Glaucoma and Retina

What is glaucoma?

Glaucoma can be defined as a progressive damage to the nerve of the eye ("Papilla"), which causes changes in the visual field, and damage to the optic nerve fibers, where the main risk factor is an intraocular pressure above the normal limit.

Are there other risk factors besides intraocular pressure and family history? 

Yes, others are high blood pressure, diabetes, severe nearsightedness or farsightedness, prolonged treatment with cortisone, obstructive pulmonary disease and cardiovascular disease, smoking and obstructive sleep apnea. Therefore, it is important, in any case, to individualize the treatment.

What symptoms causes the disease?

If it is not chronic and due to a sudden increase of the intraocular pressure, none. That's the big problem with this disease, the fact that it produces no suffering, makes it unlikely that the patient will consult a specialist. He will increasingly lose sight, first without realizing it, the border zone and in an irreversible end-stage the central vision. Prevention before damage occurs is our best weapon , to fight it, and therefore it is essential to have an eye test each year throughout life and to recognized the risk of suffering the disease. (Figure evolution of the visual field in glaucoma)

Which methods do we have in the clinic to diagnose glaucoma?

Tonometer by contact or air will give us a measurement of intraocular pressure. Taking make multiple measurements of the patient is important, because the pressure during the day is not the same and some "peaks" could go unnoticed. Strict control of glaucoma patients is essential to guarantee good eye health.

The gonioscopy is a method where a lens is mounted on the surface of the eye, and allows us to visualize the extent and characteristics of the "angle", which is the zone where the fluid inside the eye ("aqueous humor ") is filtered and is usually affected in patients with glaucoma.    
 
With the slit lamp we observe the depth of the anterior chamber of the eye in its peripheric portion which is closest to the angle in order to detect " suspect patients " who may develop the disease.
The fundus of the eye enable us to see the morphology, color and properties of the papilla.  

Optical coherence tomography (OCT) uses infrared light to measure the fiber layer of the retina and the thickness of the optic nerve and gives us a topographical study of the optic nerve head and an analysis of the development of glaucomatous damage.

Visual field measurement, pachymetry and the retinography are procedures that we use frequently to investigate the extent and development of the disease.

How is this disease treated?

We have drug treatment, laser and surgery. Antihypertensive eye drops reduce eye pressure and is a chronic glaucoma treatment, ie, for life. A laser is used in acute cases as an alternative or adjunctive drops therapy. In the surgical treatment, there are several possibilities, but nowadays the use of intraocular implants or "valves" with very good results is developed.

The eye is formed by a previous segment, where the cornea, iris and lens is, and a subsequent segment consisting of retinal papilla (optic nerve) and a gel that fills the eye called "vitreous". The retina is responsible for the acquisition of the image. It consists of two layers: the neurosensory retina and retinal pigment epithelium.

What diseases can occur in the retina?

They are very different, from infections, tumors, autoimmune processes and inflammation to vascular occlusive processes or damage to the optic nerve. The most usually, in practice, are the "holes or tears" of the retina, retinal detachments and pigmented lesions such as "nevus" (marks).

How can we explore the retina in the usual consultation at ophthalmologist?

- Retinographie:is carried out with a Retinogramm. It makes a "photo" of the fundus and with different filters, we can assess the vessels, secretions, "Druze" ... This test is a must in order to monitor the development of diabetes and age-related macular degeneration and other injury. We can also use intravenous contrast.

- OCT (Optical Coherence Tomography) makes us as a "scanner" with cuts at different levels of the retina and the optic nerve head.

Diabetes in ophthalmology

Diabetes mellitus (DM) due to serious complications in the eyes is considered as the leading cause of blindness in the working population in industrialized countries, due to the involvement of the small vessels, which can lead to the development of diabetic retinopathy.

I am a diabetic, what can I do?

¿When can I develop this eye disease if I already know I am a diabetic?

During the first 20 years of the disease, more than 60% of type 2 diabetics develop this serious complication.

When should I go to the ophthalmologist ?

From the moment when the diabetes is diagnosed.

I already have diabetic retinopathy, what treatments are available ?

First the degree of retinopathy and blood sugar levels have to be assessed, in order to know whether the patient is well controlled. Depending on the study, which your eye doctor does and monitors, there is photocoagulation of the retina with laser or injections with anti-Angiogenic medications that prevents the proliferation of blood vessels.

