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  • “Macular” refers to a particular part of the retina which is within the back part of the eye. It is the most important part of the retina because it is packed with all of the receptors that we need to see things clearly. The rest of the retina is important for peripheral vision but only the macular region can detect fine details.
  • There are many problems that can occur with the macular and many of them are not permanent or blinding. 

Age-related macular degeneration 

  • Age-related macular degeneration (AMD) is the most common and the most well-known. It is a problem that occurs in people over the age of 60 but there are very similar problems that can occur in younger people.
  • There are two main types:
    • Dry macular degeneration (dry AMD): 90% of patients have this type; slowly progressive over years - like "wear and tear" 
    • Wet macular degeneration (wet AMD): 10% of patients have this type and it can progress rapidly over days due to leakage of blood and fluid within the macular.
  • Investigations/ Diagnosis
    • Retinal examination by an Ophthalmologist
    • OCT scan (like a photograph with cross-sections of the macular to show the different layers - picture below).
    • Fluorescein angiogram: dye is injected into a vein in your arm and then special photographs are taken of the vessels within the eyes to see if they are leaking and showing signs of wet AMD (picture below).

AMD OCT 1

FFA

  • Who gets AMD and how can I reduce my risk?
    • Risk factors that you can’t fix:
      • Over the age of 60
      • Family history of AMD
    • Risk factors that you can fix
      • Smoking -> quit!!
      • Poor diet -> balanced diet high in fresh vegetables and leafy greens +/- macular vitamin supplements (ask pharmacist / doctor)
      • UV exposure -> wear sunglasses (they don’t need to be expensive) and a hat
  • Are there any treatments?
    • Dry AMD:
      • reduce your risk factors as above
      • monitor your vision for changes: cover one eye at a time and read the newspaper or look at straight lines on a page; if the lines get wavy, you should discuss with your ophthalmologist and arrange an appointment - urgently if the change is quite dramatic. 
    • Wet AMD: 
      • reduce risk factors as above
      • see an Ophthalmologist for injections into the eye. Sounds terrible but it works well. See macular treatment page. 

 

Retinal Vein Occlusion

brvo

 

 

Diabetic Retinal Disease

Also see Treatment of diabetic retinal disease. 

Diabetic eye disease usually occurs without you knowing and without treatment you can go blind. Fortunately this is rare with regular surveillence which is why your local doctor will usually recommend yearly checks. Sometimes your local optometrist can do these checks for you (with or without retinal photography). If you have been told that there are some retinal changes already, you should definitely see an Ophthalmologist for ongoing assessment.

Ways to reduce your risk of blinding retinal disease:

    • Control your blood sugars as best you can; your 3 month blood test (HbA1c) should be under 7%
    • Don't smoke
    • Control your blood pressure

Types of diabetic eye disease

  • Non-proliferative or "background" changes
    • Diabetes affects the blood vessels within the retina and makes them weak; as a result they often procuce small bleeds which can be seen on photographs of the retina. There are other signs of weak blood vessels including leakage (cotton wool spots) and bulging (microaneurysms). These early changes do not usually have any symptoms and patients will not know about them unless they have regular eye checks. If early changes are seen, the eyes need to be checked more frequently because it could be a sign of worse things to come. 
  • Diabetic macular oedema
    • Sometimes the blood vessels leak fluid at the central part of the retina (the macular) and this directly affects a person's ability to see clearly.
    • This can occur at almost any stage of diabetic eye disease and it usually requires treatment to preserve the vision. 
  • Proliferative retinal changes
    • This is a very serious level of diabetic eye disease where the blood vessels have become so unhealthy that new ones are needed to be made. Unfortunately the new blood vessels are also in poor health and they bleed and scar profusely. This scarring can have dramatic effects on the retina and can lead to permanent blindness in some patients. Fortunately, that level of disease is vastly less now that most patients are undergoing regular assessments and they receive treatment at an earlier stage. 

 

 

retinal laser