced by two different methods. One method produces tears at a slow, steady rate and is responsible for normal eye lubrication. The other method produces large quantities of tears in response to eye irritation or emotions. Tears that lubricate are constantly produced by a healthy eye. Excessive tears occur when the eye is irritated by a foreign body or when a person cries.
What are the symptoms of dry eye?
The usual symptoms include:
- Stinging or burning eyes;
- Scratchiness;
- Stringy mucus in or around the eyes;
- Eye irritation from smoke or wind;
- Excess tearing;
- Difficulty wearing contact lenses.
- An oily layer
- A watery layer
- A layer of mucus
The oily layer, produced by the meibomian glands, forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears. The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal gland, cleanses the eye and washes away foreign particles or irritants. The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain wet. Without mucus, tears would not adhere to the eye.
What causes dry eye?
Tear production normally decreases as we age. Although dry eye can occur in both men and women at any age, women are most often affected. This is especially true after menopause. Dry eye can also be associated with arthritis and accompanied by a dry mouth. People with dry eyes, dry mouth and arthritis are said to have Sjogren's syndrome. A wide variety of common medications — prescription and over-the-counter — can cause dry eye by reducing tear secretion. Be sure to tell your ophthalmologist the names of all the medications you are taking, especially if you are using:
- Diuretics
- Betablockers
- Antihistamines
- Sleeping pills
- Medications for "nerves"
- Pain relievers
Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with "artificial tears." People with dry eye are often more prone to the toxic side effects of eye medications, including artificial tears. For example, the preservatives in certain eye drops and artificial tear preparations can irritate the eye.
How is dry eye diagnosed?
An ophthalmologist (medical eye doctor) is usually able to diagnose dry eye by examining the eyes. Sometimes tests that measure tear production may be necessary. One test, called the Schirmer tear test, involves placing filter-paper strips under the lower eyelids to measure the rate of tear production under various conditions. Another uses a diagnostic drop (fluorescein or Rose Bengal) to look for certain staining patterns.
How is dry eye treated?
Adding tears
Eye drops called artificial tears are similar to your own tears. They lubricate the eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands on the market, so you may want to try several to find the one you like best. Preservative-free eye drops are available if you are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you. Solid artificial tear inserts that are placed inside the lower lid on a daily basis and gradually release lubricants may be beneficial to some people. You can use the tears as often as necessary—once or twice a day or as often as several times an hour.
Conserving the tears
Conserving your eyes' own tears is another approach to keeping the eyes moist. Tears drain out of the eye through a small canal into the nose (that is why your nose runs when you cry). Your ophthalmologist may close these canals either temporarily or permanently. The closure conserves your own tears and makes artificial tears last longer.
Other methods
Tears evaporate like any other liquid. You can take steps to prevent evaporation. In winter, when indoor heat is on, a humidifier or a pan of water on the radiator adds moisture to dry air. Wraparound glasses may reduce the drying effect of the wind, but are illegal to wear while driving in some states. Anything that may cause dryness, such as an overly warm room, hair dryers or wind, should be avoided by a person with dry eye. Smoking is especially bothersome.Some people with dry eye complain of "scratchy eyes" when they wake up. This symptom can be treated by using an ointment at bedtime. Use the smallest amount of ointment necessary for comfort, since the ointment can cause your vision to blur temporarily. Dry eye due to a lack of vitamin A in the diet is rare in the United States but is more common in poorer countries, especially among children. Ointments containing vitamin A can help dry eye if it is caused by unusual conditions such as Stevens-Johnson syndrome or pemphigoid. Vitamin A supplements do not seem to help people with ordinary dry eye.
Floaters and Flashes
What are floaters?
You may sometimes see small specks or clouds moving in your field of vision. They are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye. Although the floaters appear to be in front of the eye, they are actually floating in the vitreous fluid inside the eye. While these objects look like they are in front of your eye, they are actually floating inside. What you see are the shadows they cast on the retina, the nerve layer at the back of the eye that senses light and allows you to see. Floaters can have different shapes: little dots, circles, lines, clouds or cobwebs.
What causes floaters?
When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel pulls away from the backwall of the eye, causing a posterior vitreous detachment. It is a common cause of floaters. Posterior vitreous detachment is more common for people who:
- Are nearsighted
- Have undergone cataract operations
- Have had YAG laser surgery of the eye
- Have had inflammation inside the eye
The appearance of floaters may be alarming, especially if they develop suddenly. You should see an ophthalmologist (a medical eye physician) right away if you suddenly develop new floaters, especially if you are over 45 years of age.
Are floaters ever serious?
The retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters. A torn retina is always a serious problem, since it can lead to a retinal detachment. You should see your ophthalmologist as soon as possible if:
- Even one new floater appears suddenly
- You see sudden flashes of light
If you notice other symptoms, like the loss of side vision, you should return to your ophthalmologist.
What can be done about floaters?
Because you need to know if your retina is torn, call your ophthalmologist if a new floater appears suddenly. Floaters can get in the way of clear vision, which may be quite annoying, especially if you are trying to read. You can try moving your eyes, looking up and then down to move the floaters out of the way. While some floaters may remain in your vision, many of them will fade over time and become less bothersome. Even if you have had some floaters for years, you should have an eye examination immediately if you notice new ones.
