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CONDITIONS

Age-Related Macular Degeneration

Summary

(AMD) is a deterioration of the retina and choroid that leads to a substantial loss in visual acuity (sharpness of vision). AMD is the leading cause of significant visual acuity loss in people over age 50 in developed countries.

Causes

The exact cause of AMD is unknown, but the condition develops as the eye ages. There are 2 types of AMD: non-neovascular or dry AMD; and neovascular or wet AMD. In early stages of dry AMD, the hallmark is drusen—pale yellow lesions formed beneath the retina.

Symptoms

• Distortion (warping) of straight lines
• A decrease in the intensity or brightness of colors
• A gradual or sudden loss of central vision, or
• Dark, blurry areas in the center of vision. 

VITRECTOMY FOR FLOATERS

SUMMARY

As we get older, some of us may see “floaters” in our field of vision. In rare cases when many of these floating specks interfere with vision while driving or reading, onetreatment option is vitrectomy—surgical removal of the eye’s vitreous gel.

CAUSES

The vitreous gel is attached to the retina at birth. At some point, as a natural part of aging, the vitreous pulls free from the retina. This posterior vitreous detachment is the most common cause of floaters. Blood, inflammatory cells, or pigment cells may also collect in the vitreous cavity.

SYMPTOMS

With aging, vitreous gel may develop opacities (unclear areas) and movement, creating the sensation of bugs or dirt in the vision due to shadows cast onto the retina. 

Retinal tears

Summary

(Retinal tears) is a deterioration of the retina and choroid that leads to a substantial loss in visual acuity (sharpness of vision). AMD is the leading cause of significant visual acuity loss in people over age 50 in developed countries.

Causes

The exact cause of AMD is unknown, but the condition develops as the eye ages. There are 2 types of AMD: non-neovascular or dry AMD; and neovascular or wet AMD. In early stages of dry AMD, the hallmark is drusen—pale yellow lesions formed beneath the retina.

Symptoms

• Distortion (warping) of straight lines
• A decrease in the intensity or brightness of colors
• A gradual or sudden loss of central vision, or
• Dark, blurry areas in the center of vision.

RETINAL DETACHMENT

SUMMARY

The retina lines the back wall of the eye, and is responsible for absorbing the light that enters the eye and converting it into an electrical signal that is sent to the brain via the optic nerve, allowing you to see.

CAUSES

Rhegmatogenous tears are caused by a hole or tear in the retina that allows fluid to pass through and collect underneath the retina, detaching it from its underlying blood supply. Tractional tears are caused by scar tissue that grows on the surface of the retina. Exudative retinal detachments form when fluid leaks out of blood vessels and accumulates under the retina.

SYMPTOMS

The typical symptoms of a retinal detachment include floaters, flashing lights, and a shadow or curtain in the peripheral (noncentral) vision that can be stationary (non-moving) or progress toward, and involve, the center of vision.

Diabetic Retinopathy

Summary

Diabetic retinopathy is a complication of diabetes that causes damage to the blood vessels of the retina— the light-sensitive tissue that lines the back part of the eye, allowing you to see fine detail..

Causes

The primary cause of diabetic retinopathy is diabetes—a condition in which the levels of glucose (sugar) in the blood are too high. Elevated sugar levels from diabetes can damage the small blood vessels that nourish the retina and may, in some cases, block them completely.

Symptoms

Blurred or double vision, Difficulty reading, The appearance of spots— commonly called “floaters”— in your vision, A shadow across the field of vision, Eye pain or pressure, Difficulty with color perception

Retinal Artery Occlusion

Summary

Retinal artery occlusion refers to blockage of the retinal artery carrying oxygen to the nerve cells in the retina at the back of the eye. The lack of oxygen delivery to the retina may result in severe loss of vision.

Causes

Retinal artery occlusion occurs due to blockage of the retinal artery, often by an embolus (a small piece of cholesterol that blocks blood flow) or thrombus (blood clot). The retinal artery occlusion may be transient and last for only a few seconds or minutes if the blockage breaks up and restores blood flow to the retina, or it may be permanent.

Symptoms

Retinal artery occlusion is usually associated with sudden painless loss of vision in one eye. The area of the retina affected by the blocked vessels determines the area and extent of visual loss.

Macular Hole

Summary

The macula is a small area in the center of the retina where light is sharply focused to produce the detailed color vision needed for tasks such as reading and driving. When a full-thickness defect develops in the macula, the condition is referred to as macular hole.

Causes

Macular hole commonly affects people over the age of 55 and most often occurs in women. The vast majority of cases develop spontaneously without an obvious cause. For this reason, there is currently no effective way to prevent their formation and development. If a macular hole develops in one eye, there is a 5% to 15% risk of one developing in the other eye.

Symptoms

The most common symptom of macular hole is a gradual decline in the central (straight-ahead) vision of the affected eye. This can occur as:
• Blurring
• Distortion (straight lines appearing wavy)
• A dark spot in the central vision The degree to which vision is affected will depend on the size and location of the macular hole, as well as the stage of its development.

Central Retinal Vein Occlusion

Summary

Central retinal vein occlusion, also known as CRVO, is a condition in which the main vein that drains blood from the retina closes off partially or completely. This can cause blurred vision and other problems with the eye.

