Retinal Conditions

Branch Retinal Artery Occlusion (BRAO)

Acute, painless, partial, or complete loss of vision

Condition

BRAO is a blockage of one of the arteries in the retina and poses significant risks to vision. The most common causes of BRAO include cholesterol emboli from aorto-carotid atheromatous plaques, platelet-fibrin emboli from thrombotic disease (blood clot), and calcific emboli from cardiac valvular disease.

Risk factors

Risk factors for a BRAO include high blood pressure, smoking, diabetes, high cholesterol, coronary artery disease, heart valve problems, intravenous drug abuse, atrial fibrillation, or history of stroke or transient ischemic attack (TIA). Having a family history of blood clots or clotting disorder also increases your risk.

Symptoms

Symptoms of a branch retinal artery occlusion include acute painless loss of vision or blurring in one eye. Vision loss may be complete or partial. Some patients may experience brief episodes (1-10 minutes) of vision loss known as amaurosis fugax prior to developing a BRAO, and some patients may be asymptomatic.

Treatment

Following a BRAO, vision can range from normal to extremely limited. If you have had a BRAO, regular visits with your ophthalmologist are essential. Rarely, patients can develop neovascularization which leads to further vision loss and possibly glaucoma. Depending on your age, a focused workup will be performed to identify risk factors and find the cause (which can be identified in 90% of patients). Managing the cause, either medical or surgical, as well as controlling the factors causing the condition can lessen the chances of BRAO recurring, worsening over time, or having a stroke. Working with your general practitioner or cardiologist to best control any risk factors you may have can help to reduce the risk of a BRAO.

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Branch Retinal Vein Occlusion (BRVO)

A condition associated with high blood pressure

Condition

Branch Retinal Vein Occlusion (BRVO) is a blockage of one of the small veins (venules) in the retina and poses significant risks to vision. The arteries and veins in the retina share a common sheath where they cross each other. With time, the arteries become less like a garden hose and more like a lead pipe. This causes the artery to flatten the vein, thus stopping the flow of blood causing swelling and bleeding in the retina leading to decreased vision.

Risk factors

The main risk factors are high blood pressure, smoking, and high cholesterol which lead to atherosclerosis (hardening of the arteries).

Symptoms

The symptom of a BRVO is an acute, painless change in your vision. You may notice decreased, misty, blurred, or distorted vision.

Treatment

The mainstay of treatment is injections of medicine into the eye which have been proven to decrease swelling and improve vision. Careful observation is required as neovascularization (new leaky blood vessels) can form leading to decreased vision from swelling, vitreous hemorrhage, glaucoma, or tractional retinal detachment. A laser is sometimes employed to decrease the risk of neovascularization. Working with your primary care physician to treat the risk factors is also very important not only for the health of your eyes but also for your overall health.

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Central Retinal Artery Occlusion (CRAO)

Sudden, potentially permanent loss of vision primarily affecting those ages 50 to 70

Condition

Central Retinal Artery Occlusion is a blockage of the central retinal artery, which results in sudden, painless, and potentially permanent, loss of vision across a wide area of the visual field.

Risk factors

• CRAO usually occurs in people between the ages of 50 and 70.
• high blood pressure
• smoking
• diabetes
• high cholesterol
• coronary artery disease
• heart valve problems
• patent foramen ovale (heart anomaly)
• intravenous drug abuse
• atrial fibrillation
• history of stroke or transient ischemic attack (TIA)
• Having a family history of blood clots or clotting disorder also increases your risk.
• Giant Cell Arteritis (GCA) is another disease that can cause a CRAO.

Symptoms

Central retinal artery occlusion (CRAO) blocks the central artery in the retina, causing a sudden and painless loss of vision.

Symptoms of this disease also include: headache, temporal tenderness, jaw pain while chewing food, weight loss, double vision, and decreased vision.

Treatment

It is critical to get immediate treatment to try and avoid permanent loss of vision. Irreversible retinal damage occurs after 90 minutes, but vision may still be saved 24 hours after symptoms begin. The goal of emergency treatment is to restore retinal artery blood flow. A thorough medical evaluation is recommended after treatment. Working with your general practitioner or cardiologist to best control any risk factors you may have can help to reduce the risk of a CRAO.

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Central Retinal Vein Occlusion (CRVO)

A blockage causing decreased vision

Risk factors

CRVO often occurs with glaucoma, diabetes, high blood pressure, heart diseases, and blood disorders. It has also been associated with oral contraceptive use and obstructive sleep apnea.

Symptoms

CRVO usually is in one eye, causing a blurring or loss of vision in all or part of the eye. It can be painful because the blocked vein causes pressure in the eye.

Treatment

The mainstay of treatment is injections of medicine into the eye which have been proven to decrease swelling and improve vision. Careful observation is required as neovascularization (new leaky blood vessels) can form leading to decreased vision from swelling, vitreous hemorrhage, glaucoma, or tractional retinal detachment. Laser is sometimes employed to decrease the risk of neovascularization. Working with your primary care physician to treat the risk factors is also very important not only for the health of your eyes but also for your overall health.

