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The goal of any treatment, laser, steroid injections or anti-VEGF injections is to reduce the swelling. Usually, a fluorescein angiogram is performed to demonstrate where the normal retinal blood vessels are leaking.
Treatment can involve anywhere from a few to dozens of burns…all depending upon the number leaks. Laser treatment to the center of the macula could lead to a permanent blind spot in the vision and, therefore, is not always the best treatment for every patient. After 4-6 months, I can usually tell if the laser treatment is effective or needs to be augmented (ie. There are a variety of treatments for diabetic macular edema.   Laser treatment is still the standard of care for treating this common condition seen with diabetic retinopathy. Diabetic retinopathy can not be cured, but we are often successful maintaining status quo…provided regular checkups occur. After complete dilated exam, I was happy to report to him that he needed cataract surgery and, most importantly, there were no signs of diabetic macular edema nor active proliferative disease.
I noted his weight was stable, hinting AB is very disciplined and, unlike me, has been able to control his weight over the years.
My point is that the disease is not certain to cause blindness or even severe loss of vision and I wanted to share a good story of seeing well despite chronic disease…and a trusting friendship.
Iluvien advances in the regulatory process for use in the treatment of diabetic macular edema in Europe. Alimera Sciences’s efforts for FDA approval of Iluvien in the United States were stymied in 2011 citing concerns over safety and requesting additional clinical trials.
One of the more common symptoms of diabetic retinopathy is loss of vision due to swelling in the retina, more specifically, in the macula.  This is called Diabetic Macular Edema (DME). The macula gives us central vision.   When fluid accumulates within the macula, the vision worsens.
Alternative include intravitreal injections of steroid or anti-VEGF (such as Avastin or Lucentis). Iluvien, similar to its cousin Ozurdex (already FDA approved, but for the use of retinal vascular occlusions), is an injectable sustained release device that will release steroid for up to 36 months!  Iluvien has hopes of being the first sustained release delivery system for the treatment of diabetic retinopathy.
Iluvien represents an emerging treatment for diabetic macular edema, a disease that clearly needs to be treated in a variety of ways.  Ophthalmologists are limited in our ability to treat these patients as not all patients with this sight threatening complication are candidates for laser treatment. While we may not see Iluvien available here in the US, perhaps its approval and use in another country will be enough for a company such as Alimera Sciences to sustain them as a business and allow them to continue their research and development of newer technologies. Iluvien was to be indicated for the treatment of diabetic macular edema, a very common complication of patients with diabetic retinopathy.  Typically, patients receive laser treatment as a first line treatment, but alternative treatments have been long needed as laser can not be performed in everyone.
The sustained release device is injected into the eye and will release a steroid, fluocinolone, for up to 36 months.  Shorter acting steroid injections have demonstrated favorable results and it was anticipated that a sustained release system might offer a realistic benefit of better drug levels and little need for reinjection. Moreover, Iluvien would have validated sustained release drug delivery systems.  Ozurdex was first and Iluvien would have been the second delivery system designed for injection into the vitreous. A second approved product, regardless of indication, would have been a significant endorsement for injectable sustained release systems.  Sustained release devices for macular degeneration (sustained release drug delivery of anti-VEGF), post-operative medications and glaucoma seem logical.
I prefer treating and controlling the macular swelling first, before treating the neovascular disease (PDR). When possible, I’ll treat the macular edema with focal and wait several weeks, or months, to treat with scatter laser. Avastin, however, has improved my ability to treat those patients with both macular and proliferative disease. Such safety and efficacy data were presented recently to the public at a large ophthalmic meeting in FL last month.  The company has also submitted this data to the FDA (Food and Drug Administration). In short, the company performed two large clinical trials, the so-called FAME study showed that about 33% of patients  receiving the implant noted an improvement in vision.  Of significance is that this improvement, according to the company, was present after 3 years.
