Frequently Asked Questions
Q. What is retinal detachment?
Answer. The retina is the light-
In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.
Q. What are the different types of retinal detachment?
Answer. There are three different types of retinal detachment:
Q. Who is at risk for retinal detachment?
Answer. A retinal detachment can occur at any age, but it is more common in People over age 40.
It affects men more than women, and Whites more than Blacks.
A retinal detachment is also more likely to occur in people who:
degenerative myopia, or lattice degeneration
Q. What are the symptoms of retinal detachment?
Answer. Symptoms include a sudden or gradual increase in either the number of floaters, which are little "cobwebs" or specks that float about in your field of vision, and/or light flashes in the eye. Another symptom is the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.
Q. How is retinal detachment treated?
Answer. Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.
Retinal detachments are treated with surgery that may require the patient to stay in the hospital.
Q. What is diabetic retinopathy?
Answer. Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in adults. It is caused by changes in the blood vessels of the retina.
In some people with diabetic retinopathy, blood vessels may swell and leak fluid.
In other people, abnormal new blood vessels grow on the surface of the retina. The
retina is the light-
If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
Q. How does diabetic retinopathy cause vision loss?
Answer. Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:
1. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.
2. Fluid can leak into the center of the macula, the part of the eye where sharp,
Q. Who is at risk for diabetic retinopathy?
Answer. All people with diabetes-
During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.
Q. What can I do to protect my vision?
Answer. If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:
Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.
If you have diabetic retinopathy, you may need an eye exam more often. People with
proliferative retinopathy can reduce their risk of blindness by 95 percent with timely
treatment and appropriate follow-
The Diabetes Control and Complications Trial (DCCT) showed that better control of
blood sugar levels slows the onset and progression of retinopathy. The people with
diabetes who kept their blood sugar levels as close to normal as possible also had
much less kidney and nerve disease. Better control also reduces the need for sight-
This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.
Q. Does diabetic retinopathy have any symptoms?
Answer. Often there are no symptoms in the early stages of the disease, nor is there any pain. Don't wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.
Blurred vision may occur when the macula—the part of the retina that provides sharp central vision—swells from leaking fluid. This condition is called macular edema.
If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision.
Q. What are the symptoms of proliferative retinopathy if bleeding occurs?
Answer. At first, you will see a few specks of blood, or spots, "floating" in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.
Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.
Your eye care professional checks your retina for early signs of the disease, including:
Leaking blood vessels.
Retinal swelling (macular edema).
Pale, fatty deposits on the retina-
Damaged nerve tissue.
Any changes to the blood vessels.
Q. How is diabetic retinopathy treated?
Answer.During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.
If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.
Q. How is a macular edema treated?
Answer. Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved. Contact your eye care professional if you have vision loss.
Q. What is a vitrectomy?
Answer. If you have a lot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.
A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.
Q. What is a macular hole?
Answer. A macular hole is a small break in the macula, located in the center of the
A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60.
Q. Are there different types of a macular hole?
Answer. Yes. There are three stages to a macular hole:
■Foveal detachments (Stage I). Without treatment, about half of Stage I macular holes will progress.
The size of the hole and its location on the retina determine how much it will affect a person's vision. When a Stage III macular hole
develops, most central and detailed vision can be lost. If left untreated, a macular
hole can lead to a detached retina, a sight-
threatening condition that should receive immediate medical attention.
Q. Is a macular hole the same as age-
Answer. No. Macular holes and age-
are similar. Both conditions are common in people 60 and over. An eye care professional will know the difference.
Q. What causes a macular hole?
Answer. Most of the eye's interior is filled with vitreous, a gel-
shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly
shrinks and pulls away from the retinal surface. Natural fluids fill the area where the vitreous has contracted. This is normal. In most
cases, there are no adverse effects. Some patients may experience a small increase in floaters, which are little "cobwebs" or specks
that seem to float about in your field of vision.
However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a macular hole. Also, once
the vitreous has pulled away from the surface of the retina, some of the fibers can remain on the retinal surface and can contract.
This increases tension on the retina and can lead to a macular hole. In either case, the fluid that has replaced the shrunken vitreous
can then seep through the hole onto the macula, blurring and distorting central vision.
Macular holes can also occur from eye disorders, such as high myopia (nearsightedness), macular pucker, and retinal detachment;
eye disease, such diabetic retinopathy and Best's disease; and injury to the eye.
Q. Is my other eye at risk?
Answer. If a macular hole exists in one eye, there is a 10-
lifetime. Your doctor can discuss this with you.
Q. What are the symptoms of a macular hole?
Answer. Macular holes often begin gradually. In the early stage of a macular hole, people may notice a slight distortion or blurriness in their
affected eye become difficult.
Q. How is a macular hole treated?
Answer. Although some macular holes can seal themselves and require no treatment, surgery is necessary in many cases to help improve
vision. In this surgical procedure-
with a bubble containing a mixture of air and gas. The bubble acts as an internal, temporary bandage that holds the edge of the
macular hole in place as it heals. Surgery is performed under local anesthesia and
often on an out-
Following surgery, patients must remain in a face-
weeks. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole. As the
bubble is reabsorbed, the vitreous cavity refills with natural eye fluids.
Maintaining a face-
important to discuss this with your doctor before surgery.
Q. What are the risks of surgery?
Answer. The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract
can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and
retinal detachment either during surgery or afterward, both of which can be immediately treated.
For a few months after surgery, patients are not permitted to travel by air. Changes in air pressure may cause the bubble in the eye to
expand, increasing pressure inside the eye.
Q. How successful is this surgery?
Answer. Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance
of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery.