What causes flashing lights?
When the vitreous gel rubs or pulls on the retina, you may see what look like flashing lights or lightning streaks. You may have experienced this same sensation if you have ever been hit in the eye and seen "stars." When the vitreous rubs or pulls on the retina, it creates a sensation of flashing lights.The flashes of light can appear off and on for several weeks or months. As we grow older, it is more common to experience flashes. If you notice the sudden appearance of light flashes, you should visit your ophthalmologist immediately to see if the retina has been torn.
Migraine
Some people experience flashes of light that appear as jagged lines or "heat waves" in both eyes, often lasting 10-20 minutes. These types offlashes are usually caused by a spasm of blood vessels in the brain, which is called migraine. If a headache follows the flashes, it is called a migraine headache. However, jagged lines or "heat waves" can occur without a headache. In this case, the light flashes are called ophthalmic migraine, or migraine without headache.
How are the eyes examined?
When an ophthalmologist examines your eyes, your pupils will be dilated with eye drops. During this painless examination, your ophthalmologist will carefully observe your retina and vitreous. Because your eyes have been dilated, you may need to make arrangements for someone to drive you home afterwards. Floaters and flashes of light become more common as we grow older. While not all floaters and flashes are serious, you should always have a medical eye examination by an ophthalmologist to make sure there has been no damage to your retina.
Macular Degeneration
Macular degeneration is damage or breakdown of the macula of the eye. The macula is a small area at the back of the eye that allows us to see fine details clearly. When the macula doesn't function correctly, we experience blurriness or darkness in the center of our vision. Macular degeneration affects both distance and close vision, and can make some activities like threading a needle or reading difficult or impossible. Although macular degeneration reduces vision in the central part of the retina, it does not affect the eye's side, or peripheral, vision. For example, you could see the outline of a clock but not be able to tell what time it is. Macular degeneration alone does not result in total blindness. People continue to have some useful vision and are able to take care of themselves.
What causes macular degeneration?
Many older people develop macular degeneration as part of the body's natural aging process. The two most common types of age related macular degeneration are "dry" (atrophic) and "wet" (exudative):
"Dry" macular degeneration (atrophic)
Most people have "dry" macular degeneration. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.
"Wet" macular degeneration (exudative)
"Wet" macular degeneration accounts for about 10% of all cases. It results when abnormal blood vessels form at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.
What are the symptoms of macular degeneration?
Macular degeneration can cause different symptoms in different people. The condition may be hardly noticeable in its early stages. Sometimes only one eye loses vision while the other eye continues to see well for many years.
But when both eyes are affected, the loss of central vision may be noticed more quickly. Following are some common ways vision loss is detected: :
- Words on a page look blurred;
- A dark or empty area appears in the center of vision;
- Straight lines look distorted, as in the diagram below:
How is macular degeneration diagnosed?
Many people do not realize that they have a macular problem until blurred vision becomes obvious. Your ophthalmologist (medical eye doctor) can detect early stages of macular degeneration during a medical eye examination that includes the following:
- Viewing the macula with an ophthalmoscope;
- A simple vision test in which you look at a grid resembling graph paper;
- Sometimes special photographs, called angiograms, are taken to find abnormal blood vessels under the retina. Fluorescent dye is injected into your arm and your eye is photographed as the dye passes through the blood vessels in the back of the eye.
How is macular degeneration treated?
Despite ongoing medical research, there is no cure yet for "dry" macular degeneration. Some doctors believe that nutritional supplements may slow macular degeneration, although this has not yet been proven. Treatment of this condition focuses on helping a person find ways to cope with visual impairment.
In its early stages "wet" macular degeneration can be treated with laser surgery, a brief and usually painless outpatient procedure. Laser surgery uses a highly focused beam of light to seal the leaking blood vessels that damage the macula. Although a small, permanently dark "blind spot" is left at the point of laser contact, the procedure can preserve more sight overall.
Despite advanced medical treatment, people with macular degeneration still experience some vision loss.
Your ophthalmologist can prescribe optical devices or refer you to a low vision specialist or center. A wide range of support services and rehabilitation programs are also available to help people with macular degeneration maintain a satisfying lifestyle.
Because side vision is usually not affected, a person's remaining sight can be very useful. Often, people can continue with many of their favorite activities by using low vision optical devices such as magnifying devices, closed circuit television, large print reading materials, and talking or computerized devices.
Testing your vision with the Amsier Grid
You can check your vision daily by using an Amsier grid like the one pictured below. You may find changes in your vision that you wouldn't notice otherwise. Putting the grid on the front of your refrigerator is a good way to remember to look at it each day.
Using the Grid:
- Wear your reading glasses and hold this grid at 12 - 15 inches in good light.
- Cover one eye. Look directly at the center dot with the uncovered eye.
- While looking directly at the center dot, note whether all lines of the grid are straight or if any areas are distorted, blurred or dark.
- Repeat this procedure with the other eye.
- If any area of the grid looks wavy, blurred or dark, contact your ophthalmologist immediately.
