Common Retinal Disorders

We offer the highest level of care available in the areas of retinal and vitreous disorders. We provide specialized diagnostic testing and treatment for retinal conditions of all types, but particularly for common disorders such as age-related macular degeneration, diabetic retinopathy, retinal vein occlusions and retinal detachments.

Diabetic Retinopathy

Diabetic retinopathy is the change that occurs in the blood vessels in the retina due to the abnormal blood sugar levels and other factors associated with diabetes mellitus.
What is Diabetic Retinopathy?

Diabetic retinopathy is the change that occurs in the blood vessels in the retina due to the abnormal blood sugar levels and other factors associated with diabetes mellitus. The retina is the light-sensitive tissue at the back of the eye that actually receives the light rays. Some of the small blood vessels, the capillaries, can become closed off. The retinal vessels can also leak fluid into the retina. Both the closure and the leakage can reduce vision.
How is Diabetic Retinopathy diagnosed?

Blurred vision is usually the first symptom of diabetic retinopathy. However, fairly advanced diabetic changes can occur with normal vision. This is why regular eye examinations are important for patients with diabetes. An ophthalmologist skilled at retinal exams can detect diabetic retinopathy. Fluorescein angiography, a series of photographs taken after injection of a dye, can help to pinpoint areas of leakage and blood vessel closure. Optical coherence tomography (OCT) scans using light rays can detect leakage, scar tissue, and traction on the retina.
How is Diabetic Retinopathy treated?

If there is significant leakage of fluid in the macula, the center of the retina responsible for fine, reading vision, injection of medications to reduce leakage, or laser treatment may be recommended. Sometimes the vision is improved after these treatments, but sometimes the vision is only stabilized. Studies have shown that diabetic complications, including eye problems, can be minimized by keeping the blood sugar and blood pressure as close to normal as possible.

 

Epiretinal Membrane


What causes an epiretinal membrane?

An epiretinal membrane occurs in some eyes after the vitreous gel collapses and pulls away from the front surface of the retina, the light sensitive layer at the back of the eye. If the vitreous gel pulls off the outer layer of retinal cells, the resulting repair process can cause a membrane of scar tissue to form on the surface of the retina. Symptoms can include decreased vision and distortion.
What is the treatment for an epiretinal membrane?An epiretinal membrane occurs in some eyes after the vitreous gel collapses and pulls away from the front surface of the retina, the light sensitive layer at the back of the eye.

There is no medical or laser treatment for epiretinal membrane. If the condition is severe enough, surgery to remove the vitreous gel, followed by removal of the membrane with delicate instruments can be considered. This is an outpatient surgery, done under local anesthesia.
How successful is the surgery?

In about 80% of the cases, distortion is decreased and vision improves by about 50%. If the patient’s own lens is present, this operation will likely cause clouding of the lens, a cataract, which will require another operation. Of course, with any operation, severe, rare complications, such as infection or hemorrhage, can permanently decrease vision.

 


Eye Diagram
  • The cornea is the clear, transparent front layer of the eye through which light passes
  • The iris gives our eyes colour and it functions like the aperture on a camera, enlarging in dim light and contracting in bright light. The aperture itself is known as the pupil
  • The lens helps to focus light on the retina
  • The retina is the innermost layer of the back of the eye. This layer of light-sensitive nerve endings carry the visual impulse to the optic nerve. The macula is the central zone of the retina which provides our most central, acute vision
  • The optic nerve conducts visual impulses to the brain from the retina

 

Adie’s Pupil – a pupil that does not react normally to bright light due to impaired nerve function; usually does not interfere substantially with vision

Amaurosis Fugax – temporary loss of vision in one eye; may be a sign of a transient ischemic attack (TIA) or an impending stroke

Amblyopia – the inability of an eye to see normally due to lack of input from the eye to the brain during childhood; also termed “lazy eye”

Aphakia – the absence of the eye’s natural lens, usually after cataract surgery

Arcus Senilis – a hazy ring at the edge of the cornea where the iris meets the white of the eye; does not impair vision

Bell’s Palsy – paralysis of the muscles on one side of the face due to nerve damage; usually temporary, but can interfere with blinking and protection of the eye