Last year, the FDA also asked for a review of the manufacturing process of Iluvien, but I am not aware of any specific elements that were made public.  These, too, have been addressed. About a year ago, Alimera Sciences submitted the new drug application (NDA) for it’s proprietary intraocular drug delivery system for the treatment of diabetic macular edema (DME). Last December, the FDA failed to approve the NDA, but, instead requested more data about the efficacy (how well a drug works) of Iluvien.  This was provided this Spring. If you remember, Ozurdex, the first sustained release intraocular drug delivery system was approved for treatment of retinal edema caused by retinal vascular diseases. It may be that a second such device may be shortly approved for the treatment of diabetic retinopathy.  While this further endorsed the sustained release technology, it will be a breakthrough that allows significantly more people to be helped that presently have few options. Treating diabetic retinopathy with both laser and anti-VEGF injections may be the best way to treat patients with diabetic macular edema.
The results of a large, multicenter, randomized clinical trial compared several permutations of laser and the anti-VEGF drug, Lucentis.
To date, standard treatment, or the standard of care, includes treating the retina with laser photocoagulation to retard the loss of vision. This new study not only validates the use of anti-VEGF medications, but also hints that anti-VEGF may be superior to steroids. Most importantly, however, the study describes a treatment regimen that leads to improvement, stabilization and reduction in the number of treatments! As with it’s predecessors, Macugen and Lucentis, the company must prove to the FDA that the drug is effective and safe. Regeneron has also started Phase III clinical trials for VEGF-Trap for the treatment of diabetic macular edema. Diabetic macular edema is the leading cause of decreased vision in patients with diabetes under the age of 50. On the other hand, using VEGF-Trap for the treatment of diabetic retinopathy will be the first drug to gain FDA approval. Diabetic macular edema (DME) is swelling in the retina caused by diabetic retinopathy.  More specifically, the swelling is located in the macula, the functional center of the retina. Diabetes can be considered a disease of blood vessels, caused in some way by high sugar levels.  For reasons that are not completely known, the blood vessels in the retina start to leak, both blood and the fluid component of blood. Regardless, fear not, the treatment for the disease is quite successful in preventing further vision loss.
The Food and Drug administration fails to approve Iluvien for the treatment of diabetic retinopathy and cites the need for more safety information in addition to concerns about the safety of the manufacturing process of Iluvien.   Alimera Sciences had hoped to gain approval by the end of December 2010, instead, it was told by the FDA that more information was needed. There were also concerns regarding the manufacturing, packaging and sterilization of Iluvien, though no specifics were noted. Iluvien may be the second drug approved that is based on technology to offer sustained drug delivery into the eye.  Ozurdex, a similar product, has been in use since the summer of 2009 and is used for retinal vein occlusions. Had the product been rejected, or requests for additional clinical trials, this would have been a clearer signal of failure. In the end, though disappointing, the company hopes to have a marketable product by the end of 2011. Most people know that high blood pressure and other vascular diseases pose risks to overall health, but many may not know that high blood pressure can affect vision by damaging the arteries in the eye. Branch retinal artery occlusion (BRAO) blocks the small arteries in the retina, the light-sensing nerve layer lining the back of the eye.
Central vision is lost suddenly if the blocked retinal artery is one that nourishes the macula, the part of the retina responsible for fine, sharp vision. Most people know that high blood pressure and other vascular diseases pose risks to overall health, but many may not know that high blood pressure can affect vision by damaging the veins in the eye. BRVO blocks small veins in the retina, the layer of light-sensing cells at the back of the eye. If you have had a branch retinal vein occlusion, regular visits to your ophthalmologist are essential to protect vision.
You probably know that high blood pressure and other vascular diseases pose risks to your overall health, but you may not know that they can affect your eyesight by damaging the arteries in your eye.
Central retinal artery occlusion (CRAO) usually occurs in people between the ages of 50 and 70.
CRAO blocks the central artery in your retina, the light-sensitive nerve layer at the back of the eye. You probably know that high blood pressure and other vascular diseases pose risks to overall health, but you may not know that they can affect eyesight by damaging the veins in the eye. Central retinal vein occlusion (CRVO) blocks the main vein in the retina, the light-sensitive nerve layer at the back of the eye. Central serous retinopathy (CSR) is a small, round, shallow swelling that develops on the retina, the light-sensitive nerve layer that lines the back of the eye. Cotton-wool spots are tiny white areas on the retina, the layer of light-sensing cells lining the back of the eye. Cotton-wool spots are also a common sign of infection with the human immunodeficiency virus (HIV). A retinal detachment is a very serious problem that usually causes blindness unless treated. As one gets older, the vitreous (the clear, gel-like substance that fills the inside of the eye) tends to shrink slightly and take on a more watery consistency. Small specks or clouds moving in your field of vision as you look at a blank wall or a clear blue sky are known as floaters.
