General | Cataract | Glaucoma & Macular Degeneration | Ocular Surface Disease & Eyelids | Retina | Miscellaneous
Diabetes Mellitus (DM)
If you have diabetes mellitus, your body does not use and store glucose (sugar) properly. There are two types of diabetes.
One is insulin dependent diabetes mellitus (IDDM), and this usually is diagnosed in adolescence. The pancreas is an organ in the body that produces insulin, and sometimes people have a defective pancreas and are therefore not able to produce the necessary insulin to keep the body blood sugars regulated. Insulin is the molecule that regulates blood sugar levels, and without it the blood sugar levels can increase to a dangerous level. Excessive blood sugar levels will then go on to cause significant damage to every organ in the body.
Another type of diabetes is non-insulin dependent diabetes mellitus (NIDDM). This is often called adult-onset diabetes, as it is frequently diagnosed at a later stage of life (usually over the age of 30). The ultimate problem is the same (poor regulation of blood sugars), but the body can still produce some insulin. The insulin produced by the body is not sufficient for good blood sugar control, and people may take oral medications and/or insulin to help control the blood sugars and the blood sugar level resistance to the amount of insulin produced by the body.
Over time, diabetes will damage all of the blood vessels throughout the body. This can occur despite good blood sugar control, but certainly occurs quicker in people who have poor blood sugar control. A person cannot tell if or when his or her ocular blood vessels are being affected. Significant damage can occur in the ocular vessels even when vision is completely normal. This is why a yearly eye exam is critical for everyone with diabetes. The blood vessels within the eye are among the smallest blood vessels in the body, and therefore the early (microscopic) damage that diabetes causes to all blood vessels will show up first in the eye. A person can have normal, 20/20 vision with significant damage to their ocular blood vessels without realizing it. Only a diabetic examination by an eye doctor is able to tell if these blood vessels are damaged, and to what extent. The damage to these retinal vessels is referred to as diabetic retinopathy. Diabetic retinopathy changes can often be improved if the damage is not severe. But, if left untreated and unchecked, diabetic retinopathy can lead to total and complete blindness.
Did you know that diabetes:
- is the leading cause of blindness in working-age Americans?
- is the fourth most common cause of visual loss in people over age 55?
- is responsible for 7% of legal blindness in those over age 65?
and most all of these eye problems are preventable with early diagnosis and management by an eye doctor!
Non-proliferative Diabetic Retinopathy
At a minimum, every diabetic patient need an annual eye examination with dilation (or more frequently), regardless of how good their vision is doing.
(Click HERE for video)
Non-proliferative diabetic retinopathy (NPDR), commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates (seen in picture below).
Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema or macular ischemia, or both.
If you have diabetes, early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision loss by maintaining strict control of your blood glucose and visiting your ophthalmologist regularly. People with diabetes should schedule examinations with dilation at least once a year. Pregnant women with diabetes should schedule an appointment in their first trimester, because retinopathy can progress quickly during pregnancy. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy is made.
Background Diabetic Retinopathy:
(BDR or NPDR) with exudates and bleeding
Proliferative Diabetic Retinopathy
(Click HERE for video)
Proliferative diabetic retinopathy (PDR) is a complication of diabetes caused by changes in the blood vessels of the eye. If you have diabetes, your body does not use and store sugar properly. High blood sugar levels create changes in the veins, arteries, and capillaries that carry blood throughout the body. This includes the tiny blood vessels in the retina, the light-sensitive nerve layer that lines the back of the eye.
In PDR, the retinal blood vessels are so damaged they close off. In response, the retina grows new, fragile blood vessels or develops neovascularization¯ or NV¯ (neo, for new¯ and vascularization, for vessels¯). Unfortunately, these new blood vessels are abnormal and grow on the surface of the retina, so they do not resupply the retina with blood.
Often, these new blood vessels bleed and cause a vitreous hemorrhage (VH). Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood (one drop even) will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception.