Blepharitis – inflammation of the eyelid; can cause irritation, discharge and even blurred vision

Chalazion – a bump in the eyelid caused by a clogged oil gland; may require surgical removal

Conjunctivitis – inflammation or infection of the conjunctiva, the mucous membrane covering the white of the eye

Corneal Edema – swelling of the cornea, often causing blurred vision

Corneal Erosion – spontaneous loss of a part of the surface “skin” of the eye-causes pain, light sensitivity and occasionally blurriness, and often occurs on awakening

Corneal Ulcer – a localized inflammation or infection of the cornea extending beneath the surface layer-must be treated immediately to prevent permanent damage

Central Retinal Artery Occlusion – blockage of the main blood supply to the eye often; causes blindness

Central Retinal Vein Occlusion – blockage of the main vein transporting blood away from the retina; causes hemorrhage in the retina and usually results in permanent vision impairment

Central Serous Retinopathy – spontaneous leakage of fluid into the retina, often in young, healthy people – cause is unknown

Dacryocystitis – infection in the tear sac adjacent to the nose-causes pain, swelling, tenderness and tearing

Dermatochalasis – excess or baggy skin on the eyelids, usually from loss of elastic tissue in the skin

Diplopia – double vision; usually caused by misaligned eyes

Drusen – discolored spots in the retina – can be an early sign of macular degeneration

Ectropion – loosening of the eyelid causing it to turn outward, away from the eye

Entropion – “collapsing” of the eyelid, causing the edge of the lid to turn inward, toward the eye-often results in discomfort due to eyelashes rubbing against the eye

Epiretinal Membrane – wrinkling of the surface of the retina; can cause blurriness or distortion in vision – severe cases can be treated with surgical removal

Esotropia – having an eye that turns inward

Exophthalmos – bulging forward of the eyes, sometimes caused by thyroid problems

Exotropia – having an eye that turns outward

Fuchs’ Dystrophy – a deterioration of the cells in the cornea that maintain the cornea’s clarity; often has no visual effect but may require a corneal transplant if severe

Hemianopia – the loss of one half of the visual field (left or right); usually affects both eyes and is often caused by brain injury, especially stroke

Hyphema – bleeding inside the eye, often due to an injury

Herpes Simplex – a cause of serious corneal infection – the same virus that causes cold sores

Herpes Zoster – “shingles” – the same virus that causes chicken pox, which can return and affect many areas of the body, including the eye

Iritis – inflammation inside the eye, primarily in the front of the eye – causes redness, pain, blurred vision and sensitivity to light in most cases

Keratitis – inflammation in the cornea-may cause scratchiness, pain, blurred vision and light sensitivity

Keratoconus – a progressive change in the shape of the cornea, creating a “cone” – like configuration and causing blurred vision – severe cases may require a corneal transplant

Macular Oedema – swelling in the centre of the retina caused by fluid leakage; results in blurred vision and visual distortion

Neovascularization – growth of new abnormal blood vessels – can occur at several locations in the eye

Nystagmus – oscillating movements of the eye

Ocular Migraine – a visual disturbance usually including an arc of zigzag light and blurry vision – disappears spontaneously and does not usually include a headache

Optic Neuritis – inflammation of the optic nerve, resulting in blurred vision or other visual disturbances – can be caused by multiple sclerosis

Papilledema – swelling of the optic nerve where it enters the eye – can be caused by increased fluid pressure around the brain

Pinguecula – a thickening of the white of the eye; often caused by chronic irritation

Pterygium – growth of tissue from the white of the eye over the cornea – may interfere with vision if it nears the centre of the cornea

Ptosis – droopiness of the eyelid – may result from nerve or muscle damage, and sometimes requires surgical correction

Retinal Detachment – separation of the retina from its normal location covering the inner surface of the back portion of the eye

Rubeosis – growth of abnormal blood vessels on the iris

Scotoma – a blind spot

Strabismus (Squint)– any misalignment of the eye

Stye – an acute inflammation of a gland at the base of an eyelash, caused by bacterial infection.