Causes

Most patients with CRVO develop it in one eye. And, although diabetes and high blood pressure are risk factors for CRVO, its specific cause is still unknown. What we do know is that CRVO develops from a blood clot or reduced blood flow in the central retinal vein that drains the retina. And we have learned that a large number of conditions may increase the risk of blood clots. Some eye doctors advise testing for them. However, it is not certain how these health conditions are related to CRVO—and some of them, if diagnosed, have no agreed-to or necessary recommended treatment.

Symptoms

• Many patients with CRVO have symptoms such as blurry or distorted vision due to swelling of the center part of the retina, known as the macula.
• Some patients have mild symptoms that wax and wane, called transient visual obscurations.
• Patients with severe CRVO and secondary complications such as glaucoma (a disease characterized by increased pressure in the eye) often have pain, redness, irritation and other problems.

Branch Retinal Vein Occlusion

Summary

Retinal vein occlusions occur when there is a blockage of veins carrying blood with needed oxygen and nutrients to the nerve cells in the retina. A blockage in the retina’s main vein is referred to as a central retinal vein occlusion (CRVO), while a blockage in a smaller vein is called a branch retinal vein occlusion (BRVO).

Causes

Most BRVOs occur at an arteriovenous crossing—an intersection between a retinal artery and vein. These vessels share a common sheath (connective tissue), so when the artery loses flexibility, as with atherosclerosis (hardening of the arteries), the vein is compressed.

Symptoms

BRVO causes a sudden, painless loss of vision. If the affected area is not in the center of the eye, BRVO can go unnoticed with no symptoms. In rare cases of an undetected vein occlusion, visual floaters from a vitreous hemorrhage (blood vessels leaking into the vitreous gel of the eye) can be the main symptom

Flashes & Floaters

Summary

Posterior Vitreous Detachment (PVD AKA Flashes & Floaters) is a natural change that occurs during adulthood, when the vitreous gel that fills the eye separates from the retina, the light-sensing nerve layer at the back of the eye.

Causes

Over time, the vitreous gel that fills the eye becomes liquid and condenses (shrinks) due to age and normal wear and tear. Eventually it cannot fill the whole volume of the eye’s vitreous cavity (which remains the same size during adulthood) and so the gel separates from the retina, located at the very back of the eye cavity.

Symptoms

• Floaters (mobile blurry shadows that obscure the vision)
• Flashes (streaks of light, usually at the side of the vision)
These symptoms usually become less intense over several weeks.

Lattice Degeneration

Summary

Lattice Degeneration is a condition that involves abnormal thinning of the peripheral retina, which is the tissue that lines the back wall of the eye and is critical for maintaining good vision. When lattice degeneration is present, the retina is more vulnerable to developing tears, breaks, or holes that could ultimately lead to a visually debilitating condition called a retinal detachment. For this reason, once diagnosed lattice degeneration should be closely monitored.

Causes

Lattice Degeneration is a condition that involves abnormal thinning of the peripheral retina, which is the tissue that lines the back wall of the eye and is critical for maintaining good vision. When lattice degeneration is present, the retina is more vulnerable to developing tears, breaks, or holes that could ultimately lead to a visually debilitating condition called a retinal detachment. For this reason, once diagnosed lattice degeneration should be closely monitored.

Symptoms

• Blurred vision
• Flashing lights
• Floaters
• Curtain obscuring part of your peripheral visual field If you experience any of these, seek prompt ophthalmic care.

Epiretinal Membranes

Summary

Epiretinal Membranes (ERMs), also commonly known as cellophane maculopathy or macular puckers, are avascular (having few or no blood vessels), semitranslucent, fibrocellular membranes that form on the inner surface of the retina. They most commonly cause minimal symptoms and can be simply observed, but in some cases they can result in painless loss of vision and metamorphopsia (visual distortion).

Causes

The most common cause of macular pucker is an age-related condition called posterior vitreous detachment (PVD), where the vitreous gel that fills the eye separates from the retina, causing micro-tears and symptoms of floaters and flashes.

Symptoms

Most patients with ERMs have no symptoms; their ERMs are found incidentally on dilated retinal exam or on retinal imaging such as with ocular coherence tomography (OCT).

Central Serous Chorioretinopathy

Summary

Central Serous Chorioretinopathy Central serous chorioretinopathy, commonly referred to as CSC, is a condition in which fluid accumulates under the retina, causing a serous (fluid-filled) detachment and vision loss. CSC most often occurs in young and middle-aged adults. For unknown reasons, men develop this condition more commonly than women. Vision loss is usually temporary but sometimes can become chronic or recur.

Causes

The causes of CSC are not fully understood. It is thought that any systemic exposure to a corticosteroid drug can bring about or worsen CSC. Corticosteroids are found in allergy nose sprays and anti-inflammatory skin creams available over the counter, and are often prescribed to treat a variety of medical conditions.

Symptoms

Blurry central vision, which often occurs in one eye, is the most common symptom that patients experience; however, careful examination often reveals some involvement in the other eye as well.

Ocular Histoplasmosis Syndrome

Summary

Presumed Ocular Histoplasmosis Syndrome (POHS) causes atrophy (wasting) around the optic nerve and multiple scars, called histo spots, in the choroid. These symptoms are accompanied by new blood vessel growth (neovascularization) that starts adjacent to a histo spot.

Causes

Histoplasmosis is a disease caused by Histoplasma capsulatum (H. capsulatum), a soil fungus prevalent in certain parts of the American continent, in particular the Ohio and Mississippi River valleys.

Symptoms

Symptoms include painless progressive blurring of central vision and wavy vision (metamorphosia), which can be sudden or develop slowly.