The new blood vessels or neovascularization can also cause scar tissue to grow. The scar tissue shrinks, wrinkling and pulling on the retina and distorting vision. If the pulling is severe, the macula may detach from its normal position and cause vision loss from a retinal detachment.
Laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding. Other, newer medicines may also help shrink the abnormal blood vessels. The body will usually absorb blood from a vitreous hemorrhage, but this can take days, months, or even years. 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. During a vitrectomy, the retina surgeon removes the hemorrhage and any scar tissue that has developed, and performs laser treatment to prevent new abnormal vessel growth.
People with PDR sometimes have no symptoms until it is too late to treat them. The retina may be badly injured before there is any change in vision. There is considerable evidence to suggest that rigorous control of blood sugars decreases the chance of developing serious proliferative diabetic retinopathy.
Because PDR often has no symptoms until the vision is lost, if you have any form of diabetes you should have your eyes examined at least yearly by Dr. Haas.
Proliferative Diabetic Retinopathy:
(PDR of the Optic Disc seen as tiny new blood vessels)
(Click HERE for video)
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. The swelling is caused by fluid leaking from retinal blood vessels, and is the most common cause of visual loss from diabetes. Vision loss from macular edema may be mild to severe, but even in the worst cases, peripheral (side) vision continues to function. Laser treatment and anti-VEGF injections (anti vascular endothelial growth factor) can be used to help control vision loss from macular edema.
Because the macula is surrounded by many tiny blood vessels, anything that affects blood vessels elsewhere in the body (like diabetes) can cause macular edema as well.
Retinal blood vessel obstruction, eye inflammation, and age-related macular degeneration have all been associated with macular edema. The macula may also be affected by retinal swelling following cataract extraction, although this is less common.
Treatment seeks to remedy the underlying cause of the edema. Eyedrops, injections of steroids or other, newer medicines (anti-VEGF) in or around the eye, or laser surgery can be used to treat macular edema. Recovery depends on the severity of the condition causing the edema.
Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly. Unfortunately, there are no effective treatments for macular ischemia.
A medical eye examination is the only way to discover any changes inside your eye. If Dr. Haas finds diabetic retinopathy, he may order color photographs of the retina or a special test called optical coherence tomography (OCT) to find out if you need treatment.
Diabetic Macular Edema:
Branch Retinal Artery Occlusion (BRAO)
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.
Central Retinal Artery Occlusion (CRAO)
Branch retinal artery occlusion (BRAO) blocks the small arteries in the retina, the light-sensing nerve layer lining the back of the eye. The most common cause of BRAO is a thrombosis, the formation of a blood clot. Sometimes the blockage is caused by an embolus, a clot carried by the blood from another part of the body.
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. Following BRAO, vision can range from normal (20/20) to being barely able to detect hand movement.
BRAO poses significant risks to vision. If you have had a branch retinal artery occlusion, regular visits to your ophthalmologist are essential.
(whitening in the retina where non-perfusion or ischemia occurred)
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. The most common medical problem associated with CRAO is arteriosclerosis (hardening of the arteries). Carotid artery disease is found in almost half the people with CRAO.
The most common cause of CRAO is a thrombosis (an abnormal blood clot formation). 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.
CRAO blocks the central artery in your retina, the light-sensitive nerve layer at the back of the eye. 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.
Loss of vision can be permanent without immediate treatment. Irreversible retinal damage occurs after 90 minutes, but even 24 hours after symptoms begin, vision can still be saved. The goal of emergency treatment is to restore retinal blood flow. After emergency treatment, you should have a thorough medical evaluation.
(diffuse whitening of the retina from non-perfusion with a cherry red¯ central spot)
Branch Retinal Vein Occlusion (BRVO)
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. High blood pressure is the most common condition associated with branch retinal vein occlusion (BRVO). About 10% to 12% of the people who have BRVO also have glaucoma (high pressure in the eye).
Central Retinal Vein Occlusion (CRVO)
BRVO blocks small veins in the retina, the layer of light-sensing cells at the back of the eye. 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. During the course of vein occlusion, 60% or more will have swelling of the central macular area. In about one-third of people, this macular edema will last for more than one year.
