Retinal Disease

Diabetic Retinopathy

What is Diabetic Eye Disease?

Diabetes can damage the small blood vessels at the back of the eye.  If this is left untreated then permanent visual loss can occur.

What does diabetes do to the eye?

This eye has reduced vision due to leaking blood vessels at the macula.  Also the peripheral retina has abnormal blood vessel formation, bleeding and scarring.
Both of these problems can lead to blindness if not treated.

What are the symptoms of Diabetic Eye Disease?

Early on there may be no symptoms. Reduced vision often occurs when severe disease has already occurred.  All newly diagnosed type II diabetics should have their retina checked soon after diagnosis and those with type I diabetes should be checked within five years of onset.

How is Diabetic Eye Disease detected?

Early detection is essential as the earlier the disease is treated the better the results. Your ophthalmologist will check your vision then dilate the pupils with drops.  The Doctor will examine the back of your eye with a microscope, take photos and may arrange further tests.

Do all Diabetics get retinopathy?

Most people with diabetes do not lose vision from diabetic retinopathy.
But those with poor diabetic control or who have had diabetes for a long period of time have higher risks of developing the retinal complications. Other important risk factors include blood pressure, high cholesterol and smoking.

How is diabetic retinopathy treated?

Early diabetic retinopathy may be resolved with improved diabetic, blood pressure and cholesterol control. For more advanced disease then laser and injections such as Avastin (Bevacizumab), Lucentis (Ranibizamab) and Eylea (Aflibercept) into the eye may be required. Rarely surgery may also be needed.

Macular Degeneration (ARMD)

Age-related Macular Degeneration, or ARMD, is the leading cause of vision loss in the western world, and typically affects people over 60 years of age. Eye Doctors surgeons are experts in their field in the diagnosis and treatment of ARMD.

What is the macula?

The macula is at the back of the eye in direct line of central vision. Its function is to gives us colour vision and fine detail.

What causes ARMD?

The cause of ARMD is not fully understood but, as the name implies, it increases with age and may be more common in some families.

However environmental factors such as smoking, diet and blood pressure may also contribute.

What are the symptoms of macular degeneration?

Finding it difficult to read and see small detail are warning signs to be aware of. The development of distorted vision where straight lines appear bent is an important symptom that needs expert evaluation within days.
An eye exam can detect active disease and detect those at higher risk of progressing to loss of vision. After checking the vision an Eye Doctors surgeon will dilate the eye and examine the retina. Further tests may be required to detect progressive disease. At Eye Doctors we have the latest equipment to detect even very early changes.
“Dry” age related macular degeneration where there is a slow loss of clarity. This condition thankfully rarely leads to blindness. “Wet” ARMD however causes rapid loss of central vision and can occur in both eyes. This is when a scar forms from blood vessels developing under the retina.

Active “wet” age related macular degeneration with bleeding and scar in the center of the retina.

OCT image showing normal macula compared to age related macular degeneration where the retinal surface is being distorted giving distorted vision.

What is an OCT

Optical coherence tomography (OCT) is a light scanner that can image the retina down to the cellular level. At Eye Doctors we have the latest high definition OCT scanner that can show any macular disease even before it is visible with the human eye. All this without touching your eye!

What treatments are available?

The good news is we now have a highly successful treatment for active “wet” ARMD.
Intraocular medications can reduce the scarring and improve vision in the majority of patients in the early stages of the disease. The surgeons at Eye Doctors have extensive experience with these medications, which are now available called Vascular Endothelial Growth Factor inhibitors (VEGF) such as Avastin (Bevacizumab), Lucentis (Ranibizamab) and Eylea (Aflibercept). Drs Riley and Donaldson are international phase three investigators on a number of these studies. The key is early detection and treatment to get the most benefit.
In addition, your Eye Doctor may give you nutritional advice, or recommend specific vitamin supplements to reduce the risk of ARMD progression.

Retinal Vein Occlusions

What does the retina do?

The retina is the light-sensitive nerve tissue lining the back of the eye. Like film in a video camera, the retina continually ‘takes pictures’, then sends signals through the optic nerve to the brain, producing vision. The central part of the retina, which generates fine detailed vision, is known as the macula. The retina is nourished by oxygen-rich blood that is brought to it by arteries and then drained away again by veins.

What is a retinal vein occlusion?

When a retinal vein becomes blocked, part of the retinal blood flow slows or stops. Blood backs up, leading to bleeding and swelling of the retina, hampering its nourishment. Suddenly, and usually without warning, a patch of retina loses some of its 'picture-taking’ function.

What are the main symptoms of a retinal vein occlusion?

The retinal swelling caused by a blocked vein can lead to a sudden loss of vision, or distortion of the central vision, which are often the first signs that many people notice. The symptoms vary from person to person and also depend on the type and severity of the vein occlusion. When the Central Retinal Vein becomes blocked the whole retina is affected, which can cause severe symptoms. When a Branch Vein Occlusion occurs symptoms can be minor if the periphery of the retina is affected, but more severe if the central area of the macula is involved.

What causes a vein occlusion?

Vein occlusions become more common with age and as blood vessels harden. Risk factors that ‘age’ the veins faster can include smoking, diabetes, high blood pressure and high cholesterol. Glaucoma and inflammation inside the eye can also increase the risk of a blockage.

What examinations are required?

Your eye surgeon will check your vision and examine the back of the eye. The pupil will be dilated with drops and photos may be taken with a camera. A special ‘OCT’ (Optical Coherence Tomography) scanner will often be used to map the back of the eye and demonstrate any swelling in the retina. Fluorescein angiography may be required, where dye is injected into an arm vein and is then photographed as it travels through to the back of the eye.

What treatments can help with retinal vein occlusion?

Depending on the severity and position of the occlusion, often no treatment is required. However sometimes we can speed the recovery by using medications that target the leaking vessels. These medications can include injections into the eye, which may need to be repeated. Laser treatment may also be required to close down leaking vessels and treat affected parts of the retina. With time your own healing process may open up the blocked vessel. The resulting vision will depend on the amount of damage to the retina. The treatment is tailored to the individuals needs to give the best chance of regaining long term vision.

Eye Doctors’ surgeons are very experienced in the treatment of and research into retinal vein occlusions. We use the latest diagnostic equipment and offer personalised eye care at every consultation, so that treatments can be specifically tailored to the individual’s needs.

What our patients think

"Thankyou very much for the great work you have done in restoring my eyesight."
- Mrs M - cataract patient of Dr Mark Donaldson
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