Retinal Diseases

Diagnosis

To make a diagnosis, an ophthalmologist performs a thorough eye exam and looks for irregularities anywhere in the eye. The following tests may be done to determine the location and extent of the disease:

Amsler grid test. An eye professional may use an Amsler grid to test the clarity of your central vision. You’ll be asked if the lines of the grid appear faded, broken or distorted. Identifying where the distortion occurs helps reveal the extent of retinal damage. If you have macular degeneration, you may be instructed to use this test at home to self-monitor your condition.

Optical coherence tomography (OCT). This imaging test captures precise, high-resolution images of the retina. It can help diagnose epiretinal membranes, macular holes and macular swelling, known as edema. OCT also helps monitor the severity of age-related wet macular degeneration and treatment response.

Fundus autofluorescence (FAF). FAF may be used to determine the stage of retinal diseases, including macular degeneration. It highlights a pigment in the retina called lipofuscin, which increases with retinal damage or dysfunction.

Fluorescein angiography. This test uses a dye that makes blood vessels in the retina visible under a special light. It helps identify closed, leaking or newly formed irregular blood vessels, along with subtle changes in the back of the eye.

Indocyanine green angiography. This test uses a dye that becomes visible under infrared light, allowing imaging of the retina as well as the deeper blood vessels located in the choroid, the layer beneath the retina.

Ultrasound. High-frequency sound waves are used to view the retina and other internal structures of the eye. Ultrasound can also reveal tissue characteristics that support the diagnosis and treatment of eye tumors.

CT and MRI. In rare cases, these imaging methods help evaluate eye injuries or tumors.

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Treatment

The main goals of treatment are to stop or slow the progression of disease and to preserve, improve or restore vision. Damage that has already occurred often cannot be reversed, making early detection important. Your eye doctor will work with you to decide on the most appropriate treatment.

Treatment of retinal disease may be complex and, at times, urgent. Options include:

• Using a laser. Laser surgery can repair a retinal tear or hole. Small pinpoints of heat are applied to the retina to create scars that bind it to the underlying tissue. Prompt laser treatment of a new tear can lower the risk of retinal detachment.

• Shrinking irregular blood vessels. Scatter laser photocoagulation may be used to shrink abnormal new blood vessels that are bleeding or at risk of bleeding. This treatment is commonly used for diabetic retinopathy. Extensive use may cause some loss of peripheral or night vision.

• Freezing. In a procedure called cryopexy, a freezing probe is applied to the outside wall of the eye over the retinal tear. The intense cold reaches the retina, creating a scar that helps secure it to the eye wall.

• Injecting air or gas into the eye. Pneumatic retinopexy is used to repair certain types of retinal detachment. It may be performed together with cryopexy or laser photocoagulation.

• Indenting the eye surface. In scleral buckling surgery, a small piece of silicone material is sewn to the outer surface of the eye. This indents the sclera, relieving pulling forces from the vitreous and helping reattach the retina. It may be combined with other procedures.

• Evacuating and replacing the eye’s internal fluid. During vitrectomy, the gel-like vitreous is removed and replaced with air, gas or liquid. This technique is used when bleeding or inflammation blocks the surgeon’s view or as part of treatment for retinal tears, diabetic retinopathy, macular holes, epiretinal membranes, infection, trauma or retinal detachment.

• Injecting medicine into the eye. Medication may be injected into the vitreous to treat wet macular degeneration, diabetic retinopathy or leaking blood vessels.

• Implanting a retinal prosthesis. People with severe vision loss or blindness from certain inherited retinal diseases may benefit from surgery to implant a tiny electrode chip in the retina. This chip receives input from a video camera mounted on eyeglasses and relays visual information that the damaged retina can no longer process.