Retina

What is Retina?

Retina is the part of the eye that sees light. It is like wallpaper that lines the inside of the back of the eye. When light enters the eye, the retina works like a camera film to pick up that light and sends it to the brain so that you can see.

What is Macula?

The central part of the retina is called the macula. It is responsible for detailed central vision that is important for reading and color vision.

What is Vitreous?

Vitreous is a clear gel that fills the back of the eye. It is in contact with the retina when we are born and with time, it separates from the retina.

Retina Symptoms

If you experience any of the following symptoms, then you should seek a Retina Consultation promptly:

Flashes of Light

Usually lightning bolt or an arc shaped flicker or flash of light lasting seconds and located on the side of the vision

Floaters

Gray or brown moving spots in the vision which can be in the form of dots, cobwebs, “lint”, “insects” in the vision

Shadow or Curtain in Vision

Sudden loss of one part of the vision appearing like a shadow or a curtain

Central Vision Loss

Sudden vision loss in center of the vision

Distortion

When reading, letters appear wavy or like you are looking through water. When looking at a straight edge of objects such as a door, it appears bent or crooked.


Age- related Macular Degeneration (AMD)

Like any part of the body, the macula, which is the central part of the retina, can also undergo changes with aging. When such changes are more than expected for age, it is called age-related macular degeneration or AMD, for short. It is the most common retinal condition affecting the old. It can be of two types – dry and wet. Your retina doctor may perform office-imaging tests such as optical coherence tomography (OCT) and fluorescein angiography (FA) in addition to a dilated eye exam to diagnose and monitor this condition.

Dry AMD is related to pigment changes and deposits of waste products in the macula. It usually affects the vision minimally in the early stages, but may progress slowly with time. Depending on the level of dry AMD that you have, your doctor may recommend specific vitamin supplements in order to reduce the risk of change from dry to wet AMD. Self-monitoring with Amsler grid or other such screening methods is important to monitor for change from dry to wet AMD. Regular monitoring with your retina doctor is important as well.

Wet AMD is related to new blood vessels that the body forms under the macula. These blood vessels are not good because they leak fluid and bleed causing the macula to swell. That is why it is called “wet” AMD. It leads to sudden vision decline or new distortion in vision. It is important to detect wet AMD as soon as it starts, because it is treatable with eye injections if treated early. Vision can be recovered and maintained with eye injections that may be required every 1-3 months depending on your condition. While it may sound scary, eye injections are quickly and safely performed in the office by your retina doctor using a technique that causes minimum to no pain. Rarely, your retina doctor may recommend retina surgery if there is large amount of bleeding under the macula.

Atrophy (loss of light sensitive cells) or scarring may limit the central vision in the advanced stages of AMD. Low vision resources can be helpful to improve functional vision in such stages.

Diabetic Retinopathy

Diabetes can affect the walls of the blood vessel in the retina. This leads to changes in the retinal blood vessels and bleeding in the retina referred to as diabetic retinopathy. Your retina doctor may perform office-imaging tests such as optical coherence tomography (OCT) and fluorescein angiography (FA) in addition to a dilated eye exam to diagnose and monitor this condition. The retinal blood vessels can become leaky causing swelling of the macula that can make the central vision blurry. This is called diabetic macular edema and can be treated with eye injections. While it may sound scary, eye injections are quickly and safely performed in the office by your retina doctor using a technique that causes minimum to no pain. In advanced stages of diabetic retinopathy, the body forms new blood vessels in the retina, which are not good because they bleed into the vitreous and reduce the vision. At this stage, in addition to eye injections, retina laser and surgery may be required.

Retinal Vascular Occlusion

The retinal vessels are of two types – arteries and veins. The retinal arteries carry oxygen and nutrition to the retina and the retinal veins carry the used blood back towards the heart.

The retinal vessels are of two types – arteries and veins. The retinal arteries carry oxygen and nutrition to the retina and the retinal veins carry the used blood back towards the heart.

Retina vein occlusion means blockage of a retinal vein, usually from a clot, which can reduce blood flow out of the retina, causing swelling of the retina and vision loss. This is related to risk factors such as glaucoma, high blood pressure, diabetes, obesity, and high cholesterol. Your retina doctor may perform office-imaging tests such as optical coherence tomography (OCT) and fluorescein angiography (FA) in addition to a dilated eye exam to diagnose and monitor this condition. When the swelling is affecting the vision, it can be treated with eye injections. While it may sound scary, eye injections are quickly and safely performed in the office by your retina doctor using a technique that causes minimum to no pain. In some cases, retina laser and surgery may be required. It requires regular monitoring for future eye complications by your retina doctor.

