What is Retinal Detachment by mikeholy


									              PATIENT EDUCATION

What is Age-Related Macular Degeneration?
Age-Related Macular Degeneration (ARMD) is the leading cause of vision loss in older
American adults and the most common reason patients are referred to Cape Fear
Retinal Associates for further evaluation, treatment and care. Patients afflicted with
ARMD may note a worsening of their central vision while retaining good peripheral

Many patients with macular degeneration share a common misconception and fear that
the disease will automatically progress to blindness. As suggested by its name, ARMD
only affects the macula. The macula is the central part of the retina responsible for
detailed visual tasks. In macular degeneration, patients suffer varying degrees of
destruction to this tissue and can experience a wide spectrum of visual problems. These
include, but are not limited to, blurred central vision, increasing difficulty with reading,
patchy visual loss, and the distortion or warping of straight objects. However, even
patients with advanced macular disease tend to retain excellent peripheral vision.

Who is at Risk for Developing Macular Degeneration?
Macular degeneration primarily affects older, white individuals, although cases have
been reported in younger patients and those not of Caucasian descent. Additionally, a
number of risk factors predispose certain people to the development and progression of
the disease, including:

              Hypertension (high blood pressure)
              Cigarette smoking
              UV light exposure
              Nutrition
             Having a family member with ARMD

Regarding the last risk factor, much research has been done regarding the genetics of
macular degeneration. Although there is currently no way to definitively predict who will
or will not develop ARMD, those with affected relatives are at significantly higher risk.
As a result, adult relatives of ARMD patients should schedule an appointment with a
retinal specialist and undergo a baseline evaluation and dilated exam.

Is There More Than One Kind of Macular Degeneration?

Generally, patients with ARMD are grouped into one of two categories:

“Dry” Age Related Macular Degeneration - the most common form of macular
degeneration is caused by aging and thinning of the tissues of the macula. Dry ARMD is
characterized by thinning of the macula and gradual deterioration of vision. It develops
slowly and usually causes mild vision loss. As this form of the disease develops, people
often notice a dimming of vision while reading.

“Wet” Age Related Macular Degeneration - Wet ARMD is so called because it is
marked by an accumulation of fluid underneath the retina. In contrast with dry macular
degeneration, patients with wet ARMD often, but not always, experience sudden and
severe visual losses.
Symptoms Include:

   •   A dark area or a "white-out" appears in the center of vision

   •   Blurred or fuzzy vision

   •   Color perception fades or changes

   •   Straight lines, such as sentences on a page or telephone poles, appear wavy or


What Tests are Helpful in Aiding Diagnosis?

Dry and wet macular degeneration impact vision in different ways and are also treated
quite differently. Sometimes it is difficult to differentiate between dry and wet ARMD, so
our Dr. Brownlow will use a variety of clinical tests and exam techniques to make an
accurate diagnosis.

During an initial visit for macular degeneration, patients typically undergo two tests:
Fluorescein Angiography (FA) and Optical Coherence Tomography (OCT). These tests
may even be performed prior to consulting with Dr. Brownlow.

Fluorescein Angiography (FA) is considered the “gold standard” for differentiating
between dry and wet ARMD. It involves the injection of a small amount of vegetable-
based dye through a patient’s peripheral vein -- usually the arm or hand. Shortly after, a
certified ophthalmic angiographer will take a series of time-dependent retinal
photographs. The injected dye lights up the retina’s intricate vascular network and helps
our specialists pinpoint a precise area of leakage in those patients with wet macular
degeneration. Not only is this useful in determining the extent and progression of the
disease, but it also helps when targeting specific treatment zones with specialized laser

Optical Coherence Tomography (OCT) is a relatively new, non-invasive, quick exam
that has gained universal acceptance during the last decade and is now used by many
ophthalmologists. Using reflected light rays, OCT provides a detailed, highly magnified,
cross-section view of a patient’s macula. Sometimes, it will uncover tiny areas of
leakage not readily apparent to a retina specialist during a microscopic exam.

Patients Play an Important Role in Diagnosis and Care
Despite recent advances in ophthalmic imaging, there is no single test that can be relied
upon to direct treatment and clinical decision-making. A patient’s relationship with Dr.
Brownlow is at the core of our practice philosophy, and good patient-physician
communication is critical. When making important decisions about retinal health, it is
very much a joint effort. The patient’s perception of his or her visual health and the
patient’s perception of any vision changes, however slight, is every bit as important in
directing care as are the clinical tests.