Vision recovery can continue for as long as three months after surgery.
What if I cannot remain in a face-
Answer. If you cannot remain in a face-
are unable to remain in a face-
number of devices that can make the "face-
the amount of "face-
Age related Macular degeneration (AMD)
Q. What is AMD?
Answer. AMD is a common eye condition among people age 50 and older. It is a leading cause of vision loss in older adults. It gradually destroys the macula, the part of the eye that provides sharp, central vision needed for seeing objects clearly.
In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disorder progresses faster and may lead to a loss of vision in one or both eyes. The vision loss makes it difficult to recognize faces, drive a car, read, print, or do close work, such as sewing or fixing things around the house.
Despite the limited vision, AMD does not cause complete blindness. You will be able to see using your side (peripheral) vision.
Q. Who is at risk?
Answer. AMD usually occurs in people who are age 50 and older. As people get older, the risk increases. Other risk factors include the following:
■Smoking. Research shows that smoking increases the risk of AMD two-
■Race. Caucasians are much more likely to get AMD than people of African descent.
■Family history. People with a family history of AMD are at higher risk.
Q. What are the forms of AMD that can cause vision loss?
Answer. There are two forms of AMD: dry and wet. Either form can advance and cause severe vision loss. Later sections of this booklet describe the different types in greater detail.
The following is a brief description of each:
■The dry form is more common and has three stages-
■The wet form is considered advanced AMD and can be more severe. It happens when new blood vessels under the macula leak blood and fluid. Damage to the macula can occur rapidly.
All people who have the wet form had the dry form first.
Q. What is vitreous detachment?
Answer. Most of the eye's interior is filled with vitreous, a gel-
In most cases, a vitreous detachment, also known as a posterior vitreous detachment,
is not sight-
Q. Who is at risk for vitreous detachment?
Answer. A vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80. People who are nearsighted are also at increased risk. Those who have a vitreous detachment in one eye are likely to have one in the other, although it may not happen until years later.
Q. What are the symptoms of vitreous detachment?
Answer. As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina that you may notice as floaters, which appear as little "cobwebs" or specks that seem to float about in your field of vision. If you try to look at these shadows they appear to quickly dart out of the way.
One symptom of a vitreous detachment is a small but sudden increase in the number of new floaters. This increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.
Q. How is vitreous detachment detected?
Answer. The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a macular hole or detached retina, early treatment can help prevent loss of vision.
How does vitreous detachment affect vision?
Although a vitreous detachment does not threaten sight, once in a while some of the vitreous fibers pull so hard on the retina that they
create a macular hole to or lead to a retinal detachment. Both of these conditions
If left untreated, a macular hole or detached retina can lead to permanent vision loss in the affected eye. Those who experience a
sudden increase in floaters or an increase in flashes of light in peripheral vision should have an eye care professional examine their
eyes as soon as possible.
Q. What is retinoblastoma?
Answer. Retinoblastoma is a type of cancer that forms in the retina (the light-
Q. Who is at risk for retinoblastoma?
Answer. The disease usually occurs in children younger than 5 years and may be in one eye or in both eyes. In some cases the disease is inherited from a parent.
Q. How is retinoblastoma treated?
Answer. Retinoblastoma is a serious, life-
Q. What are floaters?
Answer. Floaters are little "cobwebs" or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like
directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.
Most people have floaters and learn to ignore them; they are usually not noticed until they become numerous or more prominent.
Floaters can become apparent when looking at something bright, such as white paper or a blue sky.
Floaters and Retinal Detachment
Sometimes a section of the vitreous pulls the fine fibers away from the retina all at once, rather than gradually, causing many new
floaters to appear suddenly. This is called a vitreous detachment, which in most
cases is not sight-
However, a sudden increase in floaters, possibly accompanied by light flashes or peripheral (side) vision loss, could indicate a retinal
detachment. A retinal detachment occurs when any part of the retina, the eye's light-
position at the back wall of the eye.
A retinal detachment is a serious condition and should always be considered an emergency. If left untreated, it can lead to permanent
visual impairment within two or three days or even blindness in the eye.
Those who experience a sudden increase in floaters, flashes of light in peripheral vision, or a loss of peripheral vision should have an
eye care professional examine their eyes as soon as possible.
Q. What causes floaters?
Answer. Floaters occur when the vitreous, a gel-
As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina. These are floaters.
In most cases, floaters are part of the natural aging process and simply an annoyance. They can be distracting at first, but eventually
tend to "settle" at the bottom of the eye, becoming less bothersome. They usually settle below the line of sight and do not go away
However, there are other, more serious causes of floaters, including infection, inflammation (uveitis), hemorrhaging, retinal tears, and
injury to the eye.
Q. Who is at risk for floaters?
Answer. Floaters are more likely to develop as we age and are more common in people who are very nearsighted, have diabetes, or who have
had a cataract operation.
Symptoms and Detection
Floaters are little "cobwebs" or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like
directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.
Q. How are floaters treated?
Answer. For people who have floaters that are simply annoying, no treatment is recommended.
On rare occasions, floaters can be so dense and numerous that they significantly affect vision. In these cases, a vitrectomy, a
surgical procedure that removes floaters from the vitreous, may be needed.
A vitrectomy removes the vitreous gel, along with its floating debris, from the eye. The vitreous is replaced with a salt solution.
Because the vitreous is mostly water, you will not notice any change between the salt solution and the original vitreous.
This operation carries significant risks to sight because of possible complications, which include retinal detachment, retinal tears, and
cataract. Most eye surgeons are reluctant to recommend this surgery unless the floaters seriously interfere with vision.