The appearance of flashing lights comes from the traction of the vitreous gel on the retina at the time of vitreous separation.
Ocular histoplasmosis syndrome (OHS) is a major cause of visual impairment in the eastern and central United States, where 90% of adults have been exposed to Histoplasma capsulatum. Although the fungus is not found directly in the eye, people with OHS usually test positive for previous exposure to Histoplasma capsulatum.
Doctors believe that the histoplasmosis spores travel from the lungs to the eye where they settle in the choroid, the layer of tiny blood vessels that provide blood and nutrients to the retina, the light-sensing layer of cells lining the back of the eye.
Ocular histoplasmosis can affect vision when fragile, abnormal blood vessels grow under the retina. Although only a very small number of people infected with the histoplasmosis virus develop OHS, if you have been exposed to histoplasmosis, you should be sensitive to any changes in your eyesight, and you should monitor your vision using an Amsler grid test at home.
Retinitis pigmentosa (RP) describes a group of related diseases that tend to run in families and cause a slow but progressive loss of vision. The earliest symptom of retinitis pigmentosa, usually noticed in childhood, is night blindness or difficulty with night vision. While there is a pattern of inheritance for RP, 40% of RP patients have no known previous family history. Despite visual impairment, people with RP can maintain active and rewarding lives through the wide variety of rehabilitative services that are available today.
Stargardt's disease is an inherited disease that affects the retina, the layer of light-sensitive cells lining the back of the eye.
A buildup of lipofuscin (fatty substance) in retinal cells is thought to cause Stargardt's disease. The uvea is the middle layer in the eye sandwiched between the retina (innermost layer) and the sclera (outermost layer). Because uveitis is a serious condition that can cause permanent damage to the eye, it needs to be treated as soon as possible. If you have a "red eye" that does not clear up quickly, ocular pain, or other significant symptoms, see your ophthalmologist as soon as possible.
Age-related macular degeneration (AMD) is one of the most common causes of poor vision after age 60. Nine out of 10 people who have AMD have atrophic or "dry" AMD, which results in thinning of the macula.
Exudative or "wet" AMD is less common (occurring in one out of 10 people with AMD) but is more serious. The macula is the small area at the center of your retina that allows you to see fine details.
Age-related macular degeneration (AMD) is a disease caused by damage or breakdown of the macula, the small part of the eye's retina that is responsible for our central vision. Although the exact causes of AMD are not fully understood, a recent scientific study shows that antioxidant vitamins and zinc may reduce the effects of AMD in some people with the disease. Among people at high risk for late-stage macular degeneration (those with intermediate AMD in both eyes or advanced AMD in one eye), a dietary supplement of vitamins C, E, and beta-carotene, along with zinc, lowered the risk of the disease progressing to advanced stages by about 25% to 30%. Light may affect the eye by stimulating oxygen, leading to the production of highly reactive and damaging compounds called free radicals.


Zinc, one of the most common minerals in the body, is very concentrated in the eye, particularly in the retina and macula.
The levels of antioxidants and zinc shown to be effective in slowing the progression of AMD cannot be obtained through your diet alone. It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision you may have already lost from the disease. Symptoms of macular dystrophy can range from minimal vision loss and disturbance of color vision to profound loss of reading and night vision. Considerable research is directed toward finding the hereditary cause of many types of macular dystrophies. Low-vision devices can help affected individuals continue with many of the activities of daily life. Macular edema is the swelling of the macula, the small area of the retina responsible for central vision. Because the macula is surrounded by many tiny blood vessels, anything that affects them, such as a medical condition affecting blood vessels elsewhere in the body or an abnormal condition originating in the eye, can cause macular edema.
