What is the retina? – The retina is the back surface inside the eyeball, opposite the lens. It contains millions of light sensitive cells, called rods and cones. An image projected by the lens onto the retina is sensed by the rods and cones as different intensities of light and different colors. When light hits rods or cones, a biochemical reaction occurs, which initiates the transmission of signals along nerve cells to the brain, with information about light, color and position in the retina. In the brain, the signals from throughout the retina are assembled into the experience of seeing what is before us.
What is the macula? – The central portion of the retina directly opposite the lens, is called the macula. It is rich in cones, the cells, which enable us to see fine detail and color. There are three classes of cones, each most sensitive to a different color: red, green or blue.
What is the fovea? – At the center of the macula is very small area called the fovea. Cones are most concentrated in the fovea. Despite its small size, relative to the rest of the retina, the fovea is very important for our ability to see fine detail and color.
- Diabetic Retinopathy – The deterioration of retinal blood vessels, called diabetic retinopathy, can lead to vision loss. Although considered one disease, there are many types of diabetic retinopathy. Read more about diabetic retinopathy.
- Macular Degeneration – Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye’s macula often related to the aging eye. Read more about macular degeneration.
- Macular edema refers to fluid or swelling of the retinal tissues that make up the macula. It may also include fluid that collects underneath the macula.
- Macular Hole – A small break in the macula, located in the center of the eye’s light-sensitive tissue called the retina.
- Flashes and Floaters – Floaters are spots or lines that seem to float in a person’s field of vision. The affected person may see these accompanied by flashes of light coming from the side of the eye. You should seek immediate treatment for a possible retinal detachment.
- Retinal Detachment – A retinal detachment is a condition where the tissues of the retina separate from the back of the eye.
- Sickle Cell Disease – Sickle cell disease, like diabetes, can cause new blood vessels to grow within the eye. Neovascularization or new blood vessels is the most serious problem secondary to Sickle retinopathy.
Diabetic Retinopathy – The deterioration of retinal blood vessels, called diabetic retinopathy, can lead to vision loss. Although considered one disease, there are many types of diabetic retinopathy . The two main categories are nonproliferative (when blood vessels leak) and proliferative (new blood vessels grow, or proliferate) retinopathy.
Diabetes has severe damaging effects on blood vessels throughout the body. When the blood vessels in the retina become damaged, they may leak fluid, bleed or lead to the growth of scar tissue. All of these changes can cause blurring, distortion, loss of detail vision, floaters and blindness.
Diabetic retinopathy is the leading cause of new blindness in adults in the United States. However, with early diagnosis and treatment only a small percentage of people who develop diabetic retinopathy will go on to develop severe vision loss.
According to the National Eye Institute, it is estimated that nearly 5.4 million Americans, ages 18 and over currently have diabetic retinopathy. This eye disease causes over 8000 cases of new blindness annually, and is the primary cause of blindness for people ages 25 to 74 (Valero and Drouilhet, 2001).
Understanding Diabetic Retinopathy – Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. In the majority of diabetic retinopathy cases, blindness is completely preventable. Patients will need to work closely with the Assil Eye Institute diabetic retina eye doctors to monitor and treat this disease. The use of medications and daily blood sugar monitoring can make a major impact on containing the worsening of diabetic retinopathy.
The retina is like the film in a photographic camera; in which it is the light sensing film on the back of the eye that captures the images. In the diabetes disease, sugar (glucose) builds up within blood vessels in the retina and tissues of the body causing it to attach to the proteins in the wall. This alters the vessel’s normal structure and functioning. The vessels eventually get blocked and leak fluid. When they cannot deliver an adequate amount of blood supply to the eye, the eye can generate abnormal new blood vessels. Early diabetic retinopathy usually has no symptoms. However, worsening diabetic retinopathy can lead to visual loss and blindness.
The stages of diabetic retinopathy are divided into two categories, nonproliferative retinopathy and proliferative retinopathy.
Quick NOTE: If you have diabetic retinopathy, at first you may not notice changes to your vision. Over a long period of time, diabetic retinopathy can get worse and cause vision loss.
- Nonproliferative Retinopathy – This is the first and earliest stage of diabetic retinopathy. NPDR occurs when the small blood vessels of the retina start to leak fluid or bleed. This activity will lead to the formation of deposits called exudates. Once these blood vessels start to leak swelling within the central part of the retina occurs. When the leakage of these blood vessels causes swelling, macular edema sets in and the blood vessels can become blocked. This stage of diabetic retinopathy is common when a person develops diabetes. Most diabetics have some grade of NPDR. It is imperative to maintain regular eye examinations with the retina specialists at Assil Eye Institute to monitor and treat NPDR.
- Proliferative Retinopathy – When new vessels start to grow as a result of the existing vessels becoming blocked, this marks the beginning of the next stage of diabetic retinopathy, proliferative diabetic retinopathy. This level of diabetic retinopathy is the most severe and dangerous for the diabetic patient. These new abnormal blood vessels can grow on the retina, optic nerve, iris or into the vitreous gel inside the eye, and tend to grow poorly and are very fragile. The damage that these blood vessels bring to retina can be catastrophic and include hemorrhages on the retina, scar tissues build up, and possible retina detachment.
Diabetic Eye Retinopathy – Causes and Risk Factors
Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:
- Weak and abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision.
- Fluid can leak into the center of the macula, the fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses.
