RETINA AND VITREOUS
RETINAL DETACHMENT, RETINAL HOLES
The retina is the innermost layer of the eye and, like the film in a camera, is responsible for processing visual impressions. Illnesses of the vitreous body and the retina may threaten your eyesight and should therefore be treated as early as possible. Holes and tears in the retina may cause retinal detachment, which can lead to blindness within a short time span. In the early stages, retinal tears and holes can be treated by means of laser therapy. Once the retina has become detached, it can only be treated by retinal surgery.
VITREOUS OPACITIES
Although eye spots (floaters) are a usually harmless form of vitreous opacity, they can also be a sign of damage to the retina (retinal detachment). Particular care should be taken if patients also experience flashes of lightning, an increase in the number of spots or spots that move independently of eye movement (“mouches volantes”), or if they see any shadows (in the form of a veil or a wall, for instance). You should consult an ophthalmologist immediately if you are experiencing any of these symptoms.
DIABETIC RETINOPATHY
Diabetes can cause various types of damage to the eye. The most common and dangerous type of damage is diabetic retinal disease (retinopathy), which may cause irreversible damage to the retina or even blindness due to impaired retinal blood flow. Other types of damage include premature clouding of the lens (cataracts), increased intraocular pressure (glaucoma), and frequent inflammations of the eye’s surface. Although these problems most commonly develop due to poor blood sugar control, they can also occur with optimal diabetes control. For this reason, regular routine eye tests are important in diabetes patients.
Diabetic retinal disease may also cause fluid retention and swelling at the site of sharpest vision (macula). These can be treated with intravitreal injections. This involves the injection of active substances to transport the fluid out of the retina into the vitreous cavity. After the swelling of the retina has subsided, visual acuity may improve or at least stabilise. As this is a chronic disease, repeated injections are usually necessary.
Treatment
A basic prerequisite for the treatment of diabetic retinopathy is the optimal adjustment of the blood sugar level. Unfortunately, this does not guarantee absolute protection against the development of diabetic retinal disease. In some cases, laser treatment of the retina (retinal laser surgery) is necessary to treat diabetic retinopathy. This involves using an argon laser to specifically seal or destroy certain areas of the retina in order to ensure better blood circulation to the remaining parts. However, this laser treatment does not usually lead to an improvement in visual acuity, but is instead used to prevent further deterioration, which might lead to complete loss of vision if left untreated.
VASCULAR OCCLUSIONS (VENOUS/ARTERIAL)
Similar to the brain (stroke) or the heart (heart attack), vascular occlusions can also occur in the eye. In this case, either the veins or the arteries become blocked or close due to various internal causes (thrombus, blood pressure, high blood lipids, etc.) . The retina is then no longer supplied with blood, which causes a sudden loss of vision. The reduced oxygen supply to the retina can cause bleeding and swelling, which not only further impairs the patient’s eyesight, but also sometimes leads to the formation of new blood vessels that may eventually cause the loss of the eye. Treatment consists of laser therapy on the peripheral retina (retinal laser surgery) and the injection of antiproliferative drugs into the vitreous cavity (intravitreal injections).
AGE-RELATED MACULAR DEGENERATION (AMD)
Macular degeneration is a change in the retina that damages the site of sharpest vision. This usually occurs in old age (age-related macular degeneration / AMD) and can lead to blindness.
There are two types of AMD. The dry type is caused by deposits at the site of sharpest vision, which usually lead to a slow deterioration of vision.
The second and far more dangerous type is wet AMD, which can lead to severe visual deterioration within a very short time.
Symptoms
In macular degeneration, the central visual acuity is reduced. Although the peripheral visual field remains intact, this results in a significant deterioration of the central visual field, e.g. the ability to read. At an early stage, AMD can cause patients to see lines as no longer straight but distorted or wavy. A proven method for early detection is the so-called Amsler grid.
Treatment
Intravitreal injection, an effective treatment method for macular degeneration, has only been available for a few years. For this process, various drugs are used, which are typically injected directly into the vitreous body of the eye more than once. This direct local treatment can stabilise the retina and halt the progression of retinal degeneration. However, any damage that has already occurred is often irreversible. Early detection and treatment are therefore essential.
INTRAVITREAL INJECTIONS
By injecting specific drugs into the vitreous cavity, it is possible to treat eye diseases such as age-related macular degeneration (AMD) and diabetic as well as vascular macular edema. This usually requires repeated injections. Often this is the only treatment option available.
OCT TESTING (OPTICAL COHERENCE TOMOGRAPHY)
Fluid deposits and swellings in the macula (site of sharpest vision) are often not visible to the naked eye. They can be diagnosed and quantified by means of OCT (optical coherence tomography) testing. As with an ultrasound examination, this process creates a cross-sectional image of the individual retinal layers (within seconds, like a photo, and without touching the eye). This image makes it possible to detect even the smallest changes in the retinal layers. Likewise, the responsiveness to treatment (e.g. intravitreal injection) can also be evaluated by measuring decreases in fluid levels or retinal thickness.