BRVO causes a painless decrease in vision, resulting in misty or distorted vision. 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.
There is no cure for BRVO. Finding out what caused the blockage is the first step in treatment. Dr. Haas may recommend a period of observation, since hemorrhages and excess fluid may subside on their own. Depending on how damaged the veins are, laser surgery may help reduce the swelling and improve vision. Laser surgery may also shrink abnormal new blood vessels that can grow and that are at risk of bleeding. Newer, injectable medicines (anti-VEGF and steroids) are being investigated for treating BRVO as well.
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 Serous Retinopathy (CSR)
Central retinal vein occlusion (CRVO) blocks the main vein in the retina, the light-sensitive nerve layer at the back of the eye. The blockage causes the walls of the vein to leak blood and excess fluid into the retina. When this fluid collects in the macula (the area of the retina responsible for central vision), vision becomes blurry.
Floaters¯ in your vision are another symptom of CRVO. 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. Blood in the vitreous clumps and is seen as tiny dark spots, or floaters, in the field of vision.
In severe cases of CRVO, the blocked vein causes painful pressure in the eye. Retinal vein occlusions commonly occur with glaucoma, diabetes, age-related vascular disease, high blood pressure, and blood disorders.
The first step of treatment is finding what is causing the vein blockage. There is no cure for CRVO. Dr. Haas may recommend a period of observation, since hemorrhages and excess fluid often subside on their own. 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. Newer, injectable medicines (anti-VEGF and steroids) are being investigated for treating CRVO as well.
Central serous retinopathy (CSR) is a small, shallow swelling that develops on the retina, the light-sensitive nerve layer that lines the back of the eye. Although the swelling reduces or distorts vision, the effects are usually temporary. Vision generally recovers on its own within a few months.
In the initial stages of CSR, vision may suddenly become blurred and dim. If the macula (the area of the retina responsible for central vision) is not affected, there may be no obvious symptoms.
CSR typically affects adults between the ages of 20 and 50. 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. Some people with frequent episodes may have some permanent vision loss. Recurrences are common and can
affect 20% to 50% of people with CSR. While the cause of CSR is unknown, it seems to occur at times of personal or work-related stress.
As CSR usually resolves on its own, no treatment may be necessary. Sometimes laser surgery can reduce the swelling sooner, but the final visual outcome is usually about the same. If retinal swelling persists for more than three or four months, or if an examination reveals early retinal degeneration, laser surgery may be helpful.
OCT of CSR (demonstrating swelling):
Normal OCT (no swelling):
Flashes and Floaters
(Click HERE for video)
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. Most people have some floaters normally but do not notice them until they become numerous or more prominent.
In most cases, floaters are part of the natural aging process. Floaters look like cobwebs, squiggly lines, or floating bugs. They appear to be in front of the eye but are actually floating inside. 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 (called a posterior vitreous detachment, or PVD). What you see are the shadows these clumps cast on the retina, the light-sensitive nerve layer lining the back of the eye.
The appearance of flashing lights comes from the traction of the vitreous gel on the retina at the time of vitreous separation. Flashes look like twinkles or lightning streaks. You may have experienced the same sensation if you were ever hit in the eye and saw stars.¯
Floaters can get in the way of clear vision, often when reading. Try looking up and then down to move the floaters out of the way. While some floaters may remain, many of them will fade over time.
Floaters and flashes are sometimes associated with retinal tears. When the vitreous shrinks, it can pull on the retina and cause a tear. A torn retina is a serious problem. It can lead to a retinal detachment and blindness. If new floaters appear suddenly or you see sudden flashes of light, see Dr. Haas right away.
Detached and Torn Retina
A retinal detachment is a very serious problem that usually causes blindness unless treated. The appearance of flashing lights, floating objects, or a gray curtain moving across the field of vision are all indications of a retinal detachment. If any of these occur, see Dr. Haas right away.
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. Sometimes as the vitreous shrinks, it exerts enough force on the retina to make it tear.
