What do you need to know?
The retina is the light-sensitive layer deep inside the eyeball, lining the back of the eye. It is a piece of neural tissue that creates a focused two-dimensional image that is translated into a neural electrical impulse that translates the image to create visual perception.
For this reason, the retina can be compared to the film or digital media in a camera. It is about 0.5 mm thick. Vascularization of the retina is provided by the central retinal artery, which enters the eyeball through the papilla (the exit site of the optic nerve). The optic nerve consists of axons of ganglion cells that reach the brain and is accompanied by blood vessels that open into the retina to vascularize the retinal layers.
Retinal diseases vary greatly, but most of them cause visual symptoms. Retinal diseases can affect any part of the retina. Among the most common diseases are:
- Retinal detachment – relatively common, especially in combination with age factors, advanced refractive errors or in cases of trauma.
- Pigmentary retinopathy, tapetoretinal degeneration – is one of the degenerative diseases of the retina, generally hereditary, affecting the photoreceptor cells or pigment epithelium.
- Retinal vascular diseases – arterial or venous diseases caused by defective blood circulation in the central artery or central vein of the retina. May accompany cases of diabetes or hypertension.
- Inflammatory retinal diseases – these are rarer disorders, caused mainly by inflammation of the choroid.
- Retinal tumors (retinoblastoma), affecting young children.
Treatment is available for some retinal diseases. Depending on your disorder, the goals of treatment may be to stop or slow the disease and to preserve, improve or restore vision. Untreated, some retinal diseases can cause severe vision loss.
What symptoms do you experience in case of retinal disorders?
Many retinal diseases have some common signs and symptoms. These may include:
- Seeing floating particles or cobwebs
- Blurred or distorted vision (straight lines appear wavy)
- Side vision errors
- Vision loss
- The appearance of a “veil” before the eyes. It is important to be clear from which side the “veil” has appeared, as over time it can expand and take up the whole field of vision
- Noticing bright spots like sparks or lightning
- Distortion of the image of the letters seen, of the objects, indicating that the detachment has reached the center of the retina
- Sometimes the patient notices that in the horizontal position of the body the vision improves because the retina is repositioned, and in the vertical position the vision errors reappear, because the retina detaches again from the vascular membrane.
- It is important to note that retinal detachment is not painful.
You may have to try looking with each eye individually to notice these issues.
What are the risk factors for retinal disorders?
It’s important to be aware of any changes in your vision and to see an ophthalmologist quickly. Immediate medical attention is needed if you suddenly see many floating particles, flashes or reduced vision. These are warning signs of a potentially serious retinal disease.
Risk factors for retinal diseases might include:
- Ageing
- Smoking
- Obesity
- Diabetes or other diseases
- Eye trauma, large pressure variations, intense physical effort
- A family history of retinal diseases
- High myopia
- Diabetic retinopathy
- Intraocular tumors
- Retinal dystrophy, retinopathy of prematurity (in preterm and especially babies with a low birth weight)
How can diabetic retinopathy be prevented?
Most cases of retinal disorders are related to ageing or related vitreous detachment. These are difficult to predict or prevent. However, prevention of retinal disorders starts with regular annual eye examination. Regular examination helps us detect any changes, such as inflammation, thinning or breaks in the retina, that could progress to retinal detachment.
What types of retinal disorders are there?
Common retinal diseases and disorders include:
Retinal detachment. Occurs when the two membranes of which the retina is composed detach from each other (the light capturing retinal membrane detaches from the nourishing vascular membrane). Retinal detachment can be primitive and occurs due to ageing and can occur in people over 50-60 years of age. A retinal detachment is defined by the presence of fluid under the retina. It is often accompanied by the sudden appearance of symptoms such as floating particles and flashing lights.
Diabetic retinopathy. If you have diabetes, the small blood vessels (capillaries) at the back of the eye can become damaged and bleed into and under the retina. This causes the retina to swell, which can blur or distort your vision. Or you may develop new, abnormal capillaries that rupture and bleed. This also makes your vision worse.
