Diseases of the Eye

Diseases of the eye. The human eye is a sensitive, complex organ. And like any complex structure, it is subject to malfunction. Aging and disease can take their toll. This toll translates into diseases of the eye. The following links may serve as an introduction to some of these diseases .

Macular Degeneration

Age takes its toll on our eyes just as it does on the rest of the human body. Some of these symptoms of aging must be accepted gracefully. But other age related eye diseases can and should be taken seriously. One of these diseases is macular degeneration.

The good news: Right now there are several techniques that may help in treating macular degeneration.

The better news: Studies and research are now being conducted that we hope will one day offer more and better answers in treating this eye disease.

Meanwhile, here’s what you need to know about macular degeneration...

- Detecting/Monitoring

Many people may be unaware that they have macular degeneration because they still have good vision. The American Academy of Ophthalmology recommends that, after age 40, people have a routine screening eye examination every 2 years to check for evidence of glaucoma, cataracts and other age-related eye problems. A dilated fundus examination begins with administering dilating eye drops to open the pupils. This allows the eye doctor to see the retina and look for signs of macular degeneration.

As part of their evaluation, many patients with macular degeneration will undergo a fluorescein angiogram. In this test fluorescein dye is injected into an arm vein. A special type of camera takes photographs that show the blood vessels in the retina in clear detail. Areas of abnormal blood vessel growth (choroidal neovascularization) can be identified. The presence or absence of abnormal blood vessels is much more clearly demonstrated on the angiogram than on the eye exam. That’s why patients often may require repeat angiograms on return visits.

Amsler grid testing allows patients to monitor their vision at home. The Amsler grid is a small grid. One of the first signs of leakage from macular degeneration is that straight lines look bent or distorted. This can be detected by looking at the Amsler grid with one eye at a time. In taking this test, it is important to remember to cover one eye – and look at the grid with only one eye at a time. Otherwise, early changes in one eye may be missed. The good eye can compensate for or mask the distortion in the affected eye. If you would like an Amsler grid please register and provide us with your full name and mailing address and we will send you a magnetic grid. Or you can download the Amsler grid on this screen.

Patients with macular degeneration should get in the habit of checking a grid daily. The earlier abnormal blood vessel growth can be detected, the better the chances are of successful treatment.

- Risk Factors

Some people are at greater risk of developing macular degeneration than others. People, who are lightly pigmented, with blond hair and blue eyes, have a higher risk. Those with darker pigmentation have a lower risk. Macular degeneration is most common in people of Northern European ancestry but infrequent among African-Americans.

Family history is a well-documented risk factor for macular degeneration. Someone with a significant family history of macular degeneration in a parent or sibling has twice the risk of macular degeneration as the average person the same age. Therefore, a 65-year-old with an affected parent has a 10 percent risk rather than the 5 percent risk of the average 65-year-old.

Several studies have linked smoking to macular degeneration. There are obviously many other reasons to avoid smoking – protecting your lungs and heart. Here’s one more: quitting smoking may also be beneficial for the eyes. Medical conditions that lead to atherosclerosis (“hardening of the arteries”) have been linked to a higher risk of vision loss from macular degeneration. High blood pressure and high cholesterol have both been associated with an increased risk of ARMD.

Diet may also be a factor. Some studies have shown that people who eat greater amounts of the “dark green leafy vegetables” – Brussels sprouts, spinach, broccoli and collard greens – have a lower risk of developing macular degeneration. But this has not been definitely proven.

Exposure to ultraviolet light may also be a risk factor. It is therefore prudent to wear sunglasses outdoors on sunny days.

- What is Macular Degeneration?

Macular degeneration (ARMD) is a major public health issue–the leading cause of vision loss in Americans over age 65. ARMD is an aging change of the retina.

The eye is like a camera, with the retina as the "film." The eye’s optical parts (cornea and lens) focus images of the outside world on the retina. At the center of the retina is the macula, which provides the sharp vision needed for reading and recognizing faces.

As we get older some people develop liver spots and other aging changes on the skin. Likewise, people can develop aging spots on the retina. These aging spots on the retina are called drusen. They become more common as people get older. By age 65, about 5 percent of people have evidence of macular degeneration. By age 85, the incidence increases to 20 percent. In addition to the drusen, people can also develop pigmented spots and/or atrophic areas in the retina.

There are two types of macular degeneration - dry (atrophic) and wet (exudative). These are not two different conditions, but two different stages of the same condition. Dry ARMD refers to the earlier stage where drusen and atrophic areas are present. In about 10 percent of ARMD patients, the weak areas lead to abnormal blood vessel growth beneath the retina. These abnormal blood vessels – called choroidal neovascularization (abbreviated CNV or CNVM) – can bleed or leak. This results in blood and fluid accumulating beneath the retina – and is then referred to as wet macular degeneration.

