The Retina Service

The retina is the structure in the eye which accepts the light and transfers the information to the brain via the optic nerves. It is equivalent to the film in a camera. If the retina is not functioning properly, one cannot see clear images. The Queens Eye Center brings all technologies to bear on the treatment of posterior segment illness. The vitreous and retina provide challenges for which both diagnostic and therapeutic sophistication is required.

Photodynamic therapy for the treatment of "wet," age-related macular degeneration (ARMD) is performed, together with the use of the newest, anti-endothelial growth factors, (Macugen).

Onsite ophthalmic ultrasound is available for evaluation of retinal detachments, vitreous hemorrhage and retinal neoplasms, and fluorescein angiography allows evaluation of macular degeneration as well as diabetic and hypertensive retinopathy.

The center is able to provide prompt, in-office laser treatment for appropriately selected retinal conditions, and for other patient types, perform needed surgery at New York Presbyterian Hospital.

There are many disorders that affect the retina.

Age Related Macular Degeneration (ARMD)

The macula is the portion of the retina that is responsible for central vision. We use the macula for reading as well as seeing clearly in the distance. ARMD is the leading cause of blindness in the US for people over the age of 65. It is more prevalent in the Caucasian population. In this disease, the macula develops changes that initially cause distortion of vision due to deposits in the macula known as drusen.

There are two types of macular degeneration: Dry and Wet. Most people have the dry form of the disease, which fortunately is also the more benign of the two entities. In the dry form, accumulations of waste material called drusen are noted in the macula. Over time, central vision will be affected but most people with the dry form maintain good central visual acuity. Depending on your level of disease, special vitamins may be recommended for your eyes by your eye doctor.

The wet form of the disease is generally more vision threatening. In this form of the disease, new vessels form in the area of the macula and cause bleeding and leakage. When this occurs, central vision can be severely affected. Active research is ongoing for the treatment of wet macular degeneration and several new modalities have recently become available. A consultation with a retina specialist is strongly recommended to see if the patient is a candidate for any of these new treatments.

Diabetic Eye Disease

Diabetes can affect the retina and cause irreversible vision loss. Diabetes is a disease that causes damage to the small vessels in the body first (capillaries). The retina has a high concentration of capillaries and is therefore at great risk of being damaged by diabetes.

Non-proliferative diabetic disease is the early stage of diabetic eye disease. The eye doctor can look into the retina during the examination and see that there is leakage of both blood and fluid from the damaged blood vessels. When this occurs in the area of the macula, the fluid will build up and cause vision to be compromised. There are laser treatments available to treat this condition.

In the later stages of diabetic eye disease, the retina becomes starved of oxygen and other key nutrients and new blood vessels form in the retina. This condition is called proliferative diabetic retinopathy. Unfortunately, these new vessels are not stable and bleed easily. They generally tend to bleed into the center of the eye and thus cause dramatic loss of vision. Furthermore, the new vessels may pull on the underlying retina and cause retinal detachments. Treatments are available (lasers and surgery) but the prognosis for long term vision is guarded at this level of disease.

Hypertensive Eye Disease

People with chronic high blood pressure may develop eye problems. When the blood pressure is poorly controlled for a long time, the arteries in the retina begin to harden. Over time, the arteries that have hardened may cause a blockage of blood in the veins. When this happens, a vein occlusion occurs. A retinal vein occlusion may sometimes be asymptomatic or may case dramatic loss of vision. Vein occlusions must be followed closely by the eye doctor as long term problems leading to blindness may occur if the occuslion is not treated in a timely manner.

Retina tears and detachments

There are many causes of retinal tears and detachments. In general, retinal detachments happen when a tear is formed in the retina.

Tears in the retina have numerous causes. The most common causes are trauma, age over 50, nearsightedness, and cataract surgery. People with a history of other tears in the eye or the fellow eye are more at risk.

About half of all retinal tears happen without any symptoms. The symptoms that are most common are flashing lights (like lightning going off in the eyes, especially in the dark) and floaters. The symptoms are especially worrisome if they are new or worse that before. Prompt evaluation with an eye physician is recommended as prompt treatment of a tear may prevent a retinal detachment.

Retinal detachments are generally the result of fluid migrating through a tear in the retina and thus lifting the retina off its attachment in the back of the eye. When this happens, vision will be compromised. An untreated retinal detachment will lead to complete blindness with time. For the most part, the sooner a retinal detachment is diagnosed and treated, the better the visual prognosis for the patient. The symptoms are similar to those of a retinal tear. New floaters and flashes are noted. However, when the detachment progresses, a shadow or curtain can be seen in the eye with the detachment. Prompt medical attention should be sought.

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