The retina is the nerve tissue that lines the inside back wall of your eye. Light travels through the pupil and lens and is focused on the retina, where it is converted into a neural impulse and transmitted to the brain. If there is a break in the retina, fluid can track underneath the retina and separate it from the eye wall. Depending on the location and degree of retinal detachment, there can be very serious vision loss.

Symptoms

The three 3 F’s are the most common symptoms of a retinal detachment:

• Flashes: Flashing lights that are usually seen in peripheral (side) vision.

• Floaters: Hundreds of dark spots that persist in the center of vision.

• Field cut: Curtain or shadow that usually starts in peripheral vision that may move to involve the center of vision.

Causes

Retinal detachments can be broadly divided into three categories depending on the cause of the detachment:

Rhegmatogenous retinal detachments: Rhegmatogenous means “arising from a rupture,” so these detachments are due to a break in the retina that allows fluid to collect underneath the retina. A retinal tear can develop when the vitreous (the gel-like substance that fills the back cavity of the eye) separates from the retina as part of the normal aging process.

The risk factors associated with this type of retinal detachment:

• Lattice degeneration – thinning of the retina.

• High myopia (nearsighted) - can result in thinning of the retina.

• History of a previous retinal break or detachment in the other eye.

• Trauma.

• Family history of retinal detachment.

Tractional retinal detachments: These are caused by scar tissue that grows on the surface of the retina and contraction of the scar tissue pulls the retina off the back of the eye. The most common cause of scar tissue formation is due to uncontrolled diabetes.

Exudative retinal detachments: These types of detachments form when fluid accumulates underneath the retina. This is due to inflammation inside the eye that results in leaking blood vessels. The visual changes can vary depending on your head position because the fluid will shift as you move your head. There is no associated retinal hole or break in this type detachment. Of the three types of retinal detachments, exudative is the least common.

Diagnostic tests

• A dilated eye exam is needed to examine the retina and the periphery. This may entail a scleral depression exam where gentle pressure is applied to the eye to examine the peripheral retina.

• A scan of the retina (optical coherence tomography) may be performed to detect any subtle fluid that may accumulate under the retina.

• If there is significant blood or a clear view of the retina is not possible then an ultrasound of the eye may be performed.

Treatment

The goal of treatment is to re-attach the retina to the eye wall and treat the retinal tears or holes.

In general, there are four treatment options:

• Laser: A small retinal detachment can be walled off with a barrier laser to prevent further spread of the fluid and the retinal detachment.

• Pneumatic Retinopexy: This is an office-based procedure that requires injecting a gas bubble inside the eye. After this procedure, you need to position your head in a certain direction for the gas bubble to reposition the retina back along the inside wall of the eye. A freezing or laser procedure is performed around the retinal break. This procedure has about 70% to 80% success rate but not everyone is a good candidate for a pneumatic retinopexy.

• Scleral buckle: This is a surgery that needs to be performed in the operating room. This procedure involves placing a silicone band around the outside of the eye to bring the eye wall closer to the retina. The retinal tear is then treated with a freezing procedure. Vitrectomy: In this surgery, the vitreous inside the eye is removed and the fluid underneath the retina is drained. The retinal tear is then treated with either a laser or freezing procedure. At the completion of the surgery, a gas bubble fills the eye to hold the retina in place. The gas bubble will slowly dissipate over several weeks. Sometimes a scleral buckle is combined with a vitrectomy surgery.

Prognosis

Final vision after retinal detachment repair is usually dependent on whether the macula (central part of the retina that you use for fine vision) is involved. If the macula is detached, then there is usually some decrease in final vision after reattachment. Therefore, a good predictor is initial presenting vision. We recommend that patients with symptoms of retinal detachments (flashes, floaters, or field cuts) have a dilated eye exam. The sooner the diagnosis is made, the better the treatment outcome.

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Are you thinking about starting to wear contact lenses or switching to a different type of contact?

Wearing contacts can make a big difference in the way you see things – such as sharper details and brighter colors. And technology has made contacts more comfortable than ever.

While we look forward to discussing contact lenses and working closely with you to find the right type of lens to meet your needs, here are some things for you to think about:

Reasons to consider contact lenses

• Contact lenses move with your eye, allow a natural field of view, have no frames to obstruct your vision and greatly reduce distortions.
• Unlike glasses, they do not fog up or get water spots.
• Contact lenses are excellent for sports and other physical activities.
• Many people feel they look better in contact lenses.
• Compared to eyeglasses, contacts may offer better, more natural sight.

Some things to remember about contact lenses

• Compared to glasses, contact lenses require a longer initial examination and more follow-up visits to maintain eye health. Lens care also requires more time.
• If you are going to wear your lenses successfully, you will have to clean and store them properly, adhere to lens-wearing schedules and make appointments for follow-up care.
• If you are wearing disposable or planned replacement lenses, you will have to carefully follow the schedule for disposing the used lenses and using new ones.