Trichiasis – abnormal eyelash growth, usually pointing toward the eye

Uveitis – inflammation of the interior of the eye

Vitreous Detachment – separation of the vitreous gel from the back of the eye – a common occurrence which can result in sudden floaters and occasionally causes a tear in the retina

 

 

Normal vision relies on healthy eyes, normal visual pathways and a healthy visual area of the brain. The eye’s function is to focus a clear image onto the retina (much like a camera). Numerous receptors in the retina convert light into electrical impulses via a photochemical reaction. The electrical impulses created in retinal receptors are transferred to the visual area of the brain (occipital cortex) via the visual pathway (optic nerves, tracts and radiations). The brain converts these electrical impulses to vision. The macula is the central area of the retina which is responsible for our sharp central vision.

Focusing-clear Vision

The eye has a dual focusing system consisting of the cornea and lens (whereas the camera has only one lens). The cornea is the clear window at the front of the eye which transmits and focuses an image via the pupil through the lens to the retina. The pupil is a hole in the central iris ( the iris gives us our ‘eye colour’) . The pupil has muscles which can alter its size and thus alter the amount of light entering the eye.

The Lens

The lens is made up of a flexible tissue called the ‘lens capsule or ‘capsular bag’ which encloses/surrounds the internal lens material. The lens material is initially clear (it is made up of water and protein arranged in a precise pattern ) and the lens is soft in consistency in children and gradually hardens and yellows with age. The entire lens is suspended in the eye by small fibres called zonules which attach the capsule to the inner layers of the eye.

Muscles acting on the capsule via the zonules can change the shape of the lens allowing a wide range of focusing ( near to far) in our younger years. With age the lens flexibility decreases in part due to hardening of the lens material. This results in decreased ability to see close up, starting usually in the 40’s (this is called presbyopia ) and requiring reading glasses.

 

(Age-Related) Macular Degeneration

What is Age-Related Macular Degeneration (AMD)?

The macula is a small area of the retina located directly at the back of the eye. While the entire retina receives light rays, the macula is responsible for central vision, including fine detail and colors. When degenerative processes affect this region, the vision can be decreased. Sometimes abnormal new blood vessels grow through these thin degenerative areas, causing leakage of fluid, bleeding and scar tissue formation (wet AMD). Sometimes the retina simply becomes thinner and sees less well (dry AMD). Symptoms include decreased vision, blind spots in vision, and distortion (straight lines appearing curved or wavy). AMD is diagnosed by an examination, and by photography. The ophthalmologist examines the eye for signs of degeneration, leaking fluid, bleeding or scar tissue formation. A series of photographs, called a fluorescein angiogram, is taken to identify any leaking blood vessels. Measuring the retinal thickness with OCT (optical coherence tomography), can help to diagnose and monitor AMD.
Is AMD treatable?The macula is a small area of the retina located directly at the back of the eye. While the entire retina receives light rays, the macula is responsible for central vision, including fine detail and colors.

There is no cure for the degenerative aspect of AMD. However the Age Related Macular Degeneration Study has indicated that supplements with antioxidants may help prevent progression of dry AMD. Anti-VEGF (vascular endothelial growth factor) agents to stop the abnormal blood vessels from leaking have been shown to be effective when injected in the eye to treat wet AMD. Sub-threshold micropulse laser has been found to be a useful adjunct.
What should be done after the initial visit or treatment?

The goal is to save as much vision as possible. Sometimes, after treatment for wet AMD, the vision is improved, but sometimes we treat to prevent further vision loss. Periodic visits are recommended and treatments given whenever a change is noted in the vision, the exam, or imaging. If the vision is decreased in both eyes, low vision devices may be tried. Magnifying glasses, telescopes, and closed-circuit televisions are often the most useful. Although the vision loss with AMD can be frustrating, it is not expected that a total loss of vision will occur. Peripheral vision can be used even in most of the advanced cases.

 

Retinal Artery Occlusion

What are Retinal Artery Occlusions?