As a result, every patient diagnosed with macular degeneration should establish a daily
routine for monitoring their own vision. This is most simply and reliably performed with
an Amsler grid, a simple patchwork of straight vertical and horizontal lines. We are
happy to provide one to you at no cost – simply ask one of our nurses.

Amsler Grid

The Amsler Grid may be helpful in revealing signs of wet age-related macular
degeneration (AMD). It is not a substitute for regularly scheduled eye exams and

             1. Do not remove glasses or contacts you normally wear for reading.

             2. Stand approximately 13 inches (33 cm) from the grid in a well-lighted

             3. Cover one eye with your hand and focus only on the center dot with
                your uncovered eye. Repeat with the other eye.

             4. If you see wavy, broken or distorted lines, blurred or missing areas of
                vision, you may be displaying symptoms of AMD and should contact
                your eye care provider immediately.

Often, patients with subtle progression of macular disease will report new “waviness” or
“missing areas” when monitoring their grid. Should you or a family member notice new
changes on an Amsler grid, contact us promptly. Either Dr. Brownlow or one of his
trained ophthalmic nurses are always available to consult with you by phone. As a
general rule, patients who receive treatment in a more timely fashion tend to fare better
than those who delay evaluation by a retinal specialist.

What Treatments are Available?
Medical researchers have thrown themselves fully into the battle against macular

degeneration, and dramatic progress has been made in the effort to combat age-related

vision loss. The most promising new treatments are Avastin™ and Lucentis™ which

help block certain growth factors that are thought to cause “leaky” blood vessel growth

in wet macular degeneration. Both of these medications are introduced directly into the

eye through a tiny needle. While the thought of an “eye shot” might cause many to

cringe, in our experience, there is little, if any, patient discomfort, and the spectacular

visual gains far outweigh any fears.

Avastin™ and Lucentis™ are the first medicines that have actually improved vision for

many patients with wet macular degeneration. While most retina specialists feel that

both work equally well, this has yet to be proven in a large, nationwide, prospective

clinical trial. While they have received much media attention and deserved fanfare for

their impact on wet ARMD, invaluable work continues on the dry ARMD front as well. A

number of vitamin therapies are already available to slow the progression of dry ARMD,

and Dr. Brownlow is currently monitoring the second-generation vitamin study that will

hopefully prove even more beneficial than previously prescribed supplement regimens.
Low Vision Rehabilitation
This can help people who have experienced mild to severe vision loss adjust to their

condition and continue to enjoy active and independent lifestyles. Low Vision

Rehabilitation may involve anything from adjusting the lighting in your home to learning

to use low vision aids to help you read and perform daily tasks. Dr. Brownlow can refer

patients to local low vision specialists for this assistance.

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                What is a Retinal Detachment?

    You have been diagnosed with a retinal tear or detached retina. Symptoms of retinal
    detachment include:

          Flashes of light

          Floaters (cobwebs)

          Loss of field of vision (blind spot or shadow)

    Flashes and floaters occur when the vitreous gel that fills up 80 percent of the volume of
    the eye begins to liquefy and pulls away from the back of the eye. Floaters are protein
    aggregates that are more pronounced when they first occur and are typically seen most
    easily against a bright background. Bleeding inside of the eye can also cause a sense
    of looking through floaters.

    If the inner lining of the eye (the retina) is thin, the vitreous can pull on this area to
    produce a tear. Persistent pulling on the tear can lead to a retinal detachment, a
    condition in which fluid gets under the retina and lifts part or all of the retina away from
    the back of the eye.
    Risk Factors
    Risk factors for retinal detachment include:

          Nearsightedness

          Family History

          Trauma (e.g. blunt injury in the past)

         Cataract surgery (Approximately one percent of patients who have had cataract
     surgery ultimately develop a retinal detachment.)

    Fresh retinal tears and detachments should be treated urgently since rapid loss of vision
    can occur. The success rate for repair of a recent uncomplicated retinal detachment
    approaches 90 percent.

    Laser treatment can often be conducted in the office to seal a retinal tear if there is no
    detachment. However, close follow-up is necessary to make certain that the retina does
    not detach despite laser treatment.