Retinal tears can lead to a retinal detachment. Fluid vitreous, passing through the tear, lifts the retina off the back of the eye like wallpaper peeling off a wall. Laser surgery or cryotherapy (freezing) are often used to seal retinal tears and prevent detachment. These are essentially spot-welds of the retina to seal off the tear.
If the retina is detached, it must be reattached before sealing the retinal tear. There are three ways to repair retinal detachments. Pneumatic retinopexy involves injecting a special gas bubble into the eye that pushes on the retina to seal the tear. 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. Vitrectomy surgery removes the vitreous gel from the eye, replacing it with a gas bubble, which is slowly replaced by the body™s fluids. Sometimes silicone oil is placed in the eye rather than gas for severe detachments in order to keep the retina in place after a vitrectomy.
Retinal Detachment Drawings:
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). It may be used to treat a severe eye injury, diabetic retinopathy, retinal detachments, macular pucker (wrinkling of the retina), and macular holes.
During a vitrectomy operation, the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous and repairs the retina through these tiny incisions. Repairs include removing scar tissue or a foreign object if present.
During the procedure, the retina may be treated with a laser to reduce future bleeding or to fix a tear in the retina. 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.
Recovering from vitrectomy surgery may be uncomfortable, but the procedure often improves or stabilizes vision. 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. Vision after surgery depends on how damaged the retina was before surgery.
Retinal Side Effects From Systemic Medication
The retina is a layer of light-sensing cells that line the back of the eye. 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.
Certain systemic medications, which affect the entire body rather than one specific location, can sometimes affect the retina and lead to vision loss. If you are taking any of the medications below to treat other conditions, be sure to tell Dr. Haas so that your eyes can be examined frequently to check for potential damage and vision loss. Other drugs not listed can also have ocular side effects.
- Plaquenil (hydroxychloroquine), an anti-malarial drug commonly used in the treatment of systemic lupus erythematosus and rheumatoid arthritis;
- Niacin, also known as nicotinic acid or vitamin B3, used as both a vitamin supplement and a lipid-lowering agent;
- Chlorpromazine (Thorazine) and thioridazine, used as antipsychotics;
- Amitriptyline and imipramine, used to treat depression, sleep disorders, and neuropathic pain;
- Corticosteroids (prednisone), used to treat inflammatory disorders and for adrenal insufficiency;
- Tamoxifen, used in treating breast cancer;
- Canthaxanthine, used as an artificial tanning agent, as well as for the treatment of vitiligo and other skin conditions; and
- Viagra or other erectile dysfunction drugs.
Caught early, it is possible to prevent damage and perhaps even to reverse it, depending on the drug and on the particular case. It is not common for eyes to be damaged by these medications, so it is important to continue to take all medications that have been prescribed for you unless your doctor tells you to discontinue them.
Epiretinal Membrane or ERM (a.k.a. Macular Pucker or Cellophane Retinopathy or Surface Wrinkling Retinopathy)
The retina is a layer of light-sensing cells lining the back of your eye. 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 is the small area at the center of your retina that allows you to see fine details. The macula normally lies flat against the back of the eye, like film lining the back of a camera. As you age, the clear, gel-like substance that fills the middle of your eye begins to shrink and pull away from the retina. In some cases, a thin scar tissue¯ or membrane can grow on the surface of the macula. When wrinkles, creases, or bulges form on the macula due to this scar tissue, this is known as an epiretinal membrane (ERM) or macular pucker. Damage to your macula causes blurred central vision, making it difficult to perform tasks such as reading small print or threading a needle. Peripheral (side) vision is not affected.
Symptoms, which can be mild or severe and affect one or both eyes, may include:
- blurred detail vision;
- distorted or wavy vision (straight objects appear crooked);
- gray or cloudy area in central vision; and
- blind spot in central vision.
Dr. Haas detects an epiretinal membrane by examination and special photographic techniques. If your symptoms are mild, no treatment may be necessary. Updating your eyeglass prescription or wearing bifocals may improve your vision sufficiently. If you have more severe symptoms that interfere with your daily routine, he may refer you for vitrectomy surgery by a retinal specialist to peel and remove the abnormal scar tissue. During this outpatient procedure, tiny instruments are used to remove the wrinkled tissue. Vision often improves though may not be 100% normal.