Dry macular degeneration can sometimes lead to significant vision loss, but milder visual symptoms are more likely. More severe vision loss is usually due to wet macular degeneration. That’s why the wet form is considered a more serious or advanced stage. Still, even with wet macular degeneration, complete vision loss is very, very unlikely. But patients who lose central vision may be unable to drive, read and perform other tasks that require sharp vision. However, they almost always maintain peripheral vision. This usually allows them to walk around without assistance and perform other activities that do not require sharp central vision.

A common misconception is that macular degeneration always results in blindness. Not true. Many people do suffer significant vision loss from macular degeneration - but many more people with dry macular degeneration have little or no visual trouble.

- Thermal Laser Treatment

Thermal laser treatment is one treatment that has proven beneficial in treating macular degeneration. The Macular Photocoagulation Study (MPS) was a landmark study conducted by the National Eye Institute. The MPS provided valuable data which forms the basis for current treatment of macular degeneration. All potential treatments under investigation are judged in light of the MPS results.

In the Macular Photocoagulation Study several thousand patients with choroidal neovascularization (CNV) due to macular degeneration were randomly assigned to one of two treatment groups. One group had laser treatment. The other group was observed without any treatment. The data showed a significant benefit to laser treatment. Patients who received laser treatment had less vision loss than those who were untreated.

However, there are significant limitations to the laser treatment. On average, treated patients experienced less vision loss than untreated patients – but they still lost some vision. Laser treatment wipes out the abnormal blood vessel growth, but it also damages the normal retina in that spot. Wherever the laser treatment is applied, the patient is left with a blind spot. The size and location of this blind spot will vary with where the abnormal blood vessels were.

If the abnormal blood vessels were small, and not too close to the macular center, there may only be a small blind spot that the patient does not even notice. However, it is much more common for the abnormal blood vessels to be large and close to the center of the macula. Laser treatment then results in a noticeable – and bothersome – blind spot. Still, this blind spot is often not as bad as the vision damage from the untreated blood vessels would be. That’s why laser treatment for macular degeneration is a very common procedure.

Another limitation to treatment is that only some patients meet MPS criteria for treatment. The Macular Photocoagulation Study had specific requirements regarding the type of leakage that could be treated. Patients had to have classic well-defined leakage to qualify for treatment. This means that the abnormal blood vessels had to be clearly visible on the angiogram, with sharply defined borders. Unfortunately, in the majority of patients the leakage is occult or ill-defined. Those patients are not candidates for treatment according to the MPS criteria. Furthermore, in other patients, blood under the retina blocks us from seeing where the leakage is coming from. Only about 20 percent of patients will have angiograms that indicate treatable leakage.

Laser treatment is an outpatient procedure that causes little discomfort. Even though the laser treatment itself does not take very long, the total entire time spent in our office will be about 2 hours.

Ocular Photodynamic Therapy

Intravitreal Injections

- Vitamins and Minerals?

Some retina specialists believe that high doses of antioxidant vitamins and minerals may reduce the risk of progressing macular degeneration. However, this has yet to be proven. In spite of the uncertainty, there are companies advertising and marketing vitamins for macular degeneration. The nutrients under investigation include vitamin A, vitamin C, vitamin E, beta carotene, lutein, selenium and zinc. A few studies have shown that people with lower blood levels of particular antioxidant nutrients have a greater likelihood of also having macular degeneration. However, no study has yet shown that taking nutritional supplements offers any significant reduction in the risk of developing macular degeneration – or in the progression of macular degeneration.

Recently several health food remedies have also become very popular among patients with macular degeneration. These include bilberry and St. John’s wort. There have been no formal studies of these supplements – and no data to indicate any beneficial effect. But there are risks associated with the use of nutritional supplements.

One factor to consider is cost. Since many patients may take these supplements for years, the expense can add up to a significant amount of money.

Patients with macular degeneration often have other medical problems, and may be taking several medications. Adding another pill daily may increase the risk of patients getting confused or discouraged about the number of medications they are on. This could result in failing to take other essential medicines.

Finally, very high doses of certain vitamins may have toxic effects. Megadoses of zinc have been associated with anemia. Megadoses of vitamin E have been linked to increased risk of lung cancer in smokers. Some of the supplements increase bleeding.