A Retinal Artery Occlusion is a blockage or obstruction of the arteries in the retina. This is like a stroke in the eye. The retina is the light-sensitive layer of tissue that lines the back wall of the eye and is responsible for vision. There are two types of retinal vein occlusions:

  • Central Retinal Artery Occlusions (CRAO) occur when the main retinal artery is blocked, causing the blood flow to be reduced to the entire retina. This can cause a marked decrease in vision with bleeding, as well as pain with an increase in eye pressure.
  • Branch Retinal Artery Occlusions (BRAO) occur when a branch of the main retinal artery becomes obstructed. Blood flow is reduced in a portion of the retina. The amount of vision loss is usually not as severe as in CRAO. Vision loss may be due to bleeding or swelling in the eye.

What are the Symptoms?

Decreased vision is the most common symptom. Other symptoms include floaters or spots in the vision. In severe cases, eye pain can occur as a result of increased eye pressure. Severe cases also can result in vision loss, permanent damage to the eye, and even loss of the eye.

What causes Retinal Vein Occlusions?

A Retinal Artery Occlusion is often an indication of vascular (blood vessel) problems in the rest of your body.  Additional medical evaluation may need to be done by your primary care doctor.  Sometimes, the source of a Retinal Artery Occlusion cannot be identified, despite testing. The most common risk factors that may contribute to Retinal Artery Occlusion include carotid artery disease (blood vessels in the neck), heart disease, high blood pressure, diabetes, atherosclerosis and blood disorders.

How is a Retinal Vein Occlusion Detected?

Your eye doctor will use eye drops to dilate, or enlarge your pupils. Dilating the pupils allows your eye doctor to view the back of the eye better. You may need testing, including a fluorescein angiography. Fluorescein angiography is a test that uses a diagnostic agent called fluorescein that is injected into a vein in your arm. It is used to enhance the specialized photograph that is taken to evaluate the retina.

What are the Treatment Options?

There is no known cure for a Retinal Artery Occlusion. Laser treatment may help improve sight in some patients. Laser treatment is a high energy beam of light used to seal leaking blood vessels in the hope of reducing swelling and bleeding in the macula, which is the central part of the retina needed for reading, driving, and seeing fine detail.

In some patients with a retinal atery occlusion your eye may form abnormal new blood vessels (neovascularization). These abnormal blood vessels may cause severe bleeding or a severe form of glaucoma. If your eye develops these new abnormal blood vessels laser may need to be done to get rid of these blood vessels. The laser will probably not improve the vision but with out the laser further pain or vision loss will probably occur. Laser treatment is performed on an outpatient basis in the eye doctor’s office.

 

Retinal Detachment

What causes a Retinal Detachment?

The retina is the thin, light-sensitive layer of tissue that lines the inside back wall of the eye. When the vitreous gel pulls away from the front surface of the retina, a break in the retina is produced, if the vitreous is tightly attached to the retina. If fluid then goes through the hole, the retina pulls away from the wall of the eye, similar to wallpaper peeling off a wall, producing a retinal detachment. Because the retina receives a good portion of its nourishment from the wall of the eye, the vision decreases where the retina is detached. Typically this appears similar to a window shade being pulled across the vision.
How is the Retinal Detachment repaired?

The retina must be returned to its position against the wall of the eye, and the retinal break must be sealed to prevent fluid from going through the break again. The retinal break is sealed by either laser or cryotherapy (freezing treatment). There are a number of ways to accomplish this reattachment, depending on the type of retinal detachment present.
The retina is the thin, light-sensitive layer of tissue that lines the inside back wall of the eye. How successful is the treatment?

Approximately 95% of retinal detachments can be repaired, but it sometimes takes more than one proceedure to accomplish this. Usually there is good restoration of vision, but sometimes it is not as good as it was before the retinal detachment. As with any surgery, there can be rare unforeseen complications which can make matters worse, including severe bleeding, and serious infection. It should be kept in mind that retinal detachment is a serious condition, and can easily lead to blindness if nothing is done

 

Retinal Tear

What causes a retinal tear?

A retinal tear occurs when the vitreous gel collapses and pulls away from the front surface of the retina. If the vitreous gel is more tightly attached to retina in one spot, the retina, the light sensitive layer at the back of the eye, can be torn. Symptoms can include new floaters and flashes of light
Is treatment for a retinal tear needed?