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Lattice Degeneration

Typically affecting nearsighted patients 25 years and older

Condition

Lattice degeneration is a peripheral retina condition in which the retinal tissue is thinned, atrophied and the blood vessels are fibrosed (scarred) in a “lattice-like” appearance. Lattice lesions, usually localized, appear as round/oval or linear patches in the far peripheral retina. In uncommon cases, it may be accompanied by retinal detachment.

Risk factors

The typical patient with lattice degeneration is over 25 years of age and usually, but not always, nearsighted. There is currently no known procedure for the prevention of lattice degeneration, although accompanying retinal detachment can be prevented with lasers or cryoretinopexy.

Symptoms

The patient usually does not experience any symptoms, except for possible complaints of flashing lights.

Prevalence

Lattice degeneration is present in about 8 percent of the general population, 45% of the time affects both eyes, and occurs in about 30 percent of eyes with retinal detachment.

Treatment

Most of the time, no treatment is needed. Lasers or cryoretinopexy are sometimes used prophylactically to help prevent retinal detachments in more risky appearing eyes (eyes with atrophic holes, traction, and/or subretinal fluid in the lattice).

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Macular Pucker / Epiretinal Membrane

Scar tissue distorting vision

Condition

A macular pucker or epiretinal membrane (ERM) is scar tissue that forms on the macula, the portion of the retina responsible for central vision (reading, driving, etc.). An ERM results from cells migrating either out of the retina or from under the retina to the surface of the macula where they form a collagen membrane. The membrane then can contract and cause distortion of the underlying macular surface and vision. Any condition that allows cells normally found under the retina to propagate on the surface can lead to a macular pucker or epiretinal membrane, the most common being a posterior vitreous detachment or PVD (see Flashes and Floaters and Posterior Vitreous Detachment). An ERM is also sometimes called a retinal wrinkle, premacular fibrosis, and cellophane maculopathy. Its nasty first cousin is proliferative vitreoretinopathy (PVR), the number one cause of failure of retinal detachment repair surgery.

An ERM is another of several diseases that affects the macula. The ERM affects the front side of the retina while macular degeneration affects the underside of the retina. Although the symptoms are superficially somewhat similar, an ERM is definitely not macular degeneration. It has a distinct mechanism of action, prognosis, and therapy.

Risk factors

PVD, previous trauma to the eye, previous retinal tear or detachment, previous laser performed on the retina and/or previous inflammation in the eye.

Symptoms

The primary symptom of an ERM is the gradual development of distortion in vision in one eye – straight lines can appear wavy. Usually the distortion develops over weeks to months. After this initial contraction phase, the distortion often remains stable for a long period, if not indefinitely. Patients who are ready to consider surgery for an ERM often complain that they have to close the affected eye in order to effectively read. The problem is that the brain tries to mesh the images of the two eyes, and in the case of severe distortion coming from one eye, the two images cannot properly mesh and the overall experience of vision degrades. Unlike macular degeneration, it is very rare for ERM to produce symptoms in more than one eye.

Treatment

The majority of patients with an ERM need no treatment. Either they have no symptoms or have adjusted well to the mild distortion they experience. If symptoms affect activities of daily living, vitrectomy surgery can be performed. During this procedure, the vitreous gel is removed and specialized forceps are used to peel the scar tissue off the surface of the retina. (see Epiretinal Membrane Surgery). Surgery can be performed to remove the membrane, improve the retinal surface, and improve vision.

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Uveitis

Condition typically affecting patients 20 to 50 years old

Condition

Uveitis is inflammation of the uvea, the center section of the eye made up of the iris, ciliary body, and choroid. Causes of uveitis include allergens, viruses, bacteria, chemicals/medications, autoimmune diseases, and direct trauma to the eye.

Risk factors

Uveitis occurs most frequently in people aged 20 to 50. It is more common in women than men, and more likely to develop with age. Uveitis can also be caused by autoimmune diseases, such as rheumatoid arthritis or ankylosing spondylitis, or by exposure to toxins. It can also be associated with AIDS, psoriasis, sarcoidosis, tuberculosis, and several other conditions and infections.

Symptoms

• Red eyes
• Burning sensation
• Itchy eyes
• Discharge and/or tearing
• Blurry vision
• Sensitivity to light
• Floating dark spots in your field of vision
• Pain or soreness of the eye

Treatment

Treatment addresses the underlying cause, whether infectious, autoimmune or related to medication or trauma. Therefore, uveitis is usually treated in conjunction with your primary care physician, infectious disease specialist, or rheumatologist. Systemic control of the underlying disease is achieved with oral or IV antibiotics, antivirals, steroids, immunosuppressive, and pain medications. Eye drops and possibly injections in the eye with these agents are also usually warranted. Wearing sunglasses and using dilating drops can significantly improve light sensitivity and ocular irritation from the uveitis.

Uveitis generally goes away with proper treatment, but relapses are common, especially when the underlying condition still exists. Vision can be permanently affected.

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