    Pneumatic retinopexy is also an office-based procedure using laser or freezing
    therapy to seal off a tear, followed by injecting a small gas bubble into the eye to
    reattach the retina from inside the eye.

    Scleral buckle surgery is conducted in the operating room. A permanent, external
    support to the peripheral retina is supplied by placing a silicone band around the outside
    of the eye. Such a buckle is generally not visible after the eye has healed.
Vitrectomy surgery is also an operating room procedure that is used by itself or can be
combined with a scleral buckle. A small cutting instrument is used to enter the eye
through a 1 mm incision, and the vitreous gel is removed and replaced with a gas
bubble. The advantage of this method is that all the debris, scar tissue and membranes
on the retina can be removed, and the retina flattened at the time of surgery. A laser is
used to seal off the tears.

Gas and silicone oil are support agents used inside the eye to keep the retina
attached while permanent bonding occurs. A gas bubble is gradually absorbed over a
period of several days to several weeks, depending on the specific gas used. A patient
cannot travel by air with a gas bubble inside the eye. Silicone oil may be necessary if
longer support is required. This allows the eye more time to heal. However, silicone oil
is often removed from the eye by a later surgical procedure once the retina is stable.
Patients with silicone oil inside their eyes can fly safely.

Vitrectomy, scleral buckle and gas are sometimes used in combination. Anatomical
success rate can be as high as 80 – 90 percent. However, some eyes will develop a
recurrent retinal detachment and may need additional surgery.

Surgery is generally performed as an outpatient procedure, and patients may go
home the same day.

Healing time varies from several weeks to months depending on the extent and
severity of the detachment. If the center part of the retina (macula) has been detached,
the central (reading) vision may not completely return.

Dr. Brownlow will instruct you about postoperative eye drops and activities.
Generally, allow at least one month before returning to full physical activity. As noted
above, always check with Dr. Brownlow to determine if it is safe to resume air travel.
    Your eye power may change after the surgery. Glasses or contact lenses are
    prescribed 6 to 8 weeks after successful healing.

    Expect the eye to be puffy and red for several days with clear, reddish tears and
    discharge. Cold packs on the closed eyelids help the swelling go down and provide

    Please contact us immediately during the postoperative period if you experience the
    following symptoms:

         Significant pain

         Dramatic decrease or loss of vision

         Extreme nausea

         Prolonged vomiting

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What is a Macular Hole?
The eye functions much like a camera. It has a lens system in the front of the eye to
focus light onto the “film” in the back of the eye, the retina. The light passes from the
surface of the eye to the retina by passing through the clear vitreous gel which fills the
inside of the eye.

As we age, the vitreous jelly in our eye turns to liquid. The vitreous pulls away from the
retina as it liquefies. In a small percentage of people, as the vitreous separates, it exerts
traction on the macula – the center of the retina that is responsible for our sharp, central
vision functions like reading small print, threading a needle, or identifying small objects
with fine detail. This tugging can ultimately lead to a hole forming in the center of the
macula – a macular hole.

The Procedure

Prior to the early 1990s, there was no cure for macular holes. Different attempts were
made to try to repair such holes surgically, with limited success. In the early 1990s,
however it was discovered that if the vitreous gel were removed surgically from the eye
and the vitreous cavity was filled with a temporary gas bubble, the hole would seal itself,
resulting in visual improvement. This requires face-down positioning to allow the gas
bubble to press against the hole to help it close.

As we have improved techniques of hole closure during the last 10 years, face-down
positioning time has been decreased, and the rate of hole closure has improved to 90
percent or greater. As with any surgery, there are surgical risks. These risks include
cataract formation, retinal tears and detachment, failure of hole closure and infection or
bleeding in the eye. With these relatively low risks, many patients elect to proceed with
surgery with a realistic expectation of better vision when the repair is performed in a
timely fashion.
Without treatment, the blind spot caused by the macular hole usually enlarges, and
most patients’ ultimate visual acuity is 20/400 or worse (the size of the big “E” on the
eye chart.) Macular holes rarely close without surgery. There is also approximately a 9
to 10 percent chance of a hole forming in the opposite eye with time.