Usually treatment to seal a retinal tear is recommended to help prevent a retinal detachment. Laser treatment or freezing treatment, with appropriate anesthetic is used. The location and type of retinal break determine the choice.
What symptoms can be expected after treatment of a retinal tear?

The laser or freezing treatment does not eliminate the flashes and floaters, which may be present for weeks or months in the future. IfA retinal tear occurs when the vitreous gel collapses and pulls away from the front surface of the retina. there are many new floaters or the sensation of a dark curtain coming across the vision is noted, a new tear or a retinal detachment might be present and the eye should be examined again.

 

Retinal Vein Occlusion

What are Retinal Vein Occlusions?

A Retinal Vein Occlusion is a blockage or obstruction of the veins in the retina. This is like a stroke in the eye. The retina is the light-sensitive layer of tissue that lines the back wall of the eye and is responsible for vision. There are two types of retinal vein occlusions:

  • Central Retinal Vein Occlusions (CRVO) occur when the main retinal vein is blocked, causing the blood flow to be reduced to the entire retina. This can cause a marked decrease in vision with bleeding, as well as pain with an increase in eye pressure.
  • Branch Retinal Vein Occlusions (BRVO) occur when a branch of the main retinal vein becomes obstructed. Blood flow is reduced in a portion of the retina. The amount of vision loss is usually not as severe as in CRVO. Vision loss may be due to bleeding or swelling in the eye.

What are the Symptoms?

Decreased vision is the most common symptom. Other symptoms include floaters or spots in the vision. In severe cases, eye pain can occur as a result of increased eye pressure. Severe cases also can result in vision loss, permanent damage to the eye, and even loss of the eye.

What causes Retinal Vein Occlusions?

A Retinal Vein Occlusion is often an indication of vascular (blood vessel) problems in the rest of your body. Additional medical evaluation may need to be done by your primary care doctor. Sometimes, the source of a Retinal Vein Occlusion cannot be identified, despite testing. The most common risk factors that may contribute to Retinal Vein Occlusion include high blood pressure, diabetes, atherosclerosis, blood disorders and glaucoma.

How is a Retinal Vein Occlusion Detected?

Your eye doctor will use eye drops to dilate, or enlarge your pupils. Dilating the pupils allows your eye doctor to view the back of the eye better. You may need testing, including a fluorescein angiography. Fluorescein angiography is a test that uses a diagnostic agent called fluorescein that is injected into a vein in your arm. It is used to enhance the specialized photograph that is taken to evaluate the retina.

What are the Treatment Options?

There is no known cure for a Retinal Vein Occlusion. Laser treatment may help improve sight in some patients. Laser treatment is a high energy beam of light used to seal leaking blood vessels in the hope of reducing swelling and bleeding in the macula, which is the central part of the retina needed for reading, driving, and seeing fine detail.

In some patients with a retinal vein occlusion your eye may form abnormal new blood vessels (neovascularization). These abnormal blood vessels may cause severe bleeding or a severe form of glaucoma. If your eye develops these new abnormal blood vessels laser may need to be done to get rid of these blood vessels. The laser will probably not improve the vision but with out the laser further pain or vision loss will probably occur. Laser treatment is performed on an outpatient basis in the eye doctor’s office.

 

Retinopathy of Prematurity

What is retinopathy of prematurity (ROP)?

Babies who are born prematurely still have a growing retina. The retina usually finishes growing a few weeks to a month after birth in full term babies, but in premature babies the retina is still growing. During the course of this growth, the blood vessels that bring blood to the retina can begin to develop abnormally. This abnormal growth is called retinopathy of prematurity. Many factors interact to cause retinopathy of prematurity. We do not understand all of the causes at present. A number of research studies are taking place that will help us better understand this problem.

Which babies are more likely to develop ROP?