Central Serous Retinopathy

The back of the eye is lined by wallpaper called the retina. The tissue under the retina called choroid carries blood to the outer part of the retina. Central serous retinopathy is a condition in which the choroid leaks fluid that collects under the retina and causes vision decline or distortion. This condition commonly affects young patients. Your retina doctor may perform office-imaging tests such as optical coherence tomography (OCT) and fluorescein angiography (FA) in addition to a dilated eye exam to diagnose and monitor this condition. Stress, steroid use, sleep apnea and high blood pressure are risk factors for this condition. Treatment of these underlying condition can correct the condition. In some cases, medication, eye injection or laser may be required as well.

Macular Pucker (Epiretinal Membrane)

The back of the eye is filled with a clear gel called the vitreous and lined by wallpaper called the retina. The central part of the retina is called the macula. As we get older, the vitreous is designed to separate from the retina and the macula. Normally, as we get older, all of the vitreous should separate from the macula. Sometimes, part of the vitreous remains stuck to the macula and forms a film called an epiretinal membrane or a macular pucker. This can cause the macula to swell and develop an abnormal shape. In addition to a dilated eye exam, your retina doctor will perform an office-imaging test called optical coherence tomography (OCT) to detect this. When it starts to affect the vision, retina surgery can be done to correct the problem. It involves an outpatient surgery called vitrectomy during which the vitreous gel is removed and the membrane is peeled.

Vitreomacular Traction

The back of the eye is filled with a clear gel called the vitreous and lined by wallpaper called the retina. The central part of the retina is called the macula. As we get older, the vitreous is designed to separate from the retina and the macula. Normally, as we get older, all of the vitreous should separate from the macula. Sometimes, the vitreous continues to pull on the center of the macula without separating, causing the macula to swell up. This causes distortion or reduced vision. In addition to a dilated eye exam, your retina doctor will perform an office-imaging test called optical coherence tomography (OCT) to detect this. Treatment involves close monitoring for spontaneous release or retina surgery that involves an outpatient surgery called vitrectomy during which the vitreous gel is removed and the traction is relieved.

Macular Hole

The back of the eye is filled with a clear gel called the vitreous and lined by wallpaper called the retina. The central part of the retina is called the macula. As we get older, the vitreous is designed to separate from the retina and the macula. Normally, as we get older, all of the vitreous should separate from the macula. Sometimes, either the vitreous gel or a membrane on the surface of the macula pulls the center of the macula outward allowing a hole to form in the center, called a macular hole. This causes decrease in vision or missing central vision in that eye. In addition to a dilated eye exam, your retina doctor will perform an office-imaging test called optical coherence tomography (OCT) to detect this. Early stages of this condition can be treated with eye drops. But when it is beyond the early stage, Retina surgery is required to correct the problem. It involves an outpatient surgery called vitrectomy during which the vitreous gel is removed, a membrane is peeled from the macula, and a gas bubble is placed inside the eye to allow hole to close.

Vitreous Hemorrhage

The back of the eye is filled with a clear gel called the vitreous and bleeding in this gel is called vitreous hemorrhage. It can be from many causes such as diabetes, vitreous separation, retinal tear or retinal detachment, and retinal vein occlusion. Your retina doctor may perform office-imaging tests such as B scan ocular ultrasonography and fluorescein angiography (FA) in addition to a dilated eye exam to diagnose and monitor this condition. Treatment may involve eye injection or retina surgery depending on the cause.

Floaters and Posterior Vitreous Detachment

The back of the eye is filled with a clear gel called the vitreous and lined by wallpaper called the retina. Small fluid collections in this gel are common with age (can start as early as in your 20s) and appear as grayish dots seen in your vision occasionally. They come and go and are most commonly seen against a plain background such as the clear sky or a white wall. A sudden increase in floaters or new floaters should prompt a dilated eye exam with your retina doctor.