- Research

Unfortunately, current treatments for macular degeneration are limited. While we can often limit vision loss, after treatment we usually are left with some damage to the vision. We usually cannot recover vision damaged prior to the treatment. Furthermore, there are many patients who are not candidates for the standard laser treatment. Because our treatment options are limited, extensive research is underway in this area. Current clinical research trials at Illinois Retina Associates related to macular degeneration are summarized here:

-Age Related Eye Diseases Study (AREDS).
This National Eye Institute-sponsored study is examining the role of vitamin supplements in reducing the risk of progression of macular degeneration. Patients are randomly assigned to take either very high doses of antioxidant vitamins and minerals or a regular multivitamin tablet.

-Complication of ARMD Prevention Trial (CAPT).
The National Eye Institute is sponsoring this study evaluating the potential for early laser treatment to reduce the risk of progression from dry to wet macular degeneration. Patients with many drusen in both eyes and good vision in both eyes receive laser treatment to one eye. A light laser treatment is applied to treat the drusen. The CAPT is currently accepting new patients.

-Submacular Surgery Trials (SST).
This National Eye Institute-sponsored study is assessing surgery to remove the blood and abnormal blood vessels from beneath the retina. Patients with wet macular degeneration are randomly assigned to either a surgery group or an observation group. Patients are eligible for this study only if they do not meet MPS criteria for standard laser treatment. The SST is currently accepting new patients.

-Ocular Photodynamic Therapy (OPT).
This industry sponsored trial is testing a new type of laser treatment for macular degeneration. A photosensitive dye is injected prior to laser treatment. The dye accumulates in the abnormal blood vessels, making them more sensitive to laser treatment. A much lower laser energy is then used to treat the area. This low-power laser typically does not result in a blind spot in the area of treatment. Patients often need to be retreated at three-month intervals.

Diabetic Retinopathy.

What it is.
Diabetes affects 16 million Americans. In addition to causing numerous systemic complications - from kidney failure to hypertension and cardiovascular disease - diabetes is one of the leading causes of blindness among working?age Americans. In fact, the National Eye Institute says that diabetics are 25 times more likely to go blind than the general population. That's why diabetic retinopathy is the leading cause of blindness in patients ages 20 to 74. And that’s why we devote so much space to it here.

Diabetic retinopathy is an eye disease that affects the light sensitive retinal tissue at the back of the eye. Diabetic retinopathy comes in two forms:

-Background retinopathy. In this the earlier and milder form of the disease, tiny blood vessels within the retina deteriorate. Some vessels may shrink, others swell or form microaneurysms – weak spots where the blood vessel wall balloons out. These weak blood vessels can then leak fluid, causing the normally thin retina to swell. If these leaky vessels leave deposits that build up on the retina, it may cause blurry vision. Background retinopathy usually advances very slowly – and may not demonstrate any symptoms for many years.

-Proliferative retinopathy. Twenty percent of diabetics with background retinopathy will develop this more severe progression of the disease. When this happens, new blood vessels actually grow on the retina or optic nerve. These weak blood vessels can rupture and bleed into the clear center of the eye. The resulting blood can blur vision by blocking light from reaching the retina . The rupturing blood vessels create scar tissue that further interferes with vision. Long-term bleeding and scarring can cause the retina to pull away from the wall of the eye. If the retina detaches, the result is severe vision loss, which requires immediate surgery. The longer the duration of the diabetes and the poorer it is controlled, the higher the risk of progression to proliferative diabetic retinopathy and severe vision loss.

- Risk Factors

Anyone with diabetes is at risk – both people with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset). During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.

The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime. Because diabetes itself is often present for some time before it is first diagnosed, it is important that diabetic patients have a dilated eye exam when diabetes is first detected and at least once a year thereafter – even if no eye symptoms are apparent.

If you have diabetes, you are also at risk for other eye diseases. Studies show that you are twice as likely to get a cataract as a person who does not have the disease. Also, cataracts develop at an earlier age in people with diabetes. Cataracts can usually be treated by surgery.

Glaucoma may also become a problem. A person with diabetes is nearly twice as likely to get glaucoma as other adults. And, as with diabetic retinopathy, the longer you have had diabetes, the greater your risk of getting glaucoma. Glaucoma may be treated with medications, laser or other forms of surgery.

- Symptoms

At first, background diabetic retinopathy may not exhibit any early warning signs. By the time the patient notices vision changes, the retinopathy is usually far advanced. That is why routine screening exams are recommended. As fluid leaks from the damaged retinal vessels, vision may become blurred. Glasses cannot restore this vision because the retina itself is damaged. Similarly, early proliferative retinopathy may not produce decreased vision or symptoms. But subsequently, bleeding can cause a sudden appearance of "floaters," decreased acuity and sometimes almost total loss of vision.

At some point, macular edema may develop. This blurs vision, making it hard to do things like read or drive. In some cases, your vision will get better or worse during the day.

