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What is the macula?

The macula is the part of the retina or nerve tissue in the back of the eye that is responsible for our central fine vision. It is what allows us to see and decipher words on the page of a book or to make out the details on something smaller or a longer distance away.

What is a macular pucker and how can it affect my vision?

A macular pucker (epiretinal membrane) is a growth of clear tissue over the macula. Many of these membranes are found during examinations and do not produce any problems in asymptomatic patients. Some epiretinal membranes can contract on the surface of the macula, causing distortion in the retina and adversely affecting central vision. With significant distortion or blurring, vitrectomy surgery with peeling of the epiretinal membrane can be used to help restore vision.

What is a macular hole and how can it affect my vision?

A macular hole is a partial (lamellar) or full thickness loss of tissue in the central retina. It can lead to a progressive and permanent loss of a patient’s central vision, ultimately leading to a central black area blocking sight.

A hole in the macula can develop either from vitreous-macular traction (“idiopathic” macular hole), trauma and rarely in nearsighted people.  Idiopathic macular holes are the most common, usually occurring in patients over the age of 50. 

Vitrectomy surgery may be used to remove the vitreous gel and close the macular hole.  Fine membranes (epiretinal membrane or internal limiting membrane) are sometimes peeled from the edge of the hole and a gas bubble or oil bubble is placed in the eye to help seal the hole while it heals.  When gas is used, the patient must remain face down for some time after surgery to help the hole seal.  If oil is used, it must be removed with a second operation.

What is Posterior Vitreous Detachment?

The back of the eye is normally filled with a jelly called the vitreous.  As the eye ages, the vitreous becomes less like a gel and more like a fluid.  This is considered a normal effect of aging.  Not all the jelly becomes fluid-like all at once, so small clumps or strands of the jelly may first form.  As the light come into your eye, it is blocked by these clumps of jelly, thereby casting a shadow onto your retina.  When this happens in the eye, you end up seeing these shadows as floaters.  Over time, the jelly pulls away from the retina, the tugging on the retina may also cause you to see flashing lights.  In rare instances, as the jelly pulls away, it can rip a blood vessel or even rip a tear in your retina.  No treatment is necessary for a PVD unless it leads to a retinal tear or detachment.  Floaters will present from time to time, however they rarely cause serious impairment.  Unless floaters are disabling or prevent normal day to day functioning, then and only then would removal of the gel within the eye be recommended.  Anyone who develops a sudden onset of new floaters or flashing lights of any kind should have a complete retinal evaluation.

What is retinal detachment?

Comparable to the film in a camera, the retina is responsible for “creating” the images that we see. It is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. It separates from the back wall of the eye and is no longer connected to the layer of cells known as the retinal pigment epithelium. These cells are critical for the health of the retina. When detached, the retina degenerates and loses its ability to function. The center of the retina is called the macula, which is the only part of the eye capable of facilitating fine, detailed vision such as reading and recognizing faces. An untreated retinal detachment will spread to the macula. A detached macula can cause central vision loss. In cases where small or large areas of the retina are torn, these tears or breaks can lead to retinal detachment if left untreated. If not promptly treated, a retinal detachment can cause permanent vision loss. With early diagnosis and treatment, detached retinas may be prepared by several options: a gas bubble, scleral buckle or vitrectomy surgery and excellent vision may be restored.

What is retinal vein occlusion?

A retinal vein occlusion (RVO) is a blockage of blood flow in one of the retinal veins. It can occur in either a branch retinal vein (branch retinal vein occlusion, BRVO) or in the central retinal vein (central retinal vein occlusion, CRVO). The occlusion causes bleeding in either one section of the retina (BRVO) or throughout the retina (CRVO) and can also produce swelling of the macula (macular edema). The region of the retina in which the blockage occurs will be deprived of oxygen (ischemia). In severe vein occlusions, this oxygen deprivation can occur in the macula (macular ischemia). If a significant amount of ischemia occurs, new blood vessels may begin to grow on top of the retina (neovascularization). Your eye doctor will be able to diagnose this condition with a careful dilated examination.  Additional testing with fluorescein angiograms and OCT are often obtained to assess the degree of damage to the retina.

What is Central Serous Retinopathy?

Central serous retinopathy (CSR) is caused by leakage of fluid beneath the retina.  This bubble or blister of fluid beneath the macula can cause a central scotoma, minification, and blurred vision.  CSR is typically seen in males between 20 and 40 years of age and has been associated with stress and “Type A personality”.  Patients who are pregnant, use steroids or has a history of organ transplantation are at risk too.

The condition usually resolves spontaneously over weeks to several months but can be chronic.  Focal laser treatment, Micropulse Laser, Photodynamic Therapy (PDT) and certain medications may be used to help speed up the recovery process in some cases.  Fluorescein angiography is useful in cases when the diagnosis is questioning, in chronic cases, and when laser treatment is considered.

Diabetic Retinopathy

What is age-related Macular Degeneration?

Age-related macular degeneration (AMD) is the leading cause of blindness in the United States.  It is one of the most common causes of poor vision after age 60, but may be picked up earlier, in the 40’s and 50’s.  Evidence shows with the help of nutritional supplements and changing your lifestyle may help reduce the development of this blinding disease.

There are two forms of macular degeneration, dry and wet.  Dry AMD is usually less severe and reading vision is often maintained.  Degeneration of the outer layers of the retina, the light absorbing photo-receptors and the retinal pigment epithelium (RPE) are the cause of dry AMD.  The RPE forms the blood retinal barrier between the outer retinal circulation (choriocapillaris) and the outer retina (phot-receptors).

Wet AMD is when abnormal blood vessels grow from the outer retinal circulation beneath the retinal pigment epithelium and sometimes the retina itself.  Scars can form from these blood vessels leaking fluid and protein.  With early diagnoses of these blood vessels, injections into the eye may be used to stop the growth of the blood vessels are prevent further vision loss.  Fluorescein angiography (FA), optical coherence tomography (OCT), and Fundus Photography may be used to take images of the macula and to help guide treatment.

Anti-vascular endothelial growth factor (VEGF) are currently the standard therapy for wet macular degeneration.  These include Lucentis, Eylea, and Avastin.  These agents have been proven to stabilize vision in more than 90% of patients as well as improve vision in up to 40% of patients.  They are given as intravitreal injections through the outside of your eye.