Before Surgery: “Open” Macular Hole

After Surgery: “Closed” Macular Hole

What to Expect

Macular hole surgery is done as an outpatient procedure and usually can be performed
in one hour or less. The gas bubble that results from the surgery is slowly reabsorbed
into the bloodstream over a period of 2 to 8 weeks, depending on the concentration of
gas that is used by Dr. Brownlow.

The eye refills itself with a watery fluid as the gas bubble is reabsorbed. The eye does
not make more vitreous gel. While the gas bubble is in the eye, the patient may not
travel by air or inhale nitrous oxide (commonly used by dentists—“laughing gas”) as
either of these activities will cause the gas in the eye to expand, often leading to pain
and possible blindness.

To assist patients with the face-down positioning, there are positioning aids that may be
rented from specialty companies. Ask your doctor for this contact information.

The most common side effect of macular hole repair is cataract formation that often
requires surgery within 6 months of the macular hole repair. Please discuss this and
other implications of surgery with Dr. Brownlow.

Commonly Asked Questions
1.      How frequently does cataract formation occur? If you have not had cataract
     surgery, you will likely develop a cataract and may need surgery in the next 6 to 12

2.      How often does retinal detachment occur? Retinal detachment occurs in 1 to
     2 percent of patients and is usually repairable.

3.      How long will I need to assume the face-down position? In general, rigorous
     face-down positioning is encouraged for 7 to 10 days.

4.       What happens to the gas bubble and how long will it last? The gas bubble
     will slowly be absorbed by the body. It may persist in the vitreous space for as long
     as eight weeks.

5.       When can I travel by air? Generally, you should not fly until the bubble is
     completely gone. Your doctor may allow you to travel by air sooner if it is safe to do

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    What is a Macular Pucker?
    The macula is the small, central part of the retina that allows you to read and see fine
    details. Damage to the macula can significantly affect central vision.

    A macular pucker occurs when a clear membrane, like cellophane, covers the surface
    of the macula. The membrane is made up of a thin layer of cells that settle and grow on
    the surface of the retina. This condition can occur at any age, but more often occurs in
    people over the age of 40. Often these membranes remain completely flat and cause no
    vision problems. However, in some cases, the membrane will start to contract on the
    surface of the macula which leads to wrinkling or puckering of the retina beneath.


    Symptoms of a macular pucker include:

          Blurry central vision

          Distorted or wavy vision

          Blurred or gray spot in central vision

          Difficulty reading
    Macular puckers are associated with several eye conditions such as a torn or detached
    retina, inflammation inside the eye, blood vessel damage in the retina and previous eye

    A macular pucker is diagnosed by your ophthalmologist during a dilated eye exam and
    can be further evaluated with special tests like optical coherence tomography (OCT) or
    fluorescein angiogram.

    Treatment Options

    For mild symptoms, a macular pucker can be observed and generally does not cause
    any damage to the underlying retina. Changing your eyeglasses prescription can help
    improve vision.

    If a patient is experiencing more severe symptoms, the membrane can be removed
    surgically. Surgical removal involves a vitrectomy which requires removal of the vitreous
    gel that fills the back of the eye through three small incisions in the white of the eye.
    After removal of the gel, the membrane is gently peeled from the surface of the macula
    using fine, microscopic instruments. The eye is then filled with a saline solution, and the
    incisions are closed. Once the membrane has been removed, the retina can flatten back
    to its normal shape. Vision gradually improves over a period of weeks after the surgery.

    The major risks of a vitrectomy include:

          Retinal detachment

          Infection

          Cataract formation

          Loss of vision

    Discuss the risks with Dr. Brownlow prior to surgery

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    What are Retinal Vein Occlusions?

    A retinal vein occlusion occurs when one of the veins of the retina becomes blocked
    and cannot drain blood from the retina normally. This blockage leads to a back up of
    blood and fluid into the retina. This back up of blood can be seen in the retina as
    hemorrhages. The amount of swelling in the retina varies and depends on the degree of
    blockage of the retinal vein.

    Two Types of Vein Occlusions
          Central Retinal Vein Occlusion (CRVO) -If the blockage involves the central
     vein to the retina, located at the optic nerve, it is called a central retinal vein occlusion.
     In these cases, hemorrhages can be scattered throughout the retina, and often the
     central portion of the retina, the macula, can become swollen.
          Branch Retinal Vein Occlusion (BRVO) – If the blockage involves only one of
     the smaller retinal veins, it is called a branch retinal vein occlusion. In these cases,
     hemorrhages and swelling are limited to the area of the retina that is drained by that
     particular vein.