Retinal blood vessel obstruction, eye inflammation, and age-related macular degeneration have all been associated with macular edema. The macula is the part of the retina responsible for acute central vision, the vision you use for reading, watching television, and recognizing faces. Vitrectomy surgery is the most successful treatment for macular hole, with improvement in vision and successful closure of the hole in over 90% of patients. Most patients will experience considerable improvement in vision following closure of the macular hole, but there is typically some residual blurring or distortion. A new medication called Jetrea or Ocriplasmin is an enzyme that can be injected in the back of the eye and may dissolve the vitreo-macular adhesion if it is small enough.
Fluorescein angiography, a clinical test to look at blood circulation inside the back of the eye, aids in the diagnosis of retinal conditions associated with diabetes, age-related macular degeneration, and other eye abnormalities. If there are abnormal blood vessels, the dye leaks into the retina or stains the blood vessels. This test uses a scanning laser to provide detailed high resolution images of the macula that are helpful in the diagnosis and treatment of macular degeneration, diabetic retinopathy and other macular diseases.
This test uses sound waves to image the back of the eye when the view is obscured by a dense cataract, blood or other opaque material.
Anti-VEGF treatment is a way to slow vision loss in people who have a condition known as "wet" age-related macular degeneration (AMD).
Researchers have found that a chemical called vascular endothelial growth factor, or VEGF, is critical in causing abnormal blood vessels to grow under the retina. Treatment with the anti-VEGF drug is usually performed by injecting the medicine with a very fine needle into the back of your eye. Anti-VEGF medications are a step forward in the treatment of wet AMD because they target the underlying cause of abnormal blood vessel growth.
Vitrectomy is a type of eye surgery used to treat disorders of the retina (the light-sensing cells at the back of the eye) and vitreous (the clear gel-like substance inside the eye).
During a vitrectomy operation, the surgeon makes tiny incisions in the sclera (the white part of the eye).
During the procedure, the retina may be treated with a laser to reduce future bleeding or to fix a tear in the retina. Recovering from vitrectomy surgery may be uncomfortable, but the procedure often improves or stabilizes vision. Laser treatment of the retina utilizes specialized equipment that allows precise highly focused placement of laser applications to manage areas of disease. Nonproliferative diabetic retinopathy (NPDR), commonly known as background retinopathy, is an early stage of diabetic retinopathy. Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. If you have diabetes, early detection of diabetic retinopathy is the best protection against loss of vision. Proliferative diabetic retinopathy (PDR) is a complication of diabetes caused by changes in the blood vessels of the eye.
Laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding.
Patients with diabetes sometimes experience vision loss as a result of swelling in the central retina (macula). During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. Although you may notice some loss of your side vision, PRP can save the rest of your sight. If the bleeding in your eye is severe, you may need a surgical procedure called a vitrectomy. If you have had a branch retinal artery occlusion, regular visits to your ophthalmologist are essential. High blood pressure is the most common condition associated with branch retinal vein occlusion (BRVO). If the blocked retinal veins are ones that nourish the macula, the part of the retina responsible for straight-ahead vision, some central vision is lost.
If the veins cover a large area, new abnormal vessels may grow on the retinal surface, which can bleed into the eye and cause blurred vision. The most common medical problem associated with CRAO is arteriosclerosis (hardening of the arteries).
CRAO can also be caused by an embolus, a clot that breaks off from another area of the body and is carried to the retina by the bloodstream. The first sign of CRAO is a sudden and painless loss of vision that leaves you barely able to count fingers or determine light from dark. Irreversible retinal damage occurs after 90 minutes, but even 24 hours after symptoms begin, vision can still be saved. When retinal blood vessels are not working properly, the retina grows new fragile vessels that can bleed into the vitreous, the fluid that fills the center of the eye.
Retinal vein occlusions commonly occur with glaucoma, diabetes, age-related vascular disease, high blood pressure, and blood disorders. If the macula (the area of the retina responsible for central vision) is not affected, there may be no obvious symptoms.