As new blood vessels form at the back of the eye they, too, can bleed and blur vision. This can range from minor blood spots that appear as dark floaters to severe bleeding with significant loss of vision.

It may take anywhere from a few days to months – or even years – to clear the blood from inside of your eye. In some cases, the blood will not clear.

But even in more advanced cases, the disease may progress a long way without symptoms. That is why regular eye examinations for people with diabetes are so important.

- Treatment Options

The best treatment for diabetic retinopathy is prevention - keeping your blood sugar under control. Even when retinopathy is diagnosed, early treatment can preserve your vision. The treatment of diabetic retinopathy in any particular case depends upon multiple factors, including the type and degree of retinopathy, associated ocular factors such as cataract or vitreous hemorrhage, and the medical history of the patient.

Mild retinopathy may not require any specific eye treatment, rather just good control of your blood sugar. But if your vision is in jeopardy, more aggressive treatment may be suggested. It may first be necessary to photograph your retinas to provide a baseline to determine if the disease is progressing. This also allows for the identification of leaky blood vessels, and provides a "road-map" for possible surgical treatment. Treatment options include laser photocoagulation and vitrectomy surgery.

-Laser surgery is done as an outpatient procedure and requires no surgical incision. A strong light beam is aimed onto the retina to treat the abnormal vessels. Laser surgery has been proven to reduce the risk of severe vision loss from proliferative diabetic retinopathy by more than 50 percent. If you have macular edema, laser surgery may also be used. In this case, the laser beam is used to seal the leaking blood vessels. But even laser treatment may not help advanced cases. In these situations, a procedure called vitrectomy may be recommended.

-Vitrectomy may be required in advanced cases of proliferative retinopathy, especially when there is poor visibility within the eye due to blood and scar tissue. In this major eye operation, the surgeon uses delicate instruments - under the guidance of the operating microscope – to remove the vitreous gel along with the scar tissue and blood.

However, surgery often cannot restore vision that has already been lost. That's why finding diabetic retinopathy early is the best way to prevent vision loss. With timely treatment, the majority of those with advanced diabetic retinopathy can be saved from going blind.

Retinal Detatchment

What it is.
Retinal detachment is a fairly uncommon occurrence, more likely to occur after 50 years of age. It is a bit more common in males versus females, and similarly occurs slightly more often in white than black patients. Nearsighted patients, whose eyes are bigger than average and who have retinas that are stretched somewhat to fill the eye, also are more likely to have spontaneous retinal detachments. The illness also shows a genetic component because there is a tendency for it to occur in families.

Why do some people get detached retinas?
Any small opening – a tear or hole – in the delicate retina will permit fluid to get between the retina and the wall of the eye. As the fluid leaks into this space, the retina will slowly peel off from the back wall of the eye. By analogy, think of a thin sheet of wallpaper attached to your bedroom wall. If a small hole was made in the paper and if fluid could get through this hole and into the area between the wallpaper and the wall, the wallpaper would start to peel off, or detach from the wall onto which it had been glued. What causes small, spontaneous, openings in the retina? These tears may be caused by aging changes in the vitreous gel attached to the retina or degenerative changes in the thin peripheral areas of the retina itself.

The interior portion of the human eye is filled with a gelatinous substance called the vitreous, which helps the globe maintain its shape. When you are a child, the vitreous has the consistency of firm, cold Jello (gelatin). Light that is focused by the cornea and lens then passes through the clear vitreous to place an image on the retina, the membranous layer of nerve tissue at the back of the eye. As you get older, the vitreous may start to liquefy a bit and condense. As we approach our 50s, the vitreous gel slowly shrinks and pulls away from its attachments to the retina. If it pulls free completely, the vitreous is said to become separated or detached (a posterior vitreous detachment, or PVD). This is not the same thing as the much more serious retinal detachment.

As the PVD occurs, you may get the sensation of floaters or flashing lights within the eye. These symptoms can be a warning sign that a tear has occurred in the peripheral retina. If these symptoms occur, you should see your eye doctor for an eye examination. Sometimes the process of PVD takes a few weeks to complete itself, so your eye doctor may want to repeat the examination again about one month later. A vitreous detachment does not require treatment as long as there are no retinal holes or tears associated with it.

If your doctor discovers a tear or hole in the retina, it may need to be repaired. By performing the repair, your ophthalmologist will be attempting to prevent a retinal detachment from beginning. The type and size of hole, symptoms and conditions of the other eye all influence the decision of whether or not it needs treatment.

In addition to spontaneous occurrence, retinal tears may also appear after trauma to the eye.