           Risk Factors for Vein Occlusions

                  1. High blood pressure

                  2. Diabetes

                  3. Age

                  4. Blood clotting disorders

    Symptoms of a retinal vein occlusion can vary based on the severity of the blockage in
    the vein and amount of swelling in the retina. Common symptoms include:

             Painless loss of vision

             Blurry vision

             In severe cases, pain from increased eye pressure


    Dr. Brownlow can diagnose a CRVO or BRVO when examining your eyes based on the
    appearance of hemorrhages and swelling in the retina. Other diagnostic tests such as
    fluorescein angiogram (FA) and optical coherence tomography (OCT) can be performed
    to examine the degree of blockage of the vein and the amount of swelling present in the


    There is no cure for a vein occlusion. However, the main reason for decreased vision
    from a retinal vein occlusion is swelling in the central part of the retina called macular
    edema. Treatments for swelling include:

             Steroid injection

             Injection with medicines that decrease blood vessel leakage (Avastin, Lucentis,)
          Laser treatment

    In mild vein occlusions, often there is no significant swelling, and no treatment is
    indicated. In severe cases of CRVO, abnormal blood vessels can develop that can lead
    to glaucoma. These cases are often treated with laser and/or injection with a medication
    to decrease blood vessel leakage. Some patients do require surgery to control eye
    pressure even after laser or injections.

    What is Uveitis?

    Uveitis (y-o -o-’v-e--i’tis) refers specifically to inflammation of the “uvea” or
    middle layer of the eye. However, it is commonly used as a general term to refer to
    any inflammation of the eye. Uveitis is a rare disease. Even the most common type
    occurs in only 1 person out of 12,000.

    To understand uveitis and its treatment, it is easier to think of uveitis as arthritis.
    Arthritis is inflammation of the joints of the body. The body’s immune system becomes
    confused and starts to attack or reject the cartilage in the joints of the body, leading to
    joint damage and loss of function. The only way to prevent this damage is to suppress
    the immune system with corticosteroids or immunosuppressive drugs. Similarly, in
    uveitis, the body’s immune system attacks the eye. Unless the immune system is kept
    in check by the use of either steroids or other immunosuppressive drugs, loss of vision,
    retinal damage, cataracts, and glaucoma can occur.

    Uveitis is classified by the location. If the inflammation affects the “white” part of the
    eye, or sclera, it is known as scleritis. If the inflammation affects the front part of the
    eye, it is called iritis or iridocyclitis. Inflammation that affects the middle part of the eye is
    known as pars planitis or intermediate uveitis. Inflammation that affects the back part of
    the eye is known as a posterior uveitis. Finally, inflammation that affects the whole eye
is known as a panuveitis.

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What is Diabetic Retinopathy?

Diabetes damages the body’s normal circulation, which is why people with diabetes
may have problems with circulation to their legs, kidneys, heart, brain, and eyes. At
least 50 percent of all diabetics will develop diabetic retinopathy (abnormal retinal blood
circulation), and the incidence increases with the duration of the disease. After 20 years,
more than 90 percent of diabetics have some degree of diabetic change.

Diabetic retinopathy is a leading cause of blindness in the United States in middle-aged
adults. Fortunately, new methods of treatment in recent years have decreased
blindness among diabetics and have increased the possibility of retaining useful vision.

Types of Diabetic Retinopathy
Non-Proliferative Diabetic Retinopathy

There are two main types of diabetic retinopathy: non-proliferative and proliferative. In
non-proliferative diabetic retinopathy, there is leakage caused by damage to small
retinal blood vessels (capillaries). This leakage allows proteins and lipids from the blood
to accumulate in the retina, causing swelling. If this swelling occurs in the area of central
vision (macular edema), sight may be significantly diminished. As the disease
progresses, retinal capillaries may also become closed off, resulting in poor retinal
nutrition. Lack of circulation to the center of vision (macular ischemia) can result in
severe and permanent loss of central vision.
Proliferative Diabetic Retinopathy

When there is widespread impairment of retinal nutrition due to capillary leakage and
closure, proliferative diabetic retinopathy develops. The poorly nourished retina sends
out a chemical “distress signal” which causes new blood vessels to grow (proliferate) on
the retinal surface. Unfortunately, these new blood vessels are very fragile and often
rupture, allowing bleeding to occur within the eye (vitreous hemorrhage). Scar tissue
can also grow around the abnormal blood vessels which may lead to retinal detachment
and possible permanent blindness. The proliferative form of diabetic retinopathy is
present in approximately 20 percent of patients with diabetes of ten years duration.