It does not seem that all babies born prematurely are at risk of developing ROP. The general rule is that those born earlier (more premature) and those weighing the least at birth are the most likely to develop ROP. The neonatologist will determine which children need an examination. Any babies weighing less than 1250 grams (2 pounds, 12 ounces) or born at less than 30 weeks of gestation are at greater risk of developing ROP. It is also thought that babies who are very sick at birth and who require oxygen might be at risk of developing ROP even if they weigh more than the above-mentioned limits and if they are older than noted above. These babies may also be examined for ROP.

Why are eye exams performed on premature babies?

The only way to determine if ROP is present is by examining the inside of the eye. The retina is examined and changes and abnormalities in the retina can be noted.

When are the first eye exams performed?

Nurses and neonatologists will determine which children are at risk for ROP and need an eye examination. The first examination usually takes place at about 4-6 weeks after birth, if the child is healthy enough to undergo the examination.

Who performs the eye exams?

Ophthalmologists trained in the care of ROP; therefore retina specialists or pediatric ophthalmologists usually perform this examination.

Where are the eye exams performed?

If the baby has been discharged from the hospital before the age of 4-6 weeks, the exams are performed in the ophthalmologist’s office. In general, most of the premature babies are still in the hospital at the time of the first exam and the exam is performed at the bedside in the neonatal intensive care unit.

How are the eye exams performed?

The doctor performs the exam with the help of an assistant. The assistant helps hold the baby during the examination. The baby’s eyes are dilated with eye drops prior to the examination. The doctor may use an instrument called an “eyelid speculum” to hold the eyelids open and another instrument called a “scleral depressor” to help hold and move the eye into different positions so that all of the retina can be inspected. An instrument called an “indirect ophthalmoscope” is used; it has a special lens that sends a bright light into the eye, enabling the doctor to examine the retina.

Is the eye exam uncomfortable for a premature baby?

A premature baby is very sensitive to any type of examination. An eye exam can be stressful to a premature baby, but the extreme importance of such an exam in preventing blindness has to be kept in mind. A well-trained doctor should be able to perform this exam quickly and with minimal discomfort to the baby. As with almost any exam, the baby will cry, but this is not an indication that the examination is causing pain, particularly since the baby usually calms down very quickly after the exam and returns to sleep or to feeding almost immediately. (The baby should not be fed just before the examination). After the exam, the baby’s eyelids may be red or slightly swollen. The white part of the eyes can also appear red and, occasionally, there can be small dots of blood on the white part of the eyes. These are not signs of injury or damage. The eyes will return to the way they were before the exam; however, blood may take several weeks to disappear completely.

How often are the follow-up eye exams performed?

The follow-up exams are scheduled depending on the stage and the extent of ROP. Usually exams are performed every 1-4 weeks while the baby is in the hospital and then every 1-4 weeks once the baby leaves the hospital. Occasionally some babies’ retinas grow slowly, and if no ROP is present they can be followed at longer intervals. Generally the eye exams are performed until the retina has fully developed. This can sometimes take several months.

What are the different stages of ROP?

A: Retinopathy of prematurity is classified according to the severity of the changes of the blood vessels and the region of the retina into which the vessels have grown. The severity is referred to as the “Stage” and the retinal regions as “Zones”.

Stages are as follow:

The “immature vessels” stage actually occurs in all infants, and does not necessarily lead to ROP. Also, when ROP regresses (goes away), the vessels may go through this stage again until they complete their growth.

  • Stage 1 is a mild abnormality of the retinal vessel growth and does not require treatment.
  • Stage 2 is a moderate abnormality of the retinal vessel growth and also does not require treatment.
  • Stage 3 is a severe abnormality of the retinal vessel growth in which the blood vessels grow toward the center of the eye instead of following their normal growth pattern along the surface of the retina. When a certain degree of Stage 3 is present and when “plus disease” develops, treatment is considered. “Plus disease” indicates that the blood vessels of the retina have become enlarged and twisted. This is an indication of worsening of the disease. Plus disease can occur with almost any stage and its presence alone is not sufficient to require treatment.
  • Stage 4 involves a partial detachment of the retina.
  • Stage 5 involves a complete detachment of the retina and has an extremely poor prognosis for the child to obtain any vision

What happens if the ROP does not go away?