- Risk Factors

Retinal detachment is a serious eye problem affecting 1 out of every 10,000 people in the U.S. Unfortunately, the tears and holes in the retina that lead to detachment are part of the aging process – and no one has yet found a cure for aging. However, we do know that you are at greater risk of suffering from retinal tears, holes and detachment if:

-You are extremely near-sighted.

-You have suffered a previous detachment.

-Your family has a history of retinal problems.

-You have had cataract surgery.

If you fall into any of these categories, your eye doctor may suggest regular eye exams to catch problems before they lead to limited vision. While retinal detachments primarily afflict middle-aged and older people, these detachments can happen at any age.

- Symptoms

How do you know if you have a torn retina?

The retinal neural tissue is very sensitive to any visual or mechanical stimulation. If you sustain a tear in the retina, you may notice several changes:

• You may see an increased number of black spots or floaters in the liquefied vitreous. The new floaters probably result from a little bit of blood and debris that have entered the vitreous as it pulls away from the retina and makes a small tear in it.

• You may have a series of light flashes within your visual field, even with the eyelids closed. These flashing lights are the direct result of mechanical stimulation of the retinal neural tissue by the vitreous gel that tugs on it as it separates from the retina.

• Your vision changes after a sharp blow to the eye.

• You may notice a shadow or curtain blocking an area of your vision.

Typically, you will not experience any pain.

- Treatment Options

Diagnosis begins with an eye examination for retinal tears and detachment. Several treatment options are available.

If the retina is torn but not fully detached, prompt treatment may prevent further detachment. But if the retina is completely detached, surgery is necessary. This can reattach the retina by sealing the tear to prevent the retina from pulling away from the back of the eye again. Depending upon how severe the detachment is, your eye surgeon may choose from these possible procedures:

Laser photocoagulation. If there is only a small amount of fluid around the tear, or a localized detachment, laser treatment may be recommended. The laser seals around the affected area to wall it off and prevent it from spreading.

Cryopexy. This freezing technique uses a very cold metallic probe, briefly touched to the outside of the affected area to "freeze" the back wall of the eye behind a retinal tear. Like ophthalmologic laser surgery. This stimulates scar formation that seals down the edges. Freezing may also be done on an outpatient basis – but it does require a local anesthetic to numb the eye.

Pneumatic retinopexy. In this procedure a gas bubble is injected into the vitreous cavity. It floats to reattach the retina. Laser or freezing treatment is preferred to seal the leak. For this procedure to be done there must be only one leak in the upper half of the eye.

Surgical repair. In the most severe cases – when fluid collected under the retina has completely separated it from the back of the eye – a more complex surgical procedure is required for reattachment. During the operation, the fluid collected behind the retina may be drained. This allows the retina to settle back into its original position on the eye wall. If necessary, a scleral buckle or silicone “belt” or pressure pad is used to gently push the back wall of the eye against the retina. Then a laser, freeze probe or an electric current applied through a needle (diathermy) seals the retinal tear. More severe detachments may require a vitrectomy. In this major eye operation, the surgeon uses delicate instruments - under the guidance of the operating microscope – to remove the vitreous gel away from the retina. This allows the surgeon to complete the reattachment. Eventually the body replaces the removed vitreous fluid.

Scleral Buckle. In this procedure a silicone belt is placed around the outside of the eye. The belt indents the wall of the eye to gently push the back wall of the eye against the retina. Fluid can be drained from beneath the retina, and freezing treatment applied to seal the leak.

Vitrectomy. With this operation, tiny holes are made in the wall of the eye to allow access to the center. The vitreous gel is removed from the eye. The retina is flattened under a bubble of air. Laser treatment is applied to seal around the leaks.

Outcomes
More than 90 percent of all retinal detachments can now be reattached (although more than one operation may be needed). If successful, the reattachment prevents blindness and the eye will retain some sight. It takes several months for the eye to seal and reach its final vision. This final vision may vary significantly from one eye to the other.

Central Serous Choroidopathy

What it is.
Central serous choroidopathy – also known as central serous retinopathy – describes a leakage of fluids between the choroid and retina. It’s called central because it occurs in the macula, the part of the retina responsible for your central (straight ahead) vision. This leakage creates a pocket of fluid underneath the retina. This fluid pocket distorts the light-sensitive nerve cells in the macula. This may cause some interference with your vision in that eye. A Fluorescein Angiogram may be necessary to confirm the diagnosis. Many cases resolve on their own without needing treatment. However, it still needs to be watched because some cases will require treatment. The exact cause of central serous choroidopathy remains uncertain. It usually occurs in young healthy people, and is more common in males.

Who is at risk?
We don’t know yet what triggers central serous choroidopathy. There is research on why certain people develop central serous choroidopathy – and when and why the disease will flare up in one eye or the other. But it does seem to strike young, healthy people – usually males experiencing significant stress.

