Charlotte, North Carolina
Many things can potentially go wrong with the eye’s all-important retina – the “camera film” at the back of the eye. Between the retina and the lens is a space called the vitreous chamber, filled with a fluid called vitreous humor (or just “vitreous”). (In front of the lens is a corresponding small chamber filled with aqueous humor.)
The retina’s job is to receive image information brought in by light rays. Its light-sensitive nerve endings process the light information. The vitreous is a clear gel and has the job of bathing the retina and supporting the eye’s overall shape.
Macula and Fovea – Central Vision
In the center of the retina is the macula, which gives us our central vision – what we are looking at directly. Most of the cells here (called cones) distinguish color and fine details, and function well in bright light. The other cells (called rods) function more in dim light and give us our night and peripheral vision.
In the center of the macula is the tiny fovea – as small as a pinprick. It has no rods, just cones, and it gives us our sharpest vision – that we use to read fine print. Around the macula in the rest of the retina are increasing numbers of rods and fewer cones, and this is where we have our peripheral vision.
Some Retinal Vitreous Problems:
Diabetic Retinopathy: The longer a person suffers from diabetes, the more likely it is that their eyes will sustain damage. It typically occurs in two stages, with the second one being more severe – Proliferative Diabetic Retinopathy (PDR). In the earlier stage, the retinal capillaries weaken and begin to leak blood (hemorrhage) into the retina. This causes swelling (edema) but may or may not affect the person’s vision.
In PDR, capillaries close down and starve the retina of oxygen and nutrients. The retina attempts to grow new blood vessels, but they are dysfunctional and leak and bleed. Scars may develop, the retina may detach from the back of the eye, and pressure inside the eye may increase, causing glaucoma. Blindness may eventually result. Please see our page on Diabetic Retinopathy for more information.
Age-Related Macular Degeneration (ARMD or AMD): ARMD begins as “dry” AMD which involves changes in the pigment cells under the macula and results in a thinning of the central retina (the macula). This starts to blur the person’s central vision. Twenty percent of patients progress to “wet” AMD, where new but abnormal capillaries develop under the retina.
By leaking under the retina, they cause a blister of sub-retina fluid causing damage and distorted vision. Please see our ARMD page for more details.
Macular Holes: As we age, the vitreous tends to shift forward which can create a small hole in the macula. If the hole penetrates the full thickness of the macula, vision loss occurs. Our surgeons can do macular hole surgery to repair this problem.
Retinal Tearing and Detachment: These can also result from the vitreous from shifting forward. If the vitreous shift tears the retina, it can flow through the hole into the space under the retina, and cause the retina to detach from the wall of the eye. Vision is lost in the area of the detachment. When it is sudden you will notice such things as:
- Flashes of light
- Floaters
- Darkness moving across your vision
- Waviness or wateriness in your vision or a "curtain" over part of your vision
Please contact us immediately, as our eye surgeons usually have great success in repairing a retinal tear or detachment.
Uveitis: This is an infection and inflammation in the uvea, the membrane beneath the white part of the eye (sclera). You can read about it on our Uveitis page.
Cytomegalovirus Retinitis (CMV): This infection mostly occurs in people suffering from AIDS or other immunosuppressive diseases. No pain may occur, but there can be flashing lights, floaters, and blurriness of either central vision or peripheral vision. Usually one eye is affected first, and then the other one. This is a serious condition which can destroy the retina and cause blindness in just a few months. Early treatment can stop the virus and save vision.
Retinitis Pigmentosa (RP): RP refers to a group of eye diseases which tend to be hereditary. They involve progressive retinal deterioration, and can appear at any age. They usually start to give symptoms during adolescence or young adulthood. Typically, night blindness occurs first, then loss of peripheral vision, which results in “tunnel vision” where the person can see only straight ahead. After some years, blindness is the result.
There is currently no cure for RP, but research is ongoing and some find that certain vitamin supplements can slow down the RP progression. We offer a variety of vision aids such as magnifying lenses, telescopic lenses, and field enhancers.
Retinopathy of Prematurity (ROP): A baby born prematurely has a low weight and is not fully developed. By themselves, the lungs are unable to deliver enough oxygen to the small body, which means that the baby must be placed on oxygen (life support). Typically, this works well and the baby is able to grow and go home to its new family.
However, if oxygen is required for a long time (through the second to fourth weeks of life), the baby’s eyes develop abnormal blood vessels. This can cause scars to appear on the retina. In some cases the damage is not severe and the baby recovers, developing full vision. In other cases, the damage is serious, causing retinal detachment and blindness.
Our eye surgeons can use digital photography, ultrasound, and laser therapy to diagnose and treat the over-abundance of abnormal blood vessels, and in some cases this solves the problem. Research and new technology for monitoring oxygen amounts will improve outcomes.
Our Retinal Vitreous Disease Surgeons are:
Miriam E. Ridley, MD
Strutha C. Rouse II, MD
Frederick H.D. Weidman III, MD
Our Retinopathy of Prematurity Doctors are:
Stephen A. Daugherty, MD
Charles F. Marshall, MD
Retinal Vitreous diseases are often sight-threatening. We urge you to contact us as soon as you can if you are wondering what sort of eye or vision problem you are having. We will be glad to schedule a personal consultation for you on short notice.