Widespread impairment of retinal blood circulation leads to the development of new,
fragile blood vessels. Large clinical trials have shown that a procedure called scatter
laser photocoagulation can be effective in halting or reversing new vessel growth. Many
eyes, even without visual problems, need to begin laser treatments if there are certain
abnormal vessels present. Those eyes, having no visual problems, must be detected by
examination. Overall, the incidence of blindness over two years can be reduced by 66
percent for eyes with new vessels on the optic nerve and by 37 percent for eyes with
new vessels in other locations. The laser treatment consists of applying multiple laser
burns to the peripheral retina, often divided into several sessions. Although mildly
uncomfortable, the treatment usually can be done without the need for local anesthesia.
The main complications from treatment are loss of some peripheral vision, a decrease
in night vision, occasionally some loss of central vision, and possible mild enlargement
of the pupil. If laser treatment is needed, the risk factors of not being treated are much
higher than the risk of being treated.
Again, a new class of medications targeting VEGF produced by poorly nourished retina
can be directly injected into the eye. The anti-VEGF drugs Avastin and Lucentis have
been used with good results in managing proliferative diabetic retinopathy, often along
with scatter laser photocoagulation treatment.


In the early stages of diabetic retinopathy, there are usually no symptoms. Therefore, it
is very important that all patients with diabetes have a comprehensive dilated eye
examination at least once a year before any symptoms develop. During this exam, Dr.
Brownlow can check for any signs of damage to the retina and optic nerve, including
leaking blood vessels, swelling of the macula, and growth of new vessels. To help
prevent the development and progression of diabetic retinopathy, patients are urged to
control their blood sugar, blood pressure, and cholesterol levels.

Good control of diabetes with intensive management and control of blood sugar will
delay, and possibly prevent, both the development and progression of diabetic
retinopathy. Patients with diabetic retinopathy frequently need to have special
photographs of the retina taken. This series of photos is called fluorescein angiography

Laser photocoagulation is one of the most common treatments for diabetic
retinopathy. Focal photocoagulation consists of a laser directed at the retina to seal
living blood vessels in patients with background diabetic retinopathy. Panretinal
photocoagulation consists of laser spots scattered through the sides of the retina to
reduce abnormal blood vessel growth (neovascularization) and help seal the retina to
the back of the eye in patients with proliferative diabetic retinopathy. This can help
prevent retinal detachment. There is little recuperation needed after laser surgery for
    diabetic retinopathy. Laser surgery may require more than one treatment to be effective.
    Vitrectomy surgery is scheduled for patients with very advanced proliferative diabetic
    retinopathy or retinal detachment. In vitrectomy surgery, Dr. Brownlow removes the
    blood-filled vitreous and replaces it with a clear solution. This allows light to pass
    through the clear fluid to the retina, where the images are conveyed to the brain.
    Pharmacotherapy: Increasingly, a variety of medications are being used to treat the
    manifestations of background and proliferative diabetic retinopathy. These involve
    intravitreal injections of small amounts of medication into the eye.

    The type of retinopathy, as well as the patient’s general health and eye structure, will
    determine the kind of treatment needed and the type of anesthesia utilized.

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    Macular Edema
    Macular edema is caused by damage to retinal capillaries which leads to leakage of
    blood products into the retina. Large clinical trials have shown that the application of
    focal laser to areas of retinal swelling can stabilize the vision and reduce the risk of
    vision loss by 50 percent.
          The injection of steroids, such as triamcinolone, either around or into the eye has
     also recently been found to be of benefit. Side effects of steroid injections include
     increased eye pressure and cataract formation.