Treatment options.
Usually nothing. That’s because this leakage usually seals itself off over a period of weeks or months. If this happens, your body may resorb the leaked fluid and your vision in that eye will return to almost normal.

However, if the fluid is not resorbed after three months a repeat Fluorescein Angiogram may be performed. If there is a persistent leak, the photocoagulations of this leak could be performed to hasten the resorption of the fluid.

Retinopathy of Prematurity

The retina is the light-sensitive lining of the eye. In unborn babies that lining usually develops normally – as does the rest of the fetus. But sometimes in premature babies that lining can develop abnormally, a condition called retinopathy of prematurity (ROP). It generally occurs in both eyes, but one eye may be worse than the other. Having ROP in only one eye is very rare.

Infants are not born with ROP. Rather they are born with an immature retina, one with incomplete development of the vessels that supply blood to the retina. Not all premature infants develop retinopathy of prematurity. And even for those infants born with this condition, it often resolves without treatment. But if ROP worsens, the condition must be treated. That’s because ROP can worsen into a potentially blinding eye problem, one which each year results in the blindness of about 500 infants in the United States alone.

- Additional Complications of ROP

For most infants with mild retinopathy of prematurity (stages 1 to mild 3), the ROP will resolve spontaneously with no remaining scar tissue. But if the disease should progress, some infants with ROP may suffer further complications later in life. These complications may include:

-Strabismus and Amblyopia.
Strabismus (crossed eyes) and amblyopia (lazy vision in one eye) occur more often in infants with even the mildest stages of regressed ROP than in premature infants who do not develop ROP. This may require eye muscle surgery for strabismus and patching for amblyopia.

-Myopia.
This near-sightedness may occur with the mildest forms of regressed ROP. The greater the amount of ROP scar tissue remaining, the more severe the myopia. But such near-sightedness can be corrected with glasses.

-Glaucoma.
This increased pressure in eyes with regressed or treated ROP may cause pain and damage vision. Laser treatment or surgery may be necessary to help the eye drain off the build-up of watery fluid (aqueous fluid) that causes increased pressure.

-Late-onset retinal detachment.
In rare cases this may occur in the mid-teens or early adulthood. As the eye grows or the vitreous gel shrinks, ROP scar tissue can pull holes in the retina. This usually requires surgery to repair. It’s important that anyone who has had ROP see a retinal specialist or pediatric ophthalmologist at least once a year during childhood and early adult years.

- Who is at risk?

There are two critical factors for predicting which children are most likely to develop retinopathy of prematurity (ROP):

-Birth weight of less than 3 lbs 5 oz.
-Birth after a pregnancy of less than 32 weeks.

Infants weighing less than 2 lbs 3 oz. at birth and born after a pregnancy of 23 to 28 weeks have a particularly high chance of developing retinopathy of prematurity. The lower the birth weight and gestational age, the higher the risk and severity of ROP.

- Treatment Options

There are three options for treating ROP:

-Cryotherapy. This has been the standard treatment for ROP since the late 1980s. In half the cases of infants with threshold ROP, cryotherapy prevents progression to retinal detachment and possible blindness. A cold probe applied to the outside of the eye freezes the abnormal retina, eliminating its demand for oxygen. The abnormal blood vessels disappear and progression of scar tissue stops.

-Lasers. For more than 20 years lasers have been used to treat eye disorders in adults. But recent technical advances now make it possible to apply this treatment to newborn infants. The indirect ophthalmoscope – the same instrument used to examine the infant’s eye – is also used to deliver the laser beam into the eye. If the doctor can see the abnormal retina, the laser can treat it – with fewer side effects.

-Surgery. If cryotherapy or laser treatment at stage 3 is unsuccessful in preventing the progression to retinal detachment, there are still some surgical options. If the detachment is shallow – not a lot of space between the retina and the eye wall, a technique called scleral buckling may prove effective. This involves placing a silicone “belt” around the outside of the eye and tightening it until the retina is close enough to the wall to reattach itself. If scleral buckling is impossible or unsuccessful, a vitrectomy can be performed.

- Stages of ROP

If an infant does develop ROP, the condition will appear when the infant is between 5 and 15 weeks old. In many cases, the disease disappears as the retinal blood supply develops normally. But if ROP does not resolve itself, the disease can progress to retinal detachment and blindness.

CMV Retinitis

What is it?
Cytomegalovirus (CMV) is a member of the herpes simplex virus family. Mild CMV infections are common in otherwise healthy people but severe CMV disease is not. Your immune system usually keeps them from triggering an active disease. In someone with a weak immune system, it can cause CMV retinitis, an infection of the eye that can lead to blindness. If left untreated, CMV can spread throughout the body, infecting other organs to create a wide range of symptoms that can lead to serious illness, even blindness. Effective treatments for CMV diseases are now available if the infection is detected early.