Contact lens types

There are two general types of contact lenses: hard and soft.

Rigid gas-permeable (RGP):

The hard lenses most commonly used today are rigid gas-permeable lenses (RGP). They are made of materials that are designed for their optical and comfort qualities. Hard lenses hold their shape, yet allow the free flow of oxygen through the lenses to the cornea of your eye. 

RGPs provide excellent vision, have a short initial adaptation period, and are easy to care for. RGPs are comfortable to wear, have a relatively long life, and correct most vision problems.

The disadvantages are that RGPs require consistent wear to maintain how comfortable they feel, and can occasionally slip off-center of the eye.

Soft contact lenses:

Soft lenses are the choice of most contact wearers. These lenses are comfortable and come in many versions, depending on how you want to wear them.

Disposable-wear lenses are removed nightly and replaced on a daily, weekly, biweekly, or monthly basis and are easy to get used to wearing.

Daily-wear contacts do not need to be cleaned and are great for active lifestyles but don't correct all vision problems and vision may not be as sharp as with RGP lenses. 

Extended-wear soft contacts can usually be worn up to seven days without removal. Be sure to ask us about extended-wear contacts and a possible greater risk of eye infections. 

Colored soft contacts change your eye color, the appearance of your eye, or both. They are available by prescription and should only be worn after an eye exam and fitting by an eye-care professional. Over-the-counter colored contacts are illegal in some states and pose a serious danger to your eye health.

Bifocal or multifocal

Bifocal or multifocal contact lenses are available in both soft and RPG varieties. They can correct nearsightedness, farsightedness and astigmatism in combination with presbyopia. Visual quality is often not as good as with single vision lenses; however, for some people the ability to correct presbyopia is worth it.

Contacts are a great fit for many patients but don't forget to be prepared

Carry a backup pair of glasses with a current prescription—just in case you have to take out your contacts. Contacts can make your eyes more light-sensitive, so don't forget to wear sunglasses with UV protection and a wide-brim hat when you’re in the sun.

Hygiene is the most critical aspect to successfully wearing contacts

When cared for properly, contact lenses can provide a comfortable and convenient way to work, play, and live the millions of people who wear them. While contact lenses are usually a safe and effective form of vision correction, they are not entirely risk-free. 

Contact lenses are medical devices, and failure to wear, clean, and store them as directed can increase the risk of eye infections. Not following your eye doctor’s directions raises the risk of developing serious infections. Your habits, supplies, and eye doctor are all essential to keeping your eyes healthy. 

We’re here to help

If you are interested in wearing contact lenses, we will provide you with a thorough eye examination and an evaluation of your suitability for contact lens wear. Contact us today for more information about contact lenses and to schedule a contact-fitting exam. We’ll discuss the best options for your visual and lifestyle needs.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

With the legalization of medical marijuana in 29 states as of April 2017, the question of whether marijuana is a good treatment for glaucoma has resurfaced.

Glaucoma is a common eye disease that affects the optic nerve and results in loss of peripheral vision. The treatment for glaucoma is to lower the pressure - intraocular pressure - inside the eye. This can be accomplished by laser, eye drops, or surgery.

The idea that marijuana can be used to treat glaucoma dates back to the 1970s. Smoking marijuana does lower intraocular pressure but the effect lasts only 3-4 hours. In order for marijuana to be an effective treatment, a person would have to smoke marijuana every 3 hours. Since marijuana also has psychoactive effects, consistently smoking it could prevent a person from performing at maximum mental capacity, and frequent use can cause problems with short-term memory.

Marijuana not only lowers intraocular pressure but also blood pressure and blood flow throughout the body. There is, however, evidence that decreased blood flow to the optic nerve may cause further damage. Therefore, it is possible that the lower intraocular pressure is negated by the decreased blood pressure to the eye.

Other ways of administering the active ingredient of marijuana, tetrahydrocannabinol (THC), include oral and topical administration. These forms avoid the potentially harmful compounds that could damage the lungs from marijuana smoke. However, the oral form would not avoid the systemic effects of marijuana.

There has been a research program that enrolled nine patients to take either oral THC or inhaled marijuana. None of the patients could sustain treatment for more than 9 months due to side effects such as distortion of perception, confusion, anxiety, depression, and severe dizziness. (https://www.ncbi.nlm.nih.gov/pubmed/12545695)

Alternatively, though eye drops may potentially avoid systemic effects, there is no formulation currently available to introduce a sufficient amount of the active ingredient into the eye.

The position by the American Glaucoma Society and American Academy of Ophthalmology is that marijuana is not recommended in any form for treatment of glaucoma at the present time.

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.