Vitreo-Retinal Diseases

Epiretinal Membrane

An epiretinal membrane is the proliferation of a fibrocellular membrane on the inner retinal surface.  It can be thought of as a wrinkling of sorts to the top layer of the retina.  Epiretinal membranes can be idiopathic or form secondary to other retinal conditions.  Surgical peeling of epiretinal membranes with a vitreous surgery, in patients who have severe visual symptoms, typically results in improved visual acuity.  However, unless there is significant visual loss, epiretinal membranes are not treated.

Age Related Macular Degeneration

Age related macular degeneration (AMD) is a disease which affects the macula- a small area in the retina responsible for central vision.  Major risk factors for AMD are: genetic predisposition, Caucasian, female, over age 50, and cigarette smoking.   There are two types of age related macular degeneration:  Dry and Wet.

• Dry AMD comprises 90% of those with AMD and is caused by damage related to oxidative stress which results in the thinning of the macula.   Dry AMD is treated with nutritional supplements.  The most recent studies show that the risk of developing the most advanced stages of dry AMD is reduced by 25% in those patients taking:
  • Vitamin C (500 mg)
  • Vitamin E (400 iu)
  • Lutein (10 mg)
  • Zeaxanthin (2 mg)
  • Zinc (80 mg)
  • Copper (2 mg)
  • It should be noted that those who either have no signs of AMD or minimal AMD changes do not appear to benefit from supplement therapy.  Vitamins do not cure AMD or restore any vision lost.  Vitamin therapy is meant to help those at risk for developing advanced AMD maintain as much vision as possible.
• Wet AMD comprises 10% of those with AMD and results from abnormal blood vessel growth underneath the retina which leak fluid or blood.  This abnormal blood vessel growth is treated with injections of anti-VEGF agents which stops the blood vessel growth and bleeding.

 Diabetic Retinopathy

• High blood sugar levels can damage the blood vessels in the retina referred to as diabetic retinopathy.  There are two types of diabetic retinopathy:  nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).
  • NPDR- Nonproliferative diabetic retinopathy is an early stage of diabetic retinopathy where tiny blood vessels within the retina leak blood or fluid. Your vision is affected when there is macular edema (the thickening of the macula due to fluid leakage) or macular ischemia ( results from capillaries closing and thus not delivering a sufficient blood supply to the macula.
  • PDR- Proliferative diabetic retinopathy results when new blood vessels grow termed neovascularization.  It is the more severe form of diabetic retinopathy.  When there is widespread ischemia, the retina responds by growing new blood vessels to deliver blood where the former retinal vessels have been closed.  These new blood vessels are “bad” vessels and do not adequately supply the retina with the circulation needed.  In addition, these new blood vessels can be accompanied with scar tissue which can cause a detachment of the retina.

Hypertensive Retinopathy

HTN retinopathy results from systemic effects of hypertension. Hypertension affects precapillary arterioles and capillaries –which are responsible for the regulation of blood flow and perfusion.  Uncontrolled systemic hypertension can lead to areas of non perfusion at various retinal levels.  Hypertension can become more complicated with the incorporation of branch artery occlusions, branch and central vein occlusions, macroaneursyms and diabetes.

Macular Hole

A macular hole is formed when the vitreous pulls away but does not detach at the macula.  When the vitreous pulls for a period of time at the macula the tissue stretches and after several weeks or months the macula will then tear to form a hole.  Macular holes are treated with a vitrectomy.

Retinal Breaks (Holes & Tears)

A retinal break is a full-thickness retinal tissue defect.  Breaks can form due to retinal holes or tears.  Holes are formed from atrophy of the inner retinal layers.  Tears are formed from vitreoretinal traction.

Retinal Detachment

• The most common type of retinal detachment is a rhegmatogenous retinal detachment (RRD). This is where liquefied vitreous passes through the above described retinal break, separating the sensory retina from the retinal pigment epithelium.
• The second type of retinal detachment is coined a tractional retinal detachment.  This is the least common type of retinal detachment and occurs when formed membranes contract and elevate the retina.
• Exudative retinal detachments develop when retinal or choroidal diseases leak fluid which then accumulates beneath the sensory retina.

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