Be sure to discuss your options Dr. Haas. 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.
Lattice degeneration is a condition that causes thinning and weakening of the peripheral retina, the light-sensitive layer of cells lining the back of the eye, which can lead to a retinal tear.
The vitreous, a clear, gel-like substance that fills the inside of the eye, is contained in a sac loosely attached to the retina. Over time, the vitreous takes on a more fluid consistency, and the sac sometimes separates from the retina. In lattice degeneration, there are places where the sac is strongly attached to the retina and pulls on it.
This pulling weakens the retina and creates lattice¯ lesions, which look like white, crisscrossing lines on the retina.
If part of the vitreous sac becomes detached from the retina, the friction and pulling at the attachment site can create a tear in the retina. Lattice degeneration can sometimes cause retinal detachments when holes or tears in the lattice formation permit vitreous fluid to flow under the retina.
Fortunately, most people with lattice degeneration do not develop a retinal detachment. Preventive treatment of lattice degeneration is indicated in some cases, but usually Dr. Haas will only need to monitor the condition. If you have a history of lattice degeneration, you should be aware of the symptoms of retinal tears and detachment. A yearly check is also needed.
The macula is the part of the retina responsible for acute central vision, the vision you use for reading, watching television, and recognizing faces. A macular hole is a small, round opening in the macula. The hole causes a blind spot or blurred area directly in the center of your vision.
Most macular holes occur in the elderly. 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. Sometimes injury or long-term swelling can cause a macular hole. No specific medical problem is known to cause macular holes.
Vitrectomy surgery, the only treatment for a macular hole, removes the vitreous gel and scar tissue pulling on the macula and keeping the hole open. The eye is then filled with a special gas bubble to push against the macula and close the hole. The gas bubble will gradually dissolve, but the patient must maintain a face-down position for one to two weeks to keep the gas bubble in contact with the macula. Success of the surgery often depends on how well the position is maintained.
With treatment, most macular holes shrink, and some or most of the lost central vision can slowly return. The amount of visual improvement typically depends on the length of time the hole was present.
Retinitis pigmentosa (RP) describes a group of related diseases that tend to run in families and cause a slow but progressive loss of vision. 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. RP usually affects both eyes equally, with severity ranging from no visual problems in some families to blindness at an early age in others. 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.
The earliest symptom of retinitis pigmentosa, usually noticed in childhood, is night blindness or difficulty with night vision. People with normal vision adjust to the dark quickly, but people with night blindness adjust very slowly or not at all. A loss of side vision, known as tunnel vision,¯ is also common as RP progresses. Unfortunately, the combination of night blindness and the loss of peripheral vision can be severe and can lead to legal blindness in many people.
While there is a pattern of inheritance for RP, 40% of RP patients have no known previous family history. Learning more about RP in your family can help predict how RP will affect you.
Usher™s syndrome, a condition that causes both deafness and blindness, is a form of RP. The incidence of Usher™s syndrome is difficult to determine, but surveys of patients suggest up to 10% of RP patients are deaf. The incidence of Usher™s syndrome is three cases per 100,000. It is the most frequent cause of combined deafness and blindness in adults.
Considerable research is being done to find the hereditary cause of RP. As hereditary defects are discovered, it may be possible to develop treatments to prevent progression of the disease. While developments are on the horizon, particularly in the area of genetic research, there is currently no cure for retinitis pigmentosa.
Nutritional supplements may be of benefit in RP. It has been reported that vitamin A can slow the progression of RP. Large doses of vitamin A are harmful to the body, and supplements of vitamin E alone may make RP worse. Vitamin E is not harmful if taken along with vitamin A or in the presence of a normal diet.
Despite visual impairment, people with RP can maintain active and rewarding lives through the wide variety of rehabilitative services that are available today. Until there is a cure, periodic examinations by your ophthalmologist will keep you informed of legitimate scientific discoveries as they develop.