People with CSR often find that their retinal swelling resolves without treatment and their original vision returns within six months of the onset of symptoms. Sometimes laser surgery can reduce the swelling sooner, but the final visual outcome is usually about the same. Caused by a lack of blood flow to the small retinal blood vessels, they usually disappear without treatment and do not threaten vision. The presence of more than eight cotton-wool spots has been associated with a higher risk of the more severe form of diabetic retinopathy known as proliferative diabetic retinopathy (PDR). The appearance of flashing lights, floating objects, or a gray curtain moving across the field of vision are all indications of a retinal detachment.
Fluid vitreous, passing through the tear, lifts the retina off the back of the eye like wallpaper peeling off a wall. Most people have some floaters normally but do not notice them until they become numerous or more prominent.
This common fungus is found in molds from soil enriched with bat, chicken, or starling droppings and yeasts from animals.
The laser's small, powerful beam of light destroys the abnormal blood vessels as well as a small amount of the retinal tissue.
RP affects the rods and cones of the retina, the light-sensitive nerve layer at the back of the eye, and results in a decline in vision in both eyes. People with normal vision adjust to the dark quickly, but people with night blindness adjust very slowly or not at all. Learning more about RP in your family can help you and your ophthalmologist predict how RP will affect you. The incidence of Usher's syndrome is difficult to determine, but surveys of patients suggest up to 10% of RP patients are deaf. As hereditary defects are discovered, it may be possible to develop treatments to prevent progression of the disease. Until there is a cure, periodic examinations by your ophthalmologist will keep you informed of legitimate scientific discoveries as they develop. The buildup typically happens in the central retina, or macula, where it resembles beaten bronze.
Although no specific medical or surgical treatment is available, eyeglasses and magnification help affected people adapt to the disease.
It can develop more slowly than the other forms of uveitis and last longer, although this is variable. While peripheral (side) vision is unaffected, with AMD, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and looking at detail. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors. In the wet form of AMD, abnormal blood vessels may grow in a layer beneath the retina, leaking fluid and blood and creating distortion or a large blind spot in the center of your vision. In the meantime, high-intensity reading lamps, magnifiers, and other low vision aids help people with AMD make the most of their remaining vision. As light rays enter your eye, the retina converts the rays into signals that are sent through the optic nerve to your brain, where they are recognized as images.
The macula normally lies flat against the back of the eye, like film lining the back of a camera. If surgery is recommended, you should be aware that as with any surgical procedure, rare complications can occur, including infection, bleeding, retinal detachment, recurrence of the epiretinal membrane, and earlier onset of cataract. This condition affects both distance and close vision and can make some activities (like threading a needle or reading) very difficult or impossible. However, the supplements did not appear to benefit people with minimal AMD or those with no evidence of macular degeneration. Antioxidant vitamins (vitamins C and E and beta-carotene) may work against this activated oxygen and help slow the progression of macular degeneration.
Zinc is necessary for the action of over 100 enzymes, including chemical reactions in the retina. These vitamins and minerals are recommended in specific daily amounts as supplements to a healthy, balanced diet.
However, specific amounts of certain supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision.
The macula is the part of your retina responsible for acute central vision, the vision one uses to read, watch television, and recognize faces. The most common types of macular dystrophies, which tend to appear early in life, are Best's disease, Stargardt's macular dystrophy, and bull's eye maculopathy. With further research, it may be possible to develop medical treatments to prevent or slow the progression of macular dystrophy. The macula may also be affected by swelling following cataract extraction, although typically this resolves itself naturally.
Eyedrops, injections of steroids or other, newer medicines in or around the eye, or laser surgery can be used to treat macular edema. When the vitreous (the gel-like substance inside the eye) ages and shrinks, it can pull on the thin tissue of the macula, causing a tear that can eventually form a small hole. The operation removes vitreous traction and fine membranes that caused the macular hole to occur. The dye travels through the body to the blood vessels in the retina, the light-sensitive nerve layer at the back of the eye. There is little risk in having fluorescein angiography, though some people may have mild allergic reactions to the dye.
This condition damages the macula, which is located in the center of the retina and enables you to see fine details clearly. About 90% of people with AMD have the atrophic or "dry" form of AMD, which develops when the tissues of the macula grow thin with age. It may be used to treat a severe eye injury, diabetic retinopathy, retinal detachments, macular pucker (wrinkling of the retina), and macular holes.


Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous and repairs the retina through these tiny incisions. An air or gas bubble that slowly disappears on its own may be placed in the eye to help the retina remain in its proper position, or a special fluid that is later removed may be injected into the vitreous cavity.
Once the blood- or debris-clouded vitreous is removed and replaced with a clear medium (often a saltwater solution), light rays can once again focus on the retina. When placed close together, laser spots can form a bond between layers of tissue, which is helpful for sealing holes or tears in the retina, or for treating small detachments of the retina. Over time, diabetes can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. Vision blurs because the macula no longer receives sufficient blood supply to work properly. You can significantly lower your risk of vision loss by maintaining strict control of your blood glucose and visiting your ophthalmologist regularly. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina.
The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months, or even years.
Microscopic damage to the blood vessels means that patients with diabetes tend to leak more blood and fluid into their retina. Blood can leak into the gel as a result of a torn retina, or because of abnormal blood vessel growth in diseases like diabetes.
The scar tissue forms in areas where abnormal blood vessels have grown, and over time this scar tissue can place tension on the retina and nearby tissues. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. Sometimes the blockage is caused by an embolus, a clot carried by the blood from another part of the body. About 10% to 12% of the people who have BRVO also have glaucoma (high pressure in the eye). During the course of vein occlusion, 60% or more will have swelling of the central macular area. When this fluid collects in the macula (the area of the retina responsible for central vision), vision becomes blurry.
Blood in the vitreous clumps and is seen as tiny dark spots, or floaters, in the field of vision.
If retinal swelling persists for more than three or four months, or if an examination reveals early retinal degeneration, laser surgery may be helpful. Laser surgery or cryotherapy (freezing) are often used to seal retinal tears and prevent detachment. Pneumatic retinopexy involves injecting a special gas bubble into the eye that pushes on the retina to seal the tear.
If left untreated, the CNV lesion can turn into scar tissue and replace the normal retinal tissue in the macula.
RP usually affects both eyes equally, with severity ranging from no visual problems in some families to blindness at an early age in others. While developments are on the horizon, particularly in the area of genetic research, there is currently no cure for retinitis pigmentosa. Large doses of vitamin A are harmful to the body, and supplements of vitamin E alone may make RP worse. Remaining vision is good enough for most people to live fairly normal lives, though they will not drive, or read without using magnification devices.
The macula is a small area at the center of the retina in the back of the eye that allows us to see fine details clearly and perform activities such as reading and driving. If the blood vessels are not growing directly beneath the macula, laser surgery is usually the treatment of choice.
As you age, the clear, gel-like substance that fills the middle of your eye begins to shrink and pull away from the retina.
Updating your eyeglass prescription or wearing bifocals may improve your vision sufficiently. At the end of the operation, a special gas bubble is placed in the eye to temporarily "splint" the hole closed while it heals, usually requiring 3-7 days of face down positioning after surgery to keep the bubble in contact with the macula. A special camera with a green filter flashes a blue light into the eye and takes multiple photographs of the retina. You rely on your macula whenever you read, drive, or do other activities that require you to focus on precise details.
These are referred to as "anti-VEGF" drugs, and they help block abnormal blood vessels, slow their leakage, and help reduce vision loss. Although not every patient benefits from anti-VEGF treatment, a large majority of patients achieve stabilized vision, and a significant percentage can improve to some degree.
Laser can be used to reduce fluid that accumulates when the blood vessels of the retina are leaking, such as in diabetes or some forms of macular degeneration. High blood sugar levels create changes in the veins, arteries, and capillaries that carry blood throughout the body. Unfortunately, these new blood vessels are abnormal and grow on the surface of the retina, so they do not resupply the retina with blood. A small amount of blood will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception.
If the pulling is severe, the macula may detach from its normal position and cause vision loss. If the vitreous hemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, an operation called a vitrectomy can be performed. There is considerable evidence to suggest that rigorous control of blood sugar decreases the chance of developing serious proliferative diabetic retinopathy.
Laser treatment can help the body absorb some of this fluid, and can help to seal some of the leaky blood vessels. If there is too much tension the retina can be pulled away from its normal location in the eye, creating a tractional retinal detachment. Eventually, I operated to remove a vitreous hemorrhage resulting from his proliferative diabetic retinopathy.
