Understanding Retinal Diseases
The retina is a very thin but complex tissue that lines the back of the eye. It contains millions of cells, including photoreceptors that sense light and send images to the brain. Many conditions can impair the retina’s ability to receive and transmit images. The most common retinal diseases are diabetic retinopathy, age-related macular degeneration, and retinal detachments. These conditions are all very serious and can lead to loss of vision if not treated.
Comprehensive Retinal Examination
A retinal examination is the only way to diagnose retinal problems properly. Serious retinal diseases can often be treated before the patient begins to experience vision problems. During the exam, our ophthalmologists, Dr. Gaurav Gupta and Dr. Pranjal Thakuria, will begin by dilating your pupils using drops. This enables them to carefully observe the internal structures of your eyes, particularly the retina, using an ophthalmoscope.
In some cases, additional testing is required. One test is a fluorescein angiogram, which can help the doctor evaluate the retina more easily. In this test, a small amount of dye is injected into a vein in the hand or arm. As the dye circulates through the retina’s blood vessels, photographs of the retina are taken.
Another effective test is Optical Coherence Tomography (OCT), a new technology we are pleased to offer at Rhode Island Eye Institute. This rapid imaging device bounces light rays off the retina, transmitting the reflections to a computer. The result is a detailed 3D cross-section of the retina.
Advanced Treatment for Retinal Diseases in Providence
Many retinal diseases can be treated with laser light. These very powerful light beams can help destroy abnormal blood vessels in the retina or act to seal off retinal tears. Laser therapy is usually done in our office with anesthetic drops or injections around the eye to ease discomfort.
Some retinal diseases require surgery. Most retinal surgery involves removing the vitreous gel (the clear fluid inside the eye) and using delicate instruments to remove abnormal tissue from the retina’s surface. Retinal surgery usually involves a local anesthetic in a hospital operating room.
Diabetic Retinopathy Treatment
Diabetic retinopathy results when blood vessels in the retina are damaged due to high blood sugar levels in people with diabetes. Prevention through strict control of blood sugar levels is the best way to reduce the long-term risk of vision loss from diabetic retinopathy. For more advanced diabetic retinopathy, laser treatment is often recommended. Sometimes, retinal surgery is required.
What is Macular Degeneration?
Age-Related Macular Degeneration (AMD)
Age-related macular degeneration (AMD) is the leading cause of legal blindness in the United States. In fact, 2.2% of people 65 or older have severe vision problems from the disease.
AMD is a disease that affects the macula, the small area in the retina’s center. Even though the macula takes up only 3% of the retinal surface area, it is responsible for all detailed vision, like reading, artwork, recognizing faces, etc.
The first sign of macular degeneration may be the need for more light when you do close-up work. The fine print may become harder to read, and street signs more difficult to recognize. The condition usually develops gradually but may sometimes progress more quickly, leading to severe vision loss in one or both eyes.
There are two forms of macular degeneration: “dry” and “wet.” The dry form is more common and is caused by aging and thinning of the cells in the macula. Vision loss is slow and gradual.
The “wet” form occurs in only 10% of patients with AMD and causes much more rapid, and usually more serious, loss of vision. This is due to the growth of abnormal, fragile blood vessels in or near the macula. These blood vessels leak blood or fluid and blur central vision quickly. Untreated wet AMD can lead to scarring of the macular area and permanent vision loss.
Treatment of Age-Related Macular Degeneration
Although there is no cure for dry AMD, various combinations of vitamins and anti-oxidant supplements have been shown to help slow the progress of the disease.
Some treatment options are available for wet macular degeneration. These include:
- Photocoagulation Argon Laser Therapy: In photocoagulation, a high-energy laser beam is used to create small burns in areas with abnormal blood vessels. It can prevent further damage to the macula and halt continued vision loss.
- Photodynamic therapy (PDT): This therapy is for treatment CNV or abnormal blood vessels that is located directly under the fovea. PDT increases your chances of preserving some of that vision. It won’t bring back vision you have lost, but it may prevent or slow the rate of future vision loss.
- Transpupillary Thermotherapy: TTT is a technique that uses a state-of-the-art diode laser to slowly deliver heat through the pupil to the abnormal blood vessels in the retina. The heat from the laser destroys the abnormal vessels to stop or slow the effects of macular degeneration.
Retinal Detachment
Almost all retinal detachments start with a small tear in the retina, which allows fluid to go behind the retina and push it out of its normal position in the back of the eye. Detachments are very serious and almost always lead to blindness if not treated promptly.
Treating Retinal Detachment
Most retinal tears (the early stage of retinal detachment) are treated with laser surgery or cryotherapy (freezing), both of which reattach the retina to the back wall of the eye. This treatment usually prevents retinal detachment and is performed in the doctor’s office with little to no discomfort.
A retinal detachment requires surgery to first seal the tear and then reattach the retina back in its proper position. There are several types of surgery used, and the decision of which type depends upon the characteristics of the detachment. Some retinal detachments can be treated in the doctor’s office, using an injection of air inside the eye to push the retina back into position. However, most detachments require surgery in a hospital operating room.
Emerging Retinal Disease Treatments
Macugen
Approved by the Food and Drug Administration in December 2004, pegaptanib (Macugen), is a drug used for treatment of wet macular degeneration. The drug stops the formation of new blood vessels and decreases leakage from existing blood vessels. Macugen, given as a series of injections into the vitreous fluid in the eye, may prevent further loss of vision.
Lucentis
Like Macugen, ranibizumab (Lucentis) is another drug to treat wet macular degeneration by impeding new growth of abnormal blood vessels. Lucentis shows promise in reversing the effects of macular degeneration, not just preventing further vision loss. Lucentis is currently available only in clinical trials; however, it is being prescribed using a closely related drug, bevacizumab (Avastin).
Visudyne®
Visudyne is a light-activated drug that is injected into the blood stream and travels to the abnormal blood vessels in the macula where it collects. A “cold” PDT laser activates the medication and closes the abnormal blood vessels without causing damage to the healthy retina. The therapy may be reapplied at three-month intervals as needed.
Transpupillary Thermotherapy (TTT )
Transpupillary thermotherapy (TTT) is a technique that uses a state-of-the-art diode laser to slowly deliver heat through the pupil to the abnormal blood vessels in the retina. The heat from the laser destroys the abnormal vessels to stop or slow the effects of macular degeneration.
Retinal Detachment
Almost all retinal detachments start with a small tear in the retina, which allows fluid to go behind the retina and push it out of its normal position in the back of the eye. Detachments are very serious and almost always lead to blindness if not treated promptly.
Put your retinal health in the hands of our dedicated retinal specialists, Dr. Gaurav Gupta and Dr. Pranjal Thakuria. With their expertise and care, they will guide you through your retinal journey, providing personalized treatment options and ensuring your well-being.