CMV retinitis can also cause the retina to become weak, thin – and more susceptible to developing holes. This, in turn, can lead to detachment of the retina.

- Symptoms

The earliest symptoms patients with CMV notice are floaters, dark spots moving in the vision. Patients may also notice a shadow or curtain blocking vision.

- Risk Factors

Those most at risk for contracting cytomegalovirus (CMV) are people having problems with their immune systems - low T4 cell counts for example. Some 20 to 40 percent of HIV-positive patients diagnosed with AIDS also suffer from CMV retinitis. Patients with weak immune systems due to cancer, chemotherapy or other conditions can also develop CMV retinitis.

- Treatment Options

Three drugs have been approved for the treatment of CMV retinitis: foscarnet, cidofovir and gancyclovir. All three can slow down the progression of CMV, although they cannot cure the illness.

Until recently, all anti-CMV drugs had to be given by intravenous infusion, which means into a vein. New approaches are now being tested, however:

• Oral treatments:
  Different formulations of gancyclovir are now in use. Their safety and effectiveness are under study.

• Implants:
  A gancyclovir implant is also being used to deliver highly localized dosages to fight CMV in the eye. To do this a sustained-release pellet of gancyclovir is placed within the vitreous. An injectable drug called Vitravene is also available.

• If CMV retinitis leads to retinal detachment, a vitrectomy – combined with laser surgery and placing silicone oil in the eye – can reattach the retina and prevent further loss of vision. If the retinal detachment is small, laser treatment alone can be effective.

Uveitis

What it is?

The uvea is the pigmented middle layer of the eye - between the sclera and the retina - which also includes the iris, the ciliary body and the choroid. Anything that affects the uvea can affect your vision.

Uveitis is an inflammation of the inside of the eye. Causes of uveitis can include allergy, infection, chemical exposure, trauma - or the cause may be unknown. Because it may be associated with more than 100 diseases, uveitis also serves as an indication of other medical problems.

There are two types of uveitis: the more common non-granulomatous and the more serious granulomatous. Uveitis can also be classified by the specific location of the infection:

-Iritis is an inflammation of the front of the uvea.
-Cyclitis is an inflammation of the middle of the uvea.
-Choroiditis is an inflammation of the rear of the uvea.

Whatever the location of the Uveitis, remember this: If left untreated, inflammation inside the eye can lead to blindness. If you suspect you have Uveitis, consult an ophthalmologist at once.

- Risk Factors

A history of autoimmune diseases - such as rheumatoid arthritis or ankylosing spondylitis - is a risk factor. The disorder may affect only one eye and is most common in young and middle?aged people.

There is sometimes a heredity factor in Uveitis. If your family has any history of this disease, regular eye exams are advisable.

- Symptoms

The symptoms of uveitis vary and can be similar to the symptoms of many other eye conditions. Patients may notice that the eye is red, or feels irritated and uncomfortable. Tearing and light sensitivity may occur. There is often blurred vision, and patients may notice floaters.

- Treatment Options

There are many different treatments for uveitis depending on what parts of the eye are involved, associated medical conditions and the severity of involvement. Often, anti-inflammatory steroid medications are used. There are potent medicines with possible side effects. Therefore, mild cases of uveitis may be watched without treatment. Uveitis affecting the front of the eye may be treated with anti-inflammatory eye drops. Eye drops, however, can not treat uveitis in the back of the eye. When the back of the eye is involved, injection of medicine around the eye, or systemic medications may be needed. Because uveitis can be so variable, many varied treatment regiments are used.

Uveitis can lead to other problems such as glaucoma, cataract, scar tissue in the eye, and new blood vessel growth. This may require laser or surgical treatment.

What is cancer of the eye?

Cancer refers to a group of diseases marked by uncontrolled cell growth. These cancer cells displace normal cells and interrupt their function. Cancer cells can spread to other parts of the body.

Cancers of the eye are rare but they can take many forms:

-External diseases
Cancers of the eyelids and surface of the eye. These include external lesions such as conjunctival tumors. Skin cancer commonly occurs on the eyelids.

-Intraocular diseases
Cancers within the eye. These may be present as uveal tumors of the iris, choroid or ciliary body – or, in childhood, as retinal tumors.

-Orbital diseases
Cancers in areas surrounding the eye. These lesions include vascular and inflammatory tumors.

The most frequently treated adult intraocular cancer is choroidal melanoma. Spread of cancer from other parts of the body

- Diagnostic tools.