Most of the time, Stages 1, 2, and even some Stage 3 cases may go away without treatment. In a small number of babies, for reasons not well understood as yet, ROP worsens and can develop into a sight-threatening condition. If this occurs treatment is usually recommended by the doctor.

What treatments are there for ROP?

Starting in the late 1980’s, treatments became available for ROP. The first treatments for ROP were “cryotherapy” or freezing treatments. A freezing probe was held onto the outside of the eye to freeze the peripheral retina (side of the retina). This caused the ROP to go away in many cases, and reduced the chances of retinal detachments and blindness by about 50% as compared to babies who had no treatment. Not all babies responded favorably to this treatment.

More recently, lasers have been used for treatment of ROP, which appears to work better, but not all babies respond to this treatment either. Laser treatment is less painful, and causes fewer problems than the freezing treatments, but both treatments are accepted, and are still in use today.

The purpose of the treatment is to create scar tissue on the peripheral retina. This has been shown to eliminate ROP progression in many cases. The treated part of the retina will be scarred and will no longer work. The goal of the treatments is to save as much as possible of the central retina, where the best vision is located. Some of the peripheral retina and, therefore, some of the side vision will likely be lost after these treatments. It is important to keep in mind that the central retina, where the reading vision, straight ahead vision, and most of the color vision are located, is the most important part of the retina to save.

If the retina detaches due to ROP the child may need specialized surgical treatment. Despite the surgical treatment, children who develop a retinal detachment associated with ROP have a very poor visual prognosis.

How is the laser treatment done?

The laser treatment can be performed with the baby in the crib in the neonatal intensive care unit (NICU). The baby may be given medication to make it sleepy and comfortable. The baby’s heart rate and breathing is monitored during the entire procedure. The laser beam is directed through the pupil to treat the side part of the retina. The procedure is similar to the examination with the addition of laser. The treatment usually takes 30-90 minutes per eye. Afterwards, the baby’s eye may be red, and the eyelids may be red and a little swollen. Eyedrops or ointment are used for about one week. The redness and swelling usually goes away in a few days but may take a few weeks to completely disappear. A follow-up exam is usually performed 1-3 weeks after the laser treatment.

What are the risks?

Not all babies respond to the treatment, and the ROP may continue to worsen. Further treatments may be offered, either by more laser or, in some cases, surgery inside the eye. Bleeding inside the eye (vitreous hemorrhage), which is a potential complication of ROP, may occasionally follow the laser treatment. Vitreous hemorrhages do not cause damage to the eye, and usually clear up after several weeks. Scar tissue inside the eye, resulting from the disease process and/or treatment, may cause pulling on the retina that can lead to distortion or even detachments of the retina. Cataracts may form. Despite the treatment the child may develop a retinal detachment and lose most or all of their vision.

What happens if the laser treatment does not work?

The biggest concern, if the ROP laser treatments do not work to halt the scar tissue growth, is the development of retinal detachment.

Sometimes, only part of the retina detaches. If only the peripheral retina detaches, further treatments may not be performed, since these peripheral detachments may remain the same or go away without treatment.

If the center part of the retina or the entire retina detaches, then surgery may be attempted to try to reattach the retina. This surgery involves removing the scar tissue inside the eye to help the retina to reattach. Surgery is not recommended for distortion of the retina or for scar tissue that is not causing a detachment affecting the central vision.

What has to be done for the baby after the laser treatments are performed?

Eye drops or ointments are used for about 1 week. No further eye medications are usually required. Surgery inside the eye requires other medication regimens that depend on the type of surgery and on the individual surgeon.

What is the follow-up care after laser treatments?

Usually the eyes are examined after 1-3 weeks to see if they have responded to the treatment. If the eyes have responded to the laser treatment, no further treatments are required. The eyes may be examined at intervals of 2-6 weeks and then several months later to ensure that no further changes are occurring. If the eyes did not respond, further treatments might be suggested. These might include more laser or possibly surgery. It is important to keep in mind that any baby who has had ROP may develop retinal detachments later in life also. This is more likely if any scar tissue is present. Routine eye exams should be continued at regular intervals, usually yearly.

What is the long-term care?

