Retina, Uvea & Vitreous

Our Retina expert Dr Ajay Aurora is amongst the best Retina surgeons of India

What is Macular Degeneration?

Macular degeneration is an age related condition(ARMD) that affects the macula which is the central most sensitive part of the retina. The macula allows us to see fine details such as recognizing faces, reading, watching TV or driving. When the macula gets damaged, central vision is affected and it becomes difficult to perform day to day tasks. However, peripheral vision stays intact, so the patient never becomes blind.

What are the causes of Macular Degeneration?

Ageing(> 50 years) is the commonest cause of ARMD. The exact aetiology is not known though smoking,obesity,hereditary, environmental and dietary factors are thought to play a role.

How does Macular degeneration affect our vision?

There are 2 types of ARMD- Dry (or Atrophic) & Wet (or Exudative)

DRY ARMD
This is the more common form. In the early stage of macular degeneration there is the appearance of yellowish spots beneath the retina called Drusen . These may not affect vision initially and are mostly detected on routine retina examination by your eye specialist. It progresses slowly to geographic atrophy with thinning of the retina and gradual irreversible loss of vision. Currently there is no definitive treatment for Dry ARMD but nutritional supplements and low vision aids like magnifiers can help.
WET ARMD
This accounts for about 10% cases but causes more severe vision loss. There is formation of abnormal blood vessels beneath the retina which leak fluid or blood leading to sudden and rapid deterioration in vision. It is important to detect and treat this Choroidal Neovascular membrane (CNVM) early as it leads to severe vision loss.

What are the symptoms of Macular Degeneration?

In early stages, there is very little impact on vision. It may start in one eye though it eventually affects both eyes. There is gradual painless loss of central vision though side vision remains intact.

How can Macular Degeneration be detected?

The commonest symptom is a progressive blurring of vision. The vision maybe more hazy in bright or low light. Altered perception of colours, glare & sensitivity to bright light, difficulty in night driving, seeing multiple images, frequent changes in the power of glasses are some of the other problems that occur. Cataract usually develops in both eyes, but maybe more in one eye.

Routine eye check

Most people do not realise they have ARMD until vision becomes blurry. Hence it is important to have a dilated retinal examination every 2 years after the age of 40 years.

Amsler Grid

This is an easy to do self test which is like a graph paper. With one eye closed, you need to look at the central black dot and observe the grid pattern for any wavy lines or black spots.

Optical Coherence Tomography (OCT)

Specialised test which scans your retina and gives a cross sectional image of each layer. It helps in early diagnosis and follow up.

Fundus Fluorescein Angiography

A dye is injected in the vein and photographs are taken with a special camera. This can help to detect leaking blood vessels and choroidal neovascular membranes.

Tips to prevent ARMD

  • Have a diet rich in fruits and vegetables- Green and coloured fruits and vegetables that are rich in antioxidants are protective.
  • Omega 3 fatty acids found in fatty fish, almonds and flax seeds may reduce the risk of macular degeneration
  • Avoid smoking and exposure to bright sunlight
  • Regular exercise and maintain a healthy weight

How is Macular degeneration treated?

Recently there have been a lot of advancements in the treatment of ARMD. The key is early detection.Although there is no cure, the disease progress can be slowed down by lifestyle modifications, nutritional supplements, laser and antiVEGF injections.

Scientific studies have shown that antioxidants like Lutein, Zeaxanthin, vitamin C, vitamin E, zinc, selenium etc lowered the risk of developing ARMD. They need to be taken on a long term.

Scientific studies have shown that antioxidants like Lutein, Zeaxanthin, vitamin C, vitamin E, zinc, selenium etc lowered the risk of developing ARMD. They need to be taken on a long term.

What are Floaters?

It's not uncommon to see some small spots or clouds moving in front of our eyes. These appear more prominent when looking at a plain background like a blank wall or the sky. These Floaters as they are called can vary in shape and size ranging from tiny dots to threads, cobwebs or clouds. They are actually clumps of cells or degenerated gel within the Vitreous, the clear jelly-like fluid in front of the Retina. As they float inside the eye, they cast a shadow on the Retina, the sensitive nerve layer of the eye and tend to move as you move your eyes.

What are the risk factors for flashes and floaters?

What causes Floaters?

As part of the natural ageing process, the jelly like Vitreous tends to shrink and degenerate forming clumps,threads or cobwebs. When the Vitreous Gel separates from its attachments to the Retina it results in a partial or complete Posterior Vitreous Detachment (PVD). This can sometimes pull on the retina causing bleeding or a retinal tear and may lead to a sudden shower of floaters, which is very alarming.

What causes Flashes?

When the Vitreous gel shrinks it can tug on the retina causing the nerve cells to be stimulated. This produces a lightning flash or arc of light especially in dim light. The flashes can continue for several days till the vitreous separates completely from the retina. Migraine headache can be preceded by flashes and wavy lines due to spasm of the blood vessels in the brain.

Is there a treatment for Flashes and Floaters?

If you experience flashes or floaters, you should visit your eye specialist at the earliest. At Vision Plus Eye Centre our experienced doctors will dilate your eyes and thoroughly examine your vitreous and retina to see if there are any tears or bleeding. In most cases no treatment is required as the flashes and floaters tend to decrease with time and are a part of the natural ageing changes. However, if there are retinal tears our Retina specialist may advise a laser to seal them. In case of bleeding you will be advised to avoid strenuous activity and lifting heavy weights. Rarely Vitrectomy ( surgery to remove the vitreous) is required if the floaters are affecting the vision. You must discuss the pros and cons of surgery as it is not without risks. Laser Floaterectomy can be done to break up a large floater if it is blocking vision. There are no home remedies, best is to ignore them as they gradually fade though may not go away completely