Learning to live with diabetes and diabetic retinopathy
Essential nutrition tips for Los Angeles diabetic retinopathy patients – If you are diabetic patient you have most likely had some kind of discussion with your primary care doctor regarding diet. The nutrition of the food you eat becomes critical for maintaining proper blood sugar levels. Please refer to this list below fordiabetic eye nutrition tips:
- Drink water (8 glasses per day)
- Reduce artificial fats
- Juice and vegetables
- Increase fiber intake
- Reduce caffeine or refined sugar
Diabetic retinopathy treatments: Assil Eye Institute
- Laser treatments – These laser treatments are also known as photocoagulation. The laser is uses controlled bursts to seal leaking blood vessels, destroy abnormal blood vessels, seal retinal tears and remove abnormal tissue that has formed on the back of the eye.
- Intraocular corticosteroids – Many studies have been conducted recently with these types of injections. They may reduce retinal swelling and improve visual acuity in patients with diabetic macular edema.
- Vitrectomy – A vitrectomy may be performed to clear blood and debris from the eye, to remove scar tissue, or to alleviate traction on the retina. The Vitrectomy actually removes vitreous gel from the eye through a small incision using a laser. Vitrectomy allows the retina to flatten. Depending on the severity of the diabetic retinopathy, gas or air might be placed in the eye to replace the vitreous fluid that was removed. This gas or air helps smooth out the retina and prevent retinal detachment.
Living with Diabetes – If you are diabetic eye care patient we suggest regular eye examinations to monitor any activity related to your retina and blood vessels in the back of the eye. Our retina eye doctors and diabetic eye care specialists help many people with diabetes on a yearly basis and we hope to help you too!
Diabetic Retinopathy Prevention – Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise play important roles in the overall health of those with diabetes. Diabetics can also greatly reduce the possibilities of eye complications by scheduling routine examinations with an ophthalmologist. Many retina problems can be treated with much greater success when caught early.
Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye’s macula. The macula is a small area in the retina. It is actually the light-sensitive tissue lining the back of the eye. The macula is the part of the retina that is responsible for your central vision, allowing you to see fine details clearly. When macular degeneration sets in deterioration of central vision begins. Macular degeneration is one of the leading causes of decreased vision in the United States in patients over age 50. Many older people develop macular degeneration as part of the natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration. People with macular degeneration may have symptoms such as blurriness, dark areas or distortion in your central vision, and perhaps permanent loss of your central vision. It usually does not affect your side, or peripheral vision. For example, with advanced macular degeneration, you could see the outline of a television, yet may not be able to see the text of the TV screen.
Types of Macular Degeneration
Macular Degeneration typically comes in two forms known as dry macular degeneration and wet macular degeneration. If you are over the age of sixty years old and have not had a routine eye exam it is highly suggested that you schedule an eye exam to look for early signs of this degenerative eye disease.
- “Dry” form — the most common form usually progresses slowly and causes central vision loss.
- “Wet” form — rare, and more severe. May progress rapidly causing significant central vision loss.
Macular Degeneration Symptoms
- Shapes are blurry and not readable
- Straight lines look wavy and too curved (amsler grid)
- Colors look dull and dim
- Words appear blurred or difficult to read
- Dark or blank areas block the center of your vision
- There appears to be a fog in the center of your vision
Macular Degeneration Risk Factors
- Those that smoke cigarettes – this increases the risk of ARMD by 200-300%
- People with diabetes (adults or aging seniors)
- People with uncontrolled high blood pressure
- People that lack sufficient ability to absorb nutrients through their digestive system.
- Those with a family history of macular degeneration
Macular Degeneration Facts
- Fact 1. People who get AMD – Most common in people over 60, but can appear as early as age 40. Macular degeneration is the most common cause of severe vision loss among people over 65, and, as life expectancy increases, the disease is becoming an increasingly significant problem.
- Fact 2 – The causes of AMD – There is no conclusive proof as to what causes macular degeneration, however, some scientists believe heredity may play a part, as may UV light exposure and malnutrition.
- Fact 3 – The Symptoms of AMD – The symptoms are distorted vision (typically straight lines or objects appear wavy or crooked), a dark spot, and blurring vision. Later, there is a loss of reading vision.
- Fact 4 – What can be done to prevent AMD – Although there is no hard evidence as to how to prevent macular degeneration there are various things that can be done prevent vision loss. (Proper nutrition, daily vitamins, protection from UV sunlight and not smoking)
Detection of Macular Degeneration
If you are over the age of 60 and have central vision loss it’s possible that macular degeneration may have set in. In order to check for signs of this disease our eye doctors will dilate your pupils in order to view the back of the eye better. Listed below are some of the diagnostic tests that will be conducted.
- Visual acuity test – This eye chart test measures how well you see at various distances.
- Dilated eye exam – Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and 1.optic nerve for signs of AMD and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
Macular Degeneration Treatment
The treatment of wet AMD has evolved over the last 20 years. The treatment options include laser, photodynamic therapy with or without injection of steroid into the eye, and injections of anti-VEGF drugs (Avastin, or Lucentis™) into the eye.
Here are a few macular degeneration treatments:
- Macular Laser Photocoagulation
- Visudyne Photodynamic Laser Therapy
Eye floaters are a very common eye problem. Floaters are essentially little pieces of the jelly inside the eye, that have dried up, broken off and “float” around. That’s why when you try to look at them, they “float” away. Typically, floaters by themselves, are not dangerous.
If you are having a lot of floaters all of a sudden associated with lots of flashing lights (little lightning bolts in the periphery of your vision), this may be the signs of a retinal detachment or tear and you should contact our office immediately. Repairing a retinal detachment in the first 24 hours of occurrence are crucial to maintain or recover your full visual potential.