Any premature baby, whether it has had ROP or not, has a higher chance of being nearsighted or farsighted, or of having “strabismus”, which means that the eyes turn in or out. Eyes with strabismus may develop amblyopia, also called lazy eye. Some of these problems can be corrected with glasses. Even a very small baby may require glasses. If it needs glasses it is important that these be obtained, so that the visual part of the brain develops normally.

In general, any premature baby should be taken to a pediatric eye doctor, to possibly fit for glasses and to make sure that the eyes are straight, at about 3-6 months after the baby’s due date. If glasses do not straighten the eyes, surgery on the eye muscles may be considered. It is important for the eyes to be straight during the early development periods so that normal growth of the visual part of the brain can occur and the best vision can be achieved.

Many premature babies have limited vision for reasons other than ROP. Limited brain development or damage to the brain from other causes can limit vision.

ROP, even if it becomes inactive and does not require treatment, can leave scar tissue inside the eye. This scar tissue can cause some problems, including pulling (traction) on the retina, which could result in a distorted retina or even a detachment of the retina.

Does oxygen administered to babies cause ROP?

This is a complicated question that does not have a definite answer yet. A number of studies are being undertaken to evaluate the possible association of oxygen and ROP. It was thought at one time that too much oxygen caused ROP. However, many very premature babies would not survive or would be retarded without oxygen. Now there are many advances in neonatal medicine which help immature lungs develop and work better, so less oxygen can be used for the premature babies. It is also thought that not enough oxygen could cause ROP. The answer is probably that a combination of factors, all of which are not yet understood, and oxygen being only one factor, cause ROP. These days, neonatalogists are trained to not use excessive oxygen, and chances are that with better understanding of ROP in the future, we will reduce the number of babies with this problem.

Do neonatal intensive care unit (NICU) lights worsen ROP?

Studies have shown no correlation between light exposure and the development of ROP. At present there does not seem to be a connection.

Do vitamins help ROP?

Several years ago, studies were done showing that large doses of vitamin E reduced the chances of worsening ROP. However, babies who received large doses of Vitamin E had many more medical problems, some of which were life-threatening. Thus, vitamin therapy is not currently recommended for ROP.

 

(Posterior) Vitreous Detachment


What is Posterior vitreous detachment?

The vitreous is a jelly-like substance between the lens and the retina that makes up most of the volume of the eye. Usually, the vitreous gel is loosely attached to the surface of the retina. However, the vitreous can detach or separate from the retina by condensing or collapsing. This separation of the vitreous is a normal event that will happen to essentially everyone.
What are the symptoms of posterior vitreous detachment?

Sometimes this happens slowly and it is hardly noticed. Often there are flashes of light and the appearance of floaters in the vision. Whenever the retina is stimulated, it records this as light falling on the retina-hence the The vitreous is a jelly-like substance between the lens and the retina that makes up most of the volume of the eye.flashes. The floaters represent condensations of protein that once were near the surface of the retina. With collapse of the vitreous gel, clumps of this protein are suspended in front of the retina, causing a shadow to be cast on the light sensitive retina by light entering the eye.
Is this dangerous? Is it related to retinal detachment?

Vitreous detachment in itself is not a threat to vision. Sometimes, however, if the vitreous is more strongly attached to the retina in one or more locations, the retina can be torn when the vitreous gel collapses. If a retinal tear occurs, fluid from the vitreous cavity can move through the tear, separating the retina from the other layers of the eye and causing a retinal detachment, a dangerous condition requiring surgery.
How do I know if I have a vitreous or a retinal detachment?

Both of the symptoms of vitreous detachment, flashes of light and floaters, may also be seen with retinal detachment. However, one other symptom of retinal detachment is never seen with vitreous detachment only. That is the sensation that a dark curtain or window shade is being pulled across the eye. If a dark area in vision or the appearance of new flashes or floaters are noticed, a prompt retinal examination is important.
What can be done about the irritating floaters?

While they can be a nuisance, no eye drops or medications can dissolve floaters and surgery is usually not indicated. With gravity they tend to sink down out of the line of sight, and may become less noticeable with time.

 

 

 

 

 

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