What is the Thyroid Eye-disease and why does it appear?

Why is it important from an ophthalmologic point of view?

One must ensure that the involvement of the eyes does not develop into a loss of vision, therefore it is very important to see a specialist in ophthalmology once the first symptom appears.

Which eye symptoms can I have?

The most important are:

- Eye discomfort, dryness, "grain of sand in the eye", irritation, redness ...
- Exoftalmos ("bulging eyes")..
- See double.
- Strabismus.
- Decreased vision.

Is there a treatment for this disease?

Primarily, the coordination between an endocrine and an ophthalmologist with blood tests and frequent eye exams is very important to ensure a non-disease progression. The treatment is very wide: from sunglasses, gels and artificial tear in mild cases, up to radioiodine, intravenous steroids and eye surgery in advanced cases.

What is macular degeneration?

It is a degenerative disease of the macula, the central area of the retina and the most important for our sight. It represents the leading cause of blindness in people over 50 years in developed countries.
There are two types:

- The wet, or exudative AMD.It is an active form of the disease, which is characterized by sudden onset of blurred and distorted central vision. It differs from the other type, because it evolves faster as it were formed new blood vessels that bleed and leak.

What symptoms appear?

The loss of the central visual field. It's painless and progressive.

What is its treatment?

It depends on the individual case, depending on the type and the degree of evolution. Nowadays, antioxidants, anti-angiogenesis are used ... It is important to individualize each case..

What is retinal detachment?

The retina is a thin membrane which covers the inner surface of the eye, which is responsible for the detection of the visual image to be able to be interpreted in the brain. Its detachment means if it is not treated, a permanent and irreversible vision loss.

What are the symptoms it produces?

It usually starts with a sight of "sparks", "lightning" or "Flying flies", but this is not necessarily indicative of the presence of retinal detachment. Then it proceeds towards the sight of a "curtain" which prevents to see a part of the visual field. If its development progresses, you will stop to see in that eye.

Why is a retinal detachment caused?

There are many causes, from small holes in the retina due to predisposed lesions, to trauma, infections, pulling of the vitreous gel inside the eye ... The important thing is to diagnose and treat as soon as possible, to to prevent the progression.

What treatment is available?

For small and localized tear it is "sealed" with laser. If it has already progressed to a detached retina, we have to operate in the shortest possible time.

Myopic patients with known " tears or retinal holes", vitreous traction, diabetes or history of retinal detachment or predisposing diseases should check their retina often by an ophthalmologist.

Why do we sometimes see "flying flies or spiderwebs"?

The eye is filled with a gel, which is anchored in some areas, that covers the eye inside: the retina. Over the years, this gel is dehydrated and loses its transparency, which causes inside "condensation" and constitutes what we perceive as "dark flies" that move with the movement of the eyes. In addition, this gel can break away from its rear anchoring what we refer to as "posterior vitreous detachment".

I see sparks, flashes or "shadows that move," what should I do?

Consult an ophthalmologist so that he can dilate the pupil and thus see whether there is damage to the retina in one of the connecting portions with the gel.

Is there any treatment for this?

If there is damage to the retina, it is essential to diagnose and treat it with the argon laser to prevent its progression. Currently there is a new therapy with OCRIPLASMINE (JETREA ALCON), at risk of macular retinal hole. The constant monitoring of symptoms, by your ophthalmologist is essential to avoid complications.

What is macular epiretinal membrane (MER)?

It is caused by the growth of a membrane-like tissue on the surface of the retina in the macula, which corresponds to the part of the retina responsible for central vision, and therefore the most important. This membrane can contract, causing decreased vision and image distortion. With the "Amsler grid" we can suspect the existence of this disease in a simple way.

 Why does it occur?

How does it manifest itself ?

The most common symptoms are decreased vision, blurred vision, or image distortion. Straight lines are perceived crooked.

How can it be prevented?

These membranes are more common from the age of 50, but can occur at any age. They are sometimes result of a retinal tear.

Frequent examinations after a certain age are therefore very important and the seeking of an ophthalmologist at the first sign. They can be observed after an eye surgery so that the post-operative follow-up is also very important.

What is its treatment?

Instructions for using the Amsler grid:

Then ask yourself the following questions:

Are all squares seen symmetrical?
Are twisted or curved lines visible?
Is one of the lines wavy, blurred or disappear somewhere?

If one of the answers to all these questions is yes, you should contact your specialist as soon as possible.