          A new class of medications target the “distress signal” sent out by a poorly
     nourished retina. These agents bind and block the action of vascular endothelial
     growth factor (VEGF) and can be directly injected into the eye. Adverse effects of
     injections of these agents into the eye are rare but include bleeding, infection, cataract,
     and retinal tear or detachment. Patients may need multiple procedures or a
     combination of treatments to control the leaking fluid.

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    Vitreous Hemorrhage and Tractional Retinal Detachment

    In cases where laser treatment is not successful in preventing hemorrhage into the eye
    or when a retinal detachment from scar tissue has occurred, a type of surgery called
    vitrectomy is often helpful. In the operating room, a microsurgical instrument is inserted
    into the eye, and the blood-stained vitreous is removed and replaced by a clear sterile
    solution. Fibrous bands which may cause retinal detachment are removed to allow the
    retina to flatten and return to a more normal configuration. Vitrectomy remains an
    operation performed only on eyes in which no other treatment is useful. Approximately
    60 percent to 70 percent of selected eyes, otherwise hopelessly damaged, can be
    restored to at least ambulatory vision. Some eyes, however, actually can return to very
    good vision.

    Protecting Your Vision
    It is critical for all diabetics to have a comprehensive eye exam at least once a year to
    evaluate for the presence of retinopathy. Patients should remember that both macular
    edema and proliferative retinopathy can develop without symptoms. Patients with visual
    symptoms and/or visual loss, at any stage of the disease, should be evaluated without
    delay to find out the cause of the visual change. Early detection and timely treatment
    can prevent vision loss.

    The overall maintenance of health is important in avoiding circulation damage to the
    brain, heart, kidneys, and eyes. Although perfect solutions are not available for the
    prevention of visual loss, the outlook for maintenance of useful vision is favorable. Early
    detection and appropriate therapy can be sight-saving. All diabetics should work to
    lower their vascular risk factors. Important advice includes:

          Eat healthy.
          Exercise.

          Avoid smoking.

          Control your blood pressure and blood sugar.

          Lower your cholesterol levels.

          Carefully follow your medical doctor’s instructions.

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    Floaters and Light Flashes
    What Causes Floaters and Light Flashes?

    Most occurrences of floaters or light flashes relate to changes in the jelly-like substance
    called vitreous which fills the entire back cavity of the eye. The vitreous is transparent
    and has a solid consistency similar to gelatin. As people grow older, the vitreous
    undergoes a normal aging process, becoming more liquid and less jelly-like. Often the
    partially liquefied vitreous will abruptly “collapse” inside the eye causing a shower of
    floaters to appear. The floaters are aggregates of protein which have formed in the
    vitreous during the liquefaction process.

    When the vitreous collapses, it begins to separate from the retina. The mechanical pull
    of the vitreous on the retina during this separation causes light flashes. Sometimes
    during this separation process a retinal tear develops and can lead to a retinal
    detachment. Often when a retinal tear occurs, at least a small amount of bleeding is
    present in the vitreous and may be noted by the patient as a multitude of black dots or a
    hazy decrease in vision.


    Many people, at some time in their lives, notice floaters in one or both eyes. These are
perceived as small spots or strands that seem to drift in the field of vision, traveling
rapidly with eye movements and then floating slowly when eye movements cease.
Floaters are most readily seen against a bright background such as well illuminated
reading material, a computer screen, or bright sky.

Light Flashes

Light flashes may occur in conjunction with floaters or may occur separately. Unlike
floaters, light flashes (photopsias) are typically perceived in subdued lighting or even
total darkness. Photopsia can range from minimal light twinkles to flashes that are bright
enough to suggest a neon sign or camera flash.

Know the Warning Signs

The sudden occurrence of floaters or flashes can be an important warning signal of
impending retinal problems. A small percentage of people who develop the abrupt onset
of prominent floaters or light flashes in an eye will be found to have a retinal tear on
careful ophthalmoscopic examination. Retinal tears can often be treated with laser or
freezing methods if a beginning retinal detachment is not present.

Fortunately, the majority of people who experience floaters or light flashes do not
develop serious retinal problems. In most instances, the floaters and flashes gradually
subside over a period of time with no permanent alteration in vision. Since flashes and
floaters can, however, be an important warning of a retinal tear or impending retinal
detachment, their sudden appearance is of sufficient concern to warrant careful
evaluation by Dr. Brownlow.

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