On an average, between 40 and 80 years of age, the vitreous gel separates from the retina, which is called posterior vitreous detachment. This is a normal part of aging and often results in one or more new floaters in the form of cobwebs, “lint”, or “insects” in the vision. When this occurs, it should prompt a dilated eye exam with your retina doctor to evaluate for retinal conditions such as retinal tear and retinal detachment. While the floaters and posterior vitreous detachment themselves do not require any treatment, if there is a retinal tear or detachment, you will require treatment.

Retinal Tear

The back of the eye is filled with a clear gel called the vitreous and lined by wallpaper called the retina. As we get older, the vitreous is designed to separate from the retina. If the vitreous is tightly attached to the retina at any point, it can pull the retina with it during the separation causing a retinal tear. You will see flashes of light and floaters when this occurs and should seek a Retina consultation promptly. Retinal tear is treated with an office laser treatment that creates a seal around the tear and reduces risk of retinal detachment. It requires regular monitoring thereafter by your retina doctor.

Retinal Detachment

The back of the eye is filled with a clear gel called the vitreous and lined by wallpaper called the retina. The wallpaper needs to be on the wall to be able to see. Retinal detachment is a condition where the wallpaper comes off the wall causing vision loss in part or all of the vision. You will see flashes of light, floaters, and shadow or curtain in the vision when this occurs. It can also lead to complete loss of vision. Urgent treatment is required with retina surgery in order to place the retina back on the wall. Retinal detachment repair surgery involves different techniques such as:

  • Vitrectomy – the vitreous gel is removed from inside the eye, the retina is repositioned back onto the wall, laser treatment is applied to the retinal tears, and either a gas or oil bubble is placed inside the eye to keep the retina in position while it heals.
  • Scleral buckle – a belt is permanently placed around the eye to press the wall of the eye inwards to bring it close to the retina and freezing or laser treatment is used to treat the retinal tears.
  • Combination of the above procedures may be required in some cases.

If detected and treated in time, retinal detachment surgery can help recover most of the vision that was lost. It requires regular monitoring thereafter by your retina doctor.

Dropped Lens

The eye is like a camera with a lens in the front part and the retina, which works like the camera film, in the back part. The lens can become cloudy with age and this is called cataract. Either from trauma or due to a complicated cataract surgery, the lens can sometimes drop into the back part of the eye, causing a dropped lens. With the lens not in place, it causes you to experience vision loss. This can be treated with retina surgery called vitrectomy to remove the vitreous gel and the lens from the back part of the eye. A new artificial lens may be placed at the time of the surgery or at a later date.

Dislocated Intraocular Lens

The eye is like a camera with a lens in the front part and the retina, which works like the camera film, in the back part. The lens can become cloudy with age and this is called cataract. When it affects the vision significant, it can be treated with cataract surgery, which involves removing the cloudy lens and replacing it with an artificial lens called an intraocular lens. Most of the times, the intraocular lens placed during cataract surgery is good for life. However, in some cases, if the supporting structures inside the eye are weak, the intraocular lens can move out of place. This is called a dislocated intraocular lens. This requires retina surgery called vitrectomy to remove the vitreous gel and the dislocated intraocular lens from the back part of the eye. A new artificial lens may be placed in a different location at the time of the surgery or at a later date.

Uveitis

Uveitis is a condition where there is inflammation inside the eye. It can be caused by eye injury, infections, and autoimmune conditions. Your retina doctor may perform office-imaging tests such as optical coherence tomography (OCT) and fluorescein angiography (FA) in addition to a dilated eye exam to diagnose and monitor this condition. Treatment with eye drops, eye injections, and oral medications may be required depending on severity and type of uveitis. You may also be referred to a rheumatologist to help manage this condition in collaboration with your retina doctor.

Choroidal Nevus and Melanoma

The back of the eye is lined by wallpaper called the retina. The tissue under the retina called choroid carries blood to the outer part of the retina. A freckle in this layer is called a choroidal nevus that is a benign condition. However, it can be a cause of concern, as it can mimic an eye cancer called choroidal melanoma. It requires careful evaluation with your retina doctor with a dilated eye exam and office-imaging tests such as B scan ocular ultrasonography, optical coherence tomography (OCT) and fluorescein angiography (FA) to differentiate between the two conditions. A choroidal nevus is followed with regular monitoring by your retina doctor. A choroidal melanoma requires treatment with radiation and sometimes surgery, followed by regular monitoring by your retina doctor.

