The Role of the Retina

The retina is a complex, multi-layered tissue that lines the back of the eye. It plays a critical role in capturing incoming light rays and converting them into visual images that are sent to the brain. When the fragile retinal tissue is damaged due to injury or disease, the eye’s ability to convert light into images is compromised, resulting in a significant reduction in vision. However, early detection and prompt treatment can often prevent vision loss and maintain the overall health of the eye.

Plessen Ophthalmology’s retinal physicians have undergone advanced subspecialty training in diagnosing and managing retinal, vitreous, and macular diseases. Their clinical expertise and surgical experience give them a unique advantage in handling a wide range of retinal diseases in St. Croix and St. Thomas.

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Treatments are available for some retinal diseases, and depending on the condition, treatment goals may include stopping or slowing the disease’s progression and preserving, improving, or restoring vision. However, if left untreated, some retinal diseases can cause severe vision loss or blindness.

Retinal diseases can manifest in various ways, but they often share similar signs and symptoms such as:

  • Seeing specks or cobwebs floating in your vision
  • Blurred or distorted vision (e.g., straight lines appearing wavy)
  • Loss of peripheral vision
  • Complete loss of vision in one or both eyes

At Plessen Ophthalmology, we specialize in treating a range of conditions affecting the retina, including:

  • Macular Degeneration: a condition that causes the central part of the back of the eye to deteriorate, resulting in vision loss.
  • Diabetic Retinopathy: a complication of diabetes that causes damage to the blood vessels in the retina. It can be treated with injections, laser treatment, or eye surgery.
  • Epiretinal Membrane: a thin layer of scar tissue that develops on the surface of the retina, causing vision distortion.
  • Retinal Tear: occurs when the retina pulls away from the outer layer of the eye. This is treated with laser surgery to prevent further damage.
  • Floaters, Flashes and Posterior Detachment: a vitreous detachment that can sometimes result in a retinal tear. Treatment with laser can prevent further damage.
  • Branch Retinal Vein Occlusion (BRVO): a condition where a branch of a vein in the eye becomes blocked, leading to blood and fluid leakage into the retina. Treatment may involve anti-VEGF medication, laser, or steroids.
  • Central Retinal Vein Occlusion (CRVO): a more severe form of vein occlusion, where the central vein in the eye becomes blocked. Treatment involves anti-VEGF medication, laser, or steroids.
  • Vitreous Hemorrhage: bleeding into the gel-like substance that fills the eye, causing vision distortion. Treatment depends on the underlying cause and may involve laser or medication injections.
  • Hypertensive Retinopathy: damage to the retina caused by high blood pressure, resulting in vision loss. Treatment options include surgery, laser, or medication injections.
  • Plaquenil Retinopathy: a potential side effect of long-term use of the medication Plaquenil, which can damage the central vision. Regular screening is recommended to detect any damage to the retina in the earliest stages.

Diagnostic Services:

  • Optical Coherence Tomography
  • Fluorescein Angiography
  • Ocular Ultrasound
  • Indocyanine Green
  • Ultra-wide Field Fundus Photography
  • Visual Field Testing
  • Diopsys Electroretinography
  • Visual Evoked Potential Testing

Therapeutic Services

  • Laser Photocoagulation: Controlled laser treatment for various conditions, such as diabetic macular edema and retinal detachment, using an indirect ophthalmoscope or slit lamp.
  • Vitrectomy: Surgical removal of vitreous gel for conditions like macular holes, retinal detachment, and vitreous hemorrhage. Treatment may include laser photocoagulation, scar tissue removal, and filling of the vitreous cavity.
  • Intravitreal Injection: Delivery of medication directly to the back of the eye for conditions like macular degeneration using various medications, such as Avastin and Eylea. Expected side effects include floaters and mild swelling.
  • Cryotherapy: Therapeutic use of cold temperatures to treat eye disorders, creating an adhesive scar that seals the retina against the eye wall, similar to laser treatment.
  • Pneumatic Retinopexy: Non-incisional procedure for selected cases of retinal detachment using an expanding gas bubble to push the detached area against the back of the eye and seal the retina using a freezing device.

More On Diabetic Retinopathy

Diabetic retinopathy is the leading cause of blindness in people aged 24 to 70 years. Diabetes affects the blood sugar levels and causes damage to small blood vessels in various parts of the body. These changes happen gradually and are more common in individuals who have had diabetes for a longer duration. Early diabetes may not show any symptoms, and a person may have the disease for several years before it is diagnosed.

Over time, diabetes can affect the circulation to various organs in the body, including the kidneys, peripheral nerves, feet, heart, and eyes. Numbness, tingling, or loss of sensation in the feet may indicate the onset of peripheral neuropathy, which is nerve damage due to reduced blood supply. Often, individuals with neuropathy may also have diabetic retinopathy.

Initially, retinopathy may not cause any pain or discomfort. By the time symptoms appear, the degree of retinal damage may be extensive. The American Academy of Ophthalmology recommends that individuals with diabetes undergo annual eye exams that include dilating the pupils and examining the retina.

Diabetic retinopathy has two stages:

  1. Non-proliferative diabetic retinopathy (NPDR)  (background retinopathy)- NPDR is the earlier form of the disease, characterized by the development of microaneurysms, tiny bulges in the small capillaries at the back of the eye that leak clear fluid. When the macula, the center of the retina, is affected, the condition is called macular edema, which can cause vision impairment.
  2. Proliferative diabetic retinopathy (PDR)– PDR is treated with panretinal photocoagulation (PRP), which involves applying laser treatment to the peripheral retina. PRP can cause side effects such as a constriction of visual field and a reduction in night vision.

Newer medications that can be injected into the eye to treat diabetic macular edema are being developed. Education, careful follow-up, tight blood sugar management, and early laser treatment can prevent most cases of blindness from diabetes.

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