What is the Retina?

The retina is a layer of light-sensitive nerve cells along the back of the eye that directly connect to your brain. In fact, the retina is a very specialized part of the brain that is located in the back part of the eye. The retina plays a key role in vision by sensing and processing the light that reaches it after passing through the front part of the eye — the cornea, iris, and lens. Once light is received by the retina, neural signals are sent to other parts of the brain which interprets them into what we understand to be vision. The macula is the most central part of the retina and contains many photoreceptor cells that are responsible for detecting colors and fine details. The areas of the retina outside of the macula are very sensitive to motion and give us our peripheral vision.

When the retina — and especially the macula portion — is diseased or damaged, vision can be significantly impaired. Early detection and effective treatment of retinal conditions are essential to maintain eye health and preserve vision. The highly experienced eye doctors and retina surgeons at Quantum Vision Centers offer leading edge diagnostics and treatment options, including medications, injections, laser therapy, and microsurgery.

What is the Vitreous?

The back of the eye is filled by a gel-like fluid called the vitreous. It attaches to the retina and usually does not cause problems in younger patients. As we age, the vitreous ages along with the rest of the body and these aging changes can sometimes lead to problems with vision and even damage to the retina. That is why we often speak of patients with vitreo-retinal disease.

Types of Macular and Retinal Diseases

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a common eye condition and a leading cause of vision loss among older adults. It results from degeneration of the macular tissue and can cause central vision loss, blind spots, changes in color perception, and distorted vision. There are two general categories of AMD, the “wet” or exudative kind, and the “dry” or atrophic kind. The “wet” form of the disease is associated with abnormal blood vessel growth that often leads to severe visual loss. It is often treated with ocular injections. The “dry” form of the disease is treated with careful observation and vitamin therapy. Dry AMD can sometimes turn into wet AMD and when that happens, prompt diagnosis and therapy are essential to maximize visual outcomes. Many researchers across the globe are studying both dry and wet AMD and the Retina Specialists at Quantum Vision Centers are excited about new developments that are coming. 

Cancer of the Eye

Eye cancer is a very rare but serious condition that can be slight or even life threatening. Cancer can originate from the eye itself or spread to the eye from other parts of the body. Accurate diagnosis of eye cancer and prompt referral to an eye cancer specialist are needed to give eye cancer patients the best chances of a good medical and visual outcome. Medical care is often provided by a team of doctors including eye doctors, medical doctors, and cancer specialists.

Endophtlamitis

Endophthalmitis is an infection of the eye and is also an ocular emergency. Infections can spread to the eye from infections elsewhere in the body, can occur as a result of trauma to the eye, and can also be a complication of ocular injections or eye surgery. The prognosis of untreated endophthalmitis is often very poor with a high likelihood of loss of vision, loss of the eye itself, and even the spread of infection from the eye to other parts of the body. The diagnosis of infectious endophthalmitis involves careful examination of the eye which often leads to a “tap and inject” procedure where a small amount of fluid is removed from the eye for evaluation in a laboratory to identify the microbe that is causing the infection. Depending on the clinical presentation, microsurgery with vitrectomy may also be offered as treatment. The prognosis of infectious endophthalmitis can be guarded and often depends on the specific microorganism causing the condition.

Flashes & Floaters

Flashes and floaters are common visual disturbances that appear as flashes of light or as dark specks or strands. Flashes and floaters are typically the result of changes in the vitreous gel but can also be signs of more serious disease. They are often harmless, but it is important to have them evaluated by an experienced eye doctor with expertise in vitreoretinal disease.

Inherited Retinal Diseases

Macular Edema

The macula is delicate and if it becomes swollen or inflamed, a condition called macular edema can occur. This condition causes blurry central vision and may also cause redness and discomfort. Macular edema is often associated with other retinal diseases and can be treated with eye drops, injectable medications, laser and sometimes microsurgery. 

Macular Hole

A macular hole occurs when the vitreous pulls away from the retina in a way that causes a gap to form in the very center of the macula. A macular hole causes blurriness in central vision, makes straight lines look wavy, and creates difficulty reading and performing day to day tasks. Microsurgery is often performed to repair a macular hole.