Retinoblastoma, a malignant tumor that grows in the retina, the layer of light-sensing cells in the back of the eye, can destroy a child™s vision and be fatal.
Retinoblastoma can occur in one or both eyes, and usually develops in the first year or two of life. It affects children of all races, and occurs in boys and girls equally.
The most common sign is a change in the color of the pupil, which can appear white in reflected light. This phenomenon is referred to as a cat™s eye reflex. Sometimes the affected eye will cross or turn outward. Retinoblastoma can be hereditary and is more likely to develop in children with a family history of the disease.
With early diagnosis, retinoblastoma treatment is remarkably effective. More than 90% of children survive and many eyes are saved with a combination of medications, radiation therapy, and heat, freezing, or laser treatments. In severe cases, the affected eye is removed.
If a child has had retinoblastoma, there is an increased chance for a second cancer to develop. Children with retinoblastoma should have regular examinations by a retinal and/or pediatric ophthalmologist (Eye M.D.), and a pediatric oncologist. Regular lifelong physical exams are also important as patients who survive retinoblastoma have a higher risk of other soft tissue tumors throughout their lives.
Retinopathy of Prematurity
Retinopathy of Prematurity (ROP) damages premature babies™ retinas, the layer of light-sensitive cells lining the back of the eye. ROP usually occurs in both eyes, though one may be more severely affected.
The last 12 weeks of a full-term pregnancy are an especially active time for the growth of the eye. When a baby is born prematurely, blood vessels are not ready to supply blood to the retina. At birth, abnormal new blood vessels form and cause scarring or detachment of the retina. The condition is especially common in very small babies. It is more likely to occur in babies weighing one or two pounds than in babies weighing three pounds or more.
Despite improved medical care, the disease is becoming more common because smaller and sicker infants are surviving. Supplemental oxygen given to premature babies may be part of the cause of ROP, but it is not the only factor as was once thought.
In severe cases, the retina may be extremely scarred and detached. Many cases get better without treatment and only a small number of children go blind. Cryotherapy (freezing) or laser treatments can prevent progression of the disease.
Children with ROP are more likely to develop nearsightedness and amblyopia (lazy eye). Eyeglasses, patching, and eye muscle surgery can help these associated problems. Follow-up examinations of severely affected children should continue periodically.
Retinopathy of Prematurity (ROP) exams must be performed by ophthalmology subspecialists (either pediatric ophthalmology and/or retinal specialists). Though Dr. Haas does not perform these exams, he is happy to help you find an ophthalmologist who will.
The uvea is the middle layer in the eye sandwiched between the retina (innermost layer) and the sclera (outermost layer). The uvea contains many blood vessels that carry blood to and from the eye. Uveitis is inflammation of the uvea. Since the uvea nourishes many important parts of the eye, uveitis can damage your sight.
Symptoms can include pain, floaters,¯ blurriness, light sensitivity, and redness. Uveitis may develop suddenly with redness and pain or with just a blurring of vision.
In most cases, the cause is unknown. Sometimes uveitis is associated with another condition such as an infection or autoimmune condition (lupus, arthritis, etc.).
Uveitis is diagnosed by an examination of the eye. In addition, Dr. Haas may order blood tests, skin tests, or x-rays and also will want information about your overall health.
There are different types of uveitis:
With iritis, the uvea is inflamed near the front of the eye in the iris. Iritis has a sudden onset and may last up to eight weeks.
Cyclitis affects the muscle that focuses the lens in the middle part of the eye. It develops suddenly and lasts for several months.
This is an inflammation in the back of the eye. It can develop more slowly than the other forms of uveitis and last longer, although this is variable.
Because uveitis is a serious condition that can cause permanent damage to the eye, it needs to be treated as soon as possible. Eyedrops and pupil dilators reduce inflammation and pain. For more severe inflammation, oral medications or injections may be necessary. If uveitis is associated with other conditions like glaucoma or retinal damage, surgery may be required.
If you have a red eye¯ that does not clear up quickly, ocular pain, or other significant symptoms, see Dr. Haas as soon as possible.