Epiretinal membrane. The epiretinal membrane is a scar or delicate tissue-like membrane that looks like a wrinkled cellophane that lies over the retina. This membrane can pull on the retina, which distorts your vision. Objects may appear blurry or twisted.
Macular hole. A macular hole is a small defect in the center of the retina (macula). The hole may develop from abnormal traction between the retina and vitreous or it may be caused by an injury to the eye.
Macular degeneration. In macular degeneration, the center of the retina begins to deteriorate. This causes symptoms such as central blurred vision or a blind spot in the center of the visual field. There are two types – wet macular degeneration and dry macular degeneration. Many people will first have the dry form, which can progress to the wet form in one or both eyes.
Retinitis pigmentosa. Retinitis pigmentosa is an inherited degenerative disease. It affects the retina and causes loss of night and side vision.
What treatment methods exist for retinal disorders?
The main goals of treatment are to stop or slow the progression of the disease and to preserve, improve or restore vision. In many cases, damage that has already occurred cannot be reversed, making early detection important. Each case is unique, and the therapeutic approach can take place after examination and thorough investigation. Treatment of retinal disease can be complex and sometimes urgent.
Options include:
Laser surgery – can repair a tear or hole in the retina. The doctor uses a laser on small spots on the retina. This creates scars that connect (weld) the retina to the underlying tissue. Immediate laser treatment of a new retinal tear can reduce the risks of it causing a retinal detachment.
Reduction of abnormal blood vessels. We can use a technique called laser photocoagulation to shrink abnormal new blood vessels that are bleeding or threatening to bleed into the eye. This treatment can help people with diabetic retinopathy.
Vitrectomy. In this procedure, the doctor removes the gel-like fluid that fills the inside of your eye (vitreous). Air, gas or liquid is then injected into the remaining space. Vitrectomy may be used if bleeding or inflammation covers the vitreous and obstructs the surgeon’s view of the retina. This technique may be part of the treatment of people with retinal rupture, diabetic retinopathy, macular hole, epiretinal membrane, infection, eye trauma or retinal detachment.
Intravitreal injections. Your doctor may recommend intravitreal injections. This technique can be effective in treating people with wet macular degeneration, diabetic retinopathy or broken blood vessels in the eye.
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Diplopia is an ophthalmological disease in which you see two images of the same thing. The condition can affect anyone, but is more common after the age of 60.
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Epiphora is an ophthalmological disorder manifested by excessive tearing of the eyes. Most of the time, it is not severe and disappears on its own. However, if you are experiencing this and the problem persists, we recommend that you make an appointment for an ophthalmological examination. Treatment can be different, depending on the cause of the epiphora.
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Ectropion is the ophthalmic disorder in which the eyelid and eyelashes pull away from the cornea, and reorient outwards.
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Blepharitis is an ophthalmological disorder that manifests itself by inflammation of the eyelids. At the base of the eyelids, the patient notices small crusts formed by solidified oil particles or bacteria that collect in the crease at the corner of the eye.
Uveitis is an ophthalmological disorder of the uveal tract, manifested by changes in vision and eye pain.
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Amblyopia is a vision problem, popularly known as “lazy eye”. This disorder can occur in one or both eyes, and studies show that around 3% of the population suffer from this eye disease.
The sensation of “dry eyes” or “tired eyes” is known in medical terms as “dry keratoconjunctivitis” or “xerophthalmia”, and refers to a dysfunction of the tear film.
Strabismus, also known as “crossed-eyes” or “crossed vision”, is an ophthalmological disorder in which the visual axis of the eyes is not aligned. This causes one eye to deviate when it needs to look at a fixed point.
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Chalazion is manifested by inflammation of the upper or lower eyelid. It is one of the most common ophthalmological disorders, and occurs when the secretion of sebaceous glands in the eye is blocked.
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Myopia is a disorder that falls into the category of refractive errors (along with astigmatism and hypermetropia). In common terms, myopia manifests itself as blurred distance vision, while near vision is not a problem.
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Presbyopia is an age-related disorder characterized by decreased near vision. It usually appears around the age of 40.
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