Macular Pucker or Epiretinal Membrane

A macular pucker occurs when scar tissue develops on the macula, usually related to aging changes in the eye. This condition typically causes symptoms, such as mild blurriness or distortion in vision. If a macular pucker does not resolve on its own and it causes significant symptoms, it can be treated with microsurgery.

Retinal Tear and Detachment

A retinal tear can occur due to aging or an eye injury. Similar to retinal detachment, a tear in the retina can cause shadows in vision or flashes. If left untreated, a retinal tear can lead to retinal detachment. Retinal tears often require treatment – but not always.

A detached retina occurs when the retina separates from the underlying layers of the eye, which can cause vision loss, sudden shadows, bright flashes and floaters symptoms. Retinal detachment can happen gradually or suddenly, and can be associated with inflammatory conditions, vitreous aging changes, or with an eye injury. Retinal detachment is a medical emergency and should be diagnosed immediately. A variety of surgical techniques can be employed to treat retinal detachment and retinal specialist doctors will discuss and offer the best alternatives suited to the specific details of a retinal detachment. The timing of retinal detachment repair can range from emergent (within a day or two) to within many weeks or even months.

Retinal Vascular Occlusion

The small blood vessels of the retina transfer nutrients and oxygen to the retina and are essential for proper retinal function. Retinal arteries supply blood to the retina and retinal veins carry it away. The blood vessels of the retina branch from the larger blood vessels that provide blood supply to the rest of the brain. If a retinal artery becomes blocked, it is called a retinal artery occlusion (RAO). RAO is a medical emergency and can be thought of as a “stroke of the retina.” Partial or complete visual loss may become permanent without immediate diagnosis and treatment. RAO patients also have a high risk for strokes to other parts of the brain. The eye doctors often coordinate care with other medical doctors to give RAO patients the best possible chances to recover or preserve vision. 

If a retinal vein becomes blocked, it causes retinal vein occlusion, or RVO. RVO is sometimes associated with other ocular or medical conditions and preventative care for risk factors such as high blood pressure, diabetes, glaucoma, macular edema, or inflammatory conditions is an important part of caring for patients with RVO. The treatment for RVO depends on the type, location, and severity of the blockage in the retinal vein and may consist of observation, injections of medication, laser and sometimes microsurgery.

Uveitis

Uveitis is a disease where the eye or a portion of the eye becomes inflamed. When the inflammation spreads to the vitreous and retina, the patient is said to have “posterior uveitis” which may represent a more serious disease. Uveitis can be caused by infection, autoimmune disease, trauma or may not have any identifiable cause. Even after extensive medical and laboratory testing, about half of all uveitis patients never have the cause of their uveitis identified.

Vitreous Hemorrhage

A healthy vitreous gel does not contain any blood vessels and does not have any bleeding. When there is bleeding into the vitreous, patients see floaters that sometimes become so severe that near total visual loss occurs. Many different vitreoretinal diseases can cause vitreous hemorrhage such as trauma, diabetic retinopathy, retinal tears, aging changes, blood thinners, Terson’s syndrome, certain tumors, carotid artery disease, and retinal vascular occlusion. Vitreous hemorrhage sometimes resolves without any treatment at all but may also require treatment with medication injections, laser surgery or microsurgery.

The expert Metro East St. Louis retina specialists at Quantum Vision Centers will explain the advantages and disadvantages of different treatment alternatives for vitreous hemorrhage.

Vitrectomy

Vitrectomy is a microsurgery of the eye to remove the vitreous and sometimes perform other surgical maneuvers in the back of the eye and on the retina itself. It may be a recommended treatment for many of the retinal conditions listed above. Vitrectomy is typically an outpatient procedure. Local anesthesia, IV sedation, or general anesthesia may be used for pain control during surgery. The patient rests at home after the operation and typically experiences only mild discomfort for the first 24 hours after surgery. Several postoperative examinations will be required in the days, weeks, and months after vitrectomy. Sometimes, the surgeon will place a bubble of air, gas, or oil into the eye at the conclusion of vitrectomy. Patients with bubbles may need to hold their head in a particular position after vitrectomy.