Understanding the Retina

Healthy eyes and good vision are a gift that shouldn’t be taken for granted. Even though eyes can have age-related changes, with yearly eye exams and early detection and treatment of emerging issues, you have a good chance of enjoying a long active lifestyle with good vision.

One of the areas of the eye that is important for good vision is the retina. The retina is the light sensitive layer of tissue located in the back of the eye. Much like film in a camera, the retina receives images formed by the lens and transmits them through the optic nerve to the brain. Of particular significance is the macula, which is the very center of the retina that allows our eyes to see fine details clearly, thereby producing our central vision. Two of the retinal diseases that we check for during a comprehensive eye exam are Age-
related Macular Degeneration and Diabetic Retinopathy.

What is AMD?
Age-related Macular Degeneration (AMD) occurs when there is a breakdown in the macula. It currently affects approximately 15 million people in the US and is a major cause of severe vision loss in people age 60 and older. There are two forms of this disease, known as “Dry AMD” and “Wet AMD”.

What is Dry AMD?
90 percent of AMD patients have the dry form, making it the most common type of AMD. It is diagnosed when cellular waste products accumulate, causing yellowish deposits, known as drusen, in the macula. It is this drusen and subsequent atrophy of the retina that causes AMD. Dry AMD usually causes a slow, gradual deterioration of vision unlike the sudden onset of wet AMD. Current treatment/manage-
ment for dry AMD includes vitamin therapy (AREDS2 formulation); regular eye examinations; home monitoring with an Amsler Grid to note any changes; and quitting smoking. Ongoing clinical studies continue to seek additional therapies.

What is Wet AMD?
Wet AMD (also known as neovascular AMD) is less common, but a much more devastating condition with the potential to cause rapid vision loss. In this case, there is abnormal blood vessel growth beneath the retina that can leak blood, causing scarring and permanently damaging light-sensitive retinal cells. Fellowship Trained Surgical Vitreo-Retinal Specialist Dr. Joshua Mali explains, “Today, we have access to revolutionary medications that can treat wet macular degeneration to help preserve and even improve vision with early diagnosis and treatment.”

AMD Warning Signs
Some of the warning signs for AMD are:
• Gray or blank spots in your central vision
• Faces appear blurry in the middle but focused towards the edges
• Straight lines, vertical and/or horizontal, appear wavy or disconnected
• You need more light when you do close-up work
• Difficulty reading street signs

Be sure to schedule an annual eye exam so you are able to benefit from early detection and treatment. Unlike what your parents may have experienced, today we are able to offer more advanced treatments that can save sight.

Diabetes and Eyes
Another threat to good vision is diabetes. According to The American Academy of Ophthalmology, diabetics are 25 times more likely to lose vision than those without this disease. The most common complication of diabetes is diabetic retinopathy (DR), and the longer you have diabetes, the higher your risk for it. It should be noted that in the early and most treatable stages of DR, there are often no visual symptoms or pain. For this reason all diabetics should have a yearly comprehensive eye exam.

There are 2 stages of classifications of DR:
non-proliferative or proliferative. Non-proliferative
retinopathy, the most common form, is first diagnosed when small retinal blood vessels start to swell. As the disease progresses, these blood vessels can break and leak blood. Proliferative retinopathy is the more advanced stage of DR, with increasing numbers of blood vessels becoming blocked as time goes on. To satisfy the need for supplying nourishment, new blood vessels grow, but they are frail and abnormal, often hemorrhaging and scarring. Some common symptoms of advanced diabetic retinopathy include distorted central vision; items may have a blue‐yellow color tone; dark streaks in your vision; and blind spots. Patients with this type of DR can experience severe vision loss, and even blindness.

The best tool for treating DR is managing the diabetes itself. If medical treatment is necessary, laser treatment, intravitreal injections/implants, and surgery are available. The optimal time for treatment is before the patient experiences visual symptoms. At The Eye Associates, we have the latest cutting edge technology and medication treatment available in the country. Our retinal specialist, Dr. Joshua Mali, is a leader in his field and is on the forefront of developing new medications and innovative medical/surgical treatments for diabetic eye disease. He was one of the first retinal specialists in the United States to inject Iluvien, a new steroid implant used to treat patients with diabetic macular edema.

The Eye Associates

Richard E. Hector, MD
Robert S. Friedman, MD
Cathleen McCabe, MD
Brian Foster, MD
Joshua Mali, MD
Charles Anthony II, MD
Todd Berger, MD
Jeffrey Kasper, MD
Ahmad Tarabishy, MD
Scott B. Han, OD
Michael Camp, OD
Edwin Detweiler III, OD
Lori Ann Long, OD
Robert Rego, OD

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