The diversity of the disease underscores the importance of accurate diagnosis and of the state-of-the-art medical technologies that make such diagnosis possible. Among them:

-Fundus Photography
-Fluorescein angiography
-Digital angiography
-Standardized A-scan ultrasonography
-B-scan ultrasonography
-High-frequency anterior segment ultrasonography

Behind each of these tools is an experienced medical professional with the expertise to make the right diagnosis. This expertise is the logical outcome of an extensive experience seeing, diagnosing and treating eye tumors.

- Treatment Options

We approach treating ocular cancer with two goals: to cure the disease and to preserve as much vision as possible. But determining the best treatment for cancer of the eye depends upon a number of factors.

The nature of the diagnosis dictates the appropriate treatment. Determining the best treatment for ocular oncology depends upon a number of factors. The patient's needs, tumor type, location, size, thickness, histopathology and its natural history with and without therapy all play a role.

Our ocular oncology program in association with Rush-Presbyterian-St. Luke's Medical Center offers the broadest range of state-of-the-art treatments, tailored to the specific needs of each patient. Among the following options:

-Observation is sometimes called for because it is necessary to study the tumor for developments before suggesting a course of action.

-Chemotherapy is the use of cytotoxic chemicals to destroy cancer cells on a selective basis.

-Radiation therapy can involve the use of iodine 125 plaque or a linear accelerator to deter the proliferation of malignant cells by decreasing the rate of mitosis or impairing DNA synthesis.

-Transpupillary thermal therapy (TTT) uses a long-duration laser to generate heat to kill the tumor.

-Laser therapy uses an intense beam of high-energy electrons to destroy tumor cells and prevent proliferations.

-Cryotherapy is the application of extreme cold for the purpose of destroying malignant cells.

-Tumor removal requires the surgical resection of malignant tissue.

-Removal of the eye is sometimes unavoidable. But it is always the last resort.

Which is right for a specific patient? That depends upon the patient and the tumor. But there are choices. The many types of eye cancer – and the number of treatment options demand a multidisciplinary approach. The information presented here is offered as an educational service. In no way can this web site take the place of a consultation with your ophthalmologist.

- Oncology expertise.

This complete spectrum of the diagnosis and treatment of ocular oncology does not occur in a vacuum. It demands the ongoing consultation, collaboration and involvement of specialists in many critical disciplines. At Illinois Retina Associates, our ocular oncology program is led by Dr. Jack Cohen. Dr. Cohen is also Assistant Professor of Ophthalmology and Radiation Oncology at Rush Medical College and director of Ocular Oncology Services at Rush-Presbyterian-St. Luke's Medical Center.

After graduating from Rush Medical College, Dr. Cohen completed his residency at Rush-Presbyterian-St. Luke's Medical Center. This was followed by a fellowship in ocular oncology at the University of California, San Francisco, and an additional fellowship in vitreoretinal surgery at Rush-Presbyterian-St. Luke's Medical Center/Ingalls Hospital. In Dr. Cohen’s words:

"Tumors of the eye are rare, but they need to be diagnosed and treated by experts in the field. There are few doctors with the training and experience to diagnose and treat this condition. That expertise combined with the broad range of medical skills and interdisciplinary approach of Illinois Retina Associates and Rush-Presbyterian-St. Luke's Medical Center/Ingalls Hospital translates into the assurance you made the right medical decision."

Flashing Light and Floaters

What is it?

Floaters:
Most of your eye is filled with a clear gelatin-like substance called the vitreous humor. This fluid is mostly water but also contains connective tissue fibers, which actually float around inside the vitreous. These are the floaters that most people see occasionally. They may resemble dark specks, clouds, threads or spider webs moving through your field of vision. As you age, this connective tissue can loosen up – and some of the fibers adhere to each other to create bigger fibers. When that happens, the floaters become more noticeable. But they are usually harmless.

Flashes:
As you age, the vitreous gel within your eye shrinks. When it does, it pulls on the retina, causing you to see what appears as little flashes of light within your eye. In themselves, these flashes are harmless. But the pulling on the retina which triggers them can lead to a retinal tear or even to eventual detachment of the retina.

You are more likely to see flashes as you age and if you are nearsighted. Floaters are also related to age. As you get older, the more likely you are to notice them. Floaters can also be caused by an eye injury or surgery.

While floaters and flashes are common, they are sometimes a cause for concern. You should consult your doctor if:

-You suddenly start seeing a lot of flashes and floaters that you’ve never seen before.

-You have seen some flashes or floaters but the number of them suddenly increase.

-The flashes and floaters you’re used to seeing now look different.

-Flashes or floaters make it hard to do your normal tasks.

When floaters and flashes appear suddenly in one eye, you should have that eye checked as soon as possible.