Depending on how damaged the veins are, laser surgery may help reduce the swelling and improve vision. Laser surgery may be effective in preventing further bleeding into the vitreous or for treating glaucoma, but it cannot remove a hemorrhage or cure glaucoma once it is present.
The scleral buckle procedure requires the fluid to be drained from under the retina before a flexible piece of silicone is sewn on the outer eye wall to give support to the tear while it heals. As we get older, the vitreous (the clear, gel-like substance that fills the inside of the eye) tends to shrink slightly and detach from the retina, forming clumps within the eye. Generally, "histo spots," or small scars in the retina, do not affect vision, but for unknown reasons, some people can have ocular complications years or decades later. Treatment is not necessary unless the new vessels are in the macula, the part of the retina responsible for acute central vision. RP gets its name from the fact that one of the symptoms is a clumping of the retinal pigment that can be seen during an eye exam. Unfortunately, the combination of night blindness and the loss of peripheral vision can be severe and can lead to legal blindness in many people. Vitamin E is not harmful if taken along with vitamin A or in the presence of a normal diet. If uveitis is associated with other conditions like glaucoma or retinal damage, surgery may be required. If you have more severe symptoms that interfere with your daily routine, your ophthalmologist may recommend vitrectomy surgery to peel and remove the abnormal scar tissue. Because zinc is important for the health of the macula, supplements of zinc in the diet may slow down the process of macular degeneration.
The gas bubble absorbs spontaneously, allowing the vision to gradually improve over several weeks. The technique uses regular photographic film, or, more commonly, is performed with digital equipment. Being allergic to X-ray dyes with iodine does not mean you will be allergic to fluorescein. A person with AMD loses the ability to perceive fine details both up close and at a distance. There is a small risk of complications with anti-VEGF treatment, usually resulting from the injection itself. Some patients with diabetes have poor blood flow in the retina, which leads to bleeding and other complications.
Vision loss may be mild to severe, but even in the worst cases, peripheral (side) vision continues to function. Pregnant women with diabetes should schedule an appointment in their first trimester, because retinopathy can progress quickly during pregnancy. This includes the tiny blood vessels in the retina, the light-sensitive nerve layer that lines the back of the eye. During a vitrectomy, the eye surgeon removes the hemorrhage and any scar tissue that has developed, and performs laser treatment to prevent new abnormal vessel growth. Many patients benefit from injections that reduce the blood vessels' tendency to leak, or from medicines that help the body absorb the fluid faster.
Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink.
Laser surgery may also shrink abnormal new blood vessels that can grow and that are at risk of bleeding. While the cause of CSR is unknown, it seems to occur at times of personal or work-related stress. Vitrectomy surgery removes the vitreous gel from the eye, replacing it with a gas bubble, which is slowly replaced by the body's fluids. What you see are the shadows these clumps cast on the retina, the light-sensitive nerve layer lining the back of the eye.
For those patients with wet AMD whose blood vessels are growing directly under the center of the macula, a procedure called photodynamic therapy (PDT), which causes fewer visual side effects, is sometimes used.
When wrinkles, creases, or bulges form on the macula due to this scar tissue, this is known as an epiretinal membrane or macular pucker. During this outpatient procedure, your ophthalmologist uses tiny instruments to remove the wrinkled tissue.
As the bubble dissolves, the eye re-fills with the aqueous fluid which is continuously produced in the back of the eye.
Occasionally, some of the dye leaks out of the vein at the injection site, causing a slight burning sensation that usually goes away quickly.
However, for most people, the benefits of this treatment outweigh the small risk of complications. Laser treatment to the retina can stop this cycle and stabilize vision in many patients with diabetes. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy. Although the blood itself is not usually dangerous, many of the conditions that cause bleeding in the eye need to be treated immediately to prevent permanent vision loss. A similar process can occur in patients who do not have diabetes if they have suffered trauma or have had a retinal detachment in the past. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Even if bleeding has started, PRP may still be possible, depending on the amount of bleeding. Damage to your macula causes blurred central vision, making it difficult to perform tasks such as reading small print or threading a needle.



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