Retinal Treatments

Eye Injections

Eye injections, also called intravitreal injections, are a common treatment for many retinal conditions including wet age related macular degeneration, diabetic retinopathy, and retinal vein occlusion. It is a quick, safe, and effective treatment for these conditions. Your retina doctor using a technique that causes minimum to no pain performs an eye injection in the office. The eye is cleaned with an antiseptic solution and numbed using an anesthetic medication. Once the eye is numb, a tiny needle is used to deliver the desired medicine into the eye. The eye is then rinsed to wash off excess antiseptic. You may require ongoing treatment every 1-3 months depending on your condition.

Possible side effects:

  • It is common to feel some burning or irritation in the eye after the numbing effect wears off. That usually resolves within 24 hours. You may use artificial tears to soothe the eye.
  • You may see few floaters after the injection. They usually resolve within a few days.
  • The white of the eye (part or all of it) can turn red from bleeding on the surface of the eye, where the needle entered the eye, but this is not to be concerned about and resolves on its own within 1-2 weeks and causes no permanent harm to the vision.
  • The main risk of the procedure is an infection called endophthalmitis. Fortunately, the risk of this infection is very low, occurring in approximately 1 in 3000 injections.If you experience worsening eye pain, sensitivity to light, or worsening vision, then you should contact your retina doctor immediately.

Laser Panretinal Photocoagulation

Laser Panretinal Photocoagulation (PRP) is a retinal laser procedure used to treat areas of the retina that are not receiving adequate blood flow. It is used to treat certain stages of diabetic retinopathy and retinal vein occlusion. The eye is dilated and your retina doctor applies the laser treatment to the target areas of the retina. You will feel bright flashes and mild pressure/pain during the procedure, but is well tolerated. There are no restriction or eye drops to use after the procedure. You may experience mild headache after the procedure for which you can take Tylenol.

Laser Retinopexy

Laser Retinopexy is an urgent retinal laser procedure used to treat a retinal tear. The eye is dilated and your retina doctor directs you to look in a particular direction and applies the laser treatment to the areas surrounding the retinal tear. In about 10 days, the treated area heals and forms a seal around the tear, thereby reducing the risk of retinal detachment. You may experience mild headache after the procedure for which you can take Tylenol. It is recommended to limit reading and near activity for the first 10 days after the procedure.

Retina Surgery

Vitrectomy

Vitrectomy is the most common retina surgery. It is usually done under local anesthesia by injecting an anesthetic medication behind the eye by your retina doctor, while you are sedated with intravenous medication. During surgery, the instruments enter the back of the eye through the white part of the eye via 3 small incisions. The back of the eye is filled with a clear gel called vitreous, which is removed during vitrectomy and replaced with water. Additional treatments are done as necessary and may include laser treatment to the retina (for vitreous hemorrhage and retinal detachment), membrane peeling from retina surface (for epiretinal membrane and macular hole), removing fluid from under the retina (for retinal detachment), and placing either air, gas or oil bubble into the back of the eye. The instruments are then removed from the eye and the eye is patched. You may be recommended to position your head in a certain way to help maximize the success of surgery. Your retina doctor will examine you on the day after the surgery when the eye patch is removed in the office and the eye drops are started after that.

Scleral Buckle

Scleral buckle is a form of retina surgery during which a belt is placed around the eye under the eye muscles. The goal is to press the wall of the eye inwards to bring it close to the retina. Freezing or laser treatment is used to treat the retinal tears during this surgery. It may be done by itself or combined with vitrectomy as above. Your retina doctor will examine you on the day after the surgery when the eye patch is removed in the office and eye drops are started after that. Your retina doctor will examine you on the day after the surgery when the eye patch is removed in the office and the eye drops are started after that.

Choroidal Drainage

Choroidal drainage is a form of retina surgery during which your retina doctor creates an opening in the white part of the eye to drain the blood or fluid collected underneath it. It may be combined with vitrectomy as above. Your retina doctor will examine you on the day after the surgery when the eye patch is removed in the office and the eye drops are started after that.

Intraocular Lens Exchange

When the supporting structures inside the eye are weak, the intraocular lens may get dislocated. The treatment involves retina surgery with vitrectomy and intraocular lens exchange. Your retina doctor will perform vitrectomy as mentioned above, and remove the dislocated intraocular lens, and then replace it with a new intraocular lens that can be placed in a different location or fixated in a place to minimize risk of dislocation. Your retina doctor will examine you on the day after the surgery when the eye patch is removed in the office and the eye drops are started after that.