Medical Retina

Retinal Vascular Disease

Diseases which affect the retinal vessels include hypertension and diabetic retinopathy, and commonly involve other vessels throughout the body, in a similar manner. Retinal examinations provide the ophthalmologist the opportunity to directly visualise the retinal vessels, and this is very helpful in terms of detecting abnormalities that may be affecting other parts of the body.

Retinal vein occlusions, artery occlusions and diabetic retinopathy are the most common problems seen.

Symptoms of Retinal Vascular Disease include:

Symptoms, such as blurring of central vision or a loss of visual field, may occur abruptly (minutes to hours), and may have spontaneous recovery or cause permanent visual loss over years, as occurs in some patients with diabetic maculopathy and central retinal artery occlusion.

Retinal vascular disease is frequently painless. Patients with temporal arteritis may experience some days to weeks of temporal headache, scalp tenderness, as well as jaw pain when chewing and generalized lethargy and myalgia. In cases of systemic hypertension, patients may report persistent headaches.

Treatment

Successful treatment of retinal vascular disease is dependent on identifying and correcting any underlying systemic causes, especially high blood pressure, diabetes and elevated cholesterol, and involves shared care between the patient’s general practitioner and their treating ophthalmologist.

These conditions need to be managed both from the eye problem point of view, but also from the systemic angle. Strong links with key physicians result in coordinated care and improved results. The treatment of the eye problem may involve the use of laser photocoagulation of the retina and/or intraocular injections to control swelling of the retina or the development of abnormal retinal vessels (neovessels).

Macular Degeneration

Macular degeneration is an eye disease that can blur the sharp, central vision you need for activities like reading and driving. It is age-related, which means that it often happens to people over 60. “Macular” means it affects a part of your eye called the macula, which is the part of the retina responsible for the visual acuity.

What is Macular Degeneration?

It is quite a common condition and an important cause of visual loss in this age group.  There are broadly two forms, Wet and Dry. The Dry form is the most common and leads to progressive and slow changes in vision, while the Wet form can produce quite significant and fast visual loss. Current strategies aim at the management of the Wet form and involve the use of intravitreal injections of anti-VEGF agents to control disease progression. The dry form of the condition does not have an effective treatment available at the moment, but research is promising.

Symptoms

As it progresses, people may see a blurry area near the centre of their vision. In time this area may get larger or you may see blank spots. Things may also seem less bright than before.

People also notice that straight lines start to look wavy. This can be more easily perceived using an Amsler grid and represents a warning sign for advanced Macular Degeneration. If you notice this symptom, see your ophthalmologist right away.

Treatment

There is currently no treatment for early MD, so your doctor will just keep track of how your eyes are progressing with regular eye exams. Many supplement formulas exist in the market and have been used in an attempt to reduce the progression of the disease. Nutritional supplements cannot prevent AMD. However, the AREDS/AREDS2 supplements may delay progression of intermediate to advanced AMD, and may help you keep your vision longer.  In the AREDS trial, taking the AREDS formula reduced the risk of advanced AMD by about 25% over a five-year period. Results of the AREDS2 study were published in May 2013. The outcomes revealed that study participants taking the modified AREDS formula with added lutein and zeaxanthin had a 10 to 25 percent reduction in the risk of AMD progression.

If you are diagnosed with intermediate or late Macular Degeneration, ask your doctor about treatment options and how the condition may affect your vision in the future.

For people with a type of late Macular Degeneration called neovascular Macular Degeneration (Wet form), some treatments may be able to stop further vision loss. The use of intraocular injections with anti-VEGF drugs (Lucentis, Eylea) represent the current standard of care.

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