Retinal Vascular Diseases

Retinal vascular diseases are conditions that can block or restrict the blood flow throughout the eye structures. Retinal vascular diseases are common in people with high blood pressure, diabetes, and other factors that cause vascular disease in the body. You should see your eye doctor immediately if you experience symptoms of retinal vascular disease. Surgical goals for vascular disease include restoring blood flow, reducing inner eye pressure, and preventing vision loss.  

The retina is the inner coating of the eye, running from the edge of the iris back to the optic nerve. The retina is a thin tissue layer that contains millions of nerve cells. The nerve cells are sensitive to light. A main purpose of your eye is to focus light on the retina. The choroid is the lining underneath the retina. The choroid contains blood vessels that supply your retina with blood and oxygen to keep it healthy.

 

Cones and rods are specialized receptor cells in the retina. Cones are specialized for color vision and detailed vision, such as for reading or identifying distant objects. Cones work best with bright light. The greatest concentration of cones is found in the macula and fovea at the center of the retina. The macula is the center of visual attention. The fovea is the site of best visual sharpness. Rods are located throughout the rest of the retina.

 

Your eyes contain more rods than cones. Rods work best in low light. Rods perceive blacks, whites, and grays, but not colors. They detect general shapes. Rods are used for night vision and peripheral vision. High concentrations of rods at the outer portions of your retina act as motion detectors in your peripheral or side vision. 

 

The receptor cells in the retina send nerve messages about what you see to the optic nerve. The optic nerves extend from the back of each eye and join together in the brain at the optic chiasm. From the optic chiasm, the nerve signals travel along two optic tracts in the brain and eventually to the occipital cortex, where you process and perceive vision.

Retinal vascular diseases are common in people with high blood pressure, diabetes, and other factors that cause vascular disease throughout the body, such as increasing age, high cholesterol, and smoking. Retinal vascular diseases include aneurysms, blockages, glaucoma, diabetic retinopathy, and ocular ischemic syndrome. In simple terms, these are conditions that can block or restrict the blood flow throughout your eye structures and lead to vision loss or blindness.

Retinal vascular disease can cause a sudden painless loss of vision. Diabetic retinopathy may not have symptoms in the early stages but may eventually cause floaters or blurred vision. You should contact your doctor immediately if you experience changes in your vision or vision loss.

You should see your eye doctor immediately if you experience symptoms of retinal vascular disease. Your doctor will review your medical history and perform a thorough eye examination.

Imaging tests may be used to produce pictures of your inner eye blood vessels and retinal structures. Common tests include ultrasound and fluorescein angiography. Ultrasound uses high frequency sound waves to produce images of the internal eye structures. Fluorescein angiography is a specialized type of photographic eye test that is used to detect blood vessel problems in the retina and choroid. The test uses an injected dye and a special camera to take photos of the vascular structures.

The treatment goal for vascular disease is to restore blood flow. This can be accomplished by various means depending on the cause of the decreased flow. The method of treatment will be determined by your physician. Laser therapy is used to destroy abnormal blood vessels to reduce swelling and decrease blood vessel leakage. Some people may require multiple laser treatments over time. In glaucoma patients, reducing the pressure inside the eye will help increase blood flow. This is usually done with eye drops but surgery may be required.

 

Advanced retinal vascular disease may be treated with vitrectomy. A vitrectomy is an outpatient microsurgical procedure that is used as a treatment for diabetic retinopathy, macular edema, vitreous hemorrhage, neovascularization, and other eye conditions. A vitrectomy involves removing the gel and abnormal blood vessel growths and scar tissue from the inside of the eye. The gel may be replaced with an air bubble or silicone oil to promote healing and protect the retina. 

 

Treatment of the underlying systemic disease, if one exists, is crucial in helping repair damage and preventing further damage.

Controlling blood pressure and sugar levels are crucial in treatment. Thorough physical exam is required to rule out certain systemic conditions that can cause the blood to become too thick and block the small vessels in the eye. Controlling these conditions helps prevent the blockage from recurring.

Patients with diabetes mellitus, high blood pressure, elevated cholesterol levels and certain disease conditions are at risk for vascular disease of the retina. One of the most common conditions in older patients is wet macular degeneration which is also a vascular disease.

Complications vary depending on the cause of the blocked blood vessels. In some cases the blockage is severe and the body attempts to grow new blood vessels to bypass the blocked areas. These blood vessels are usually leaky and can cause further bleeding in the eye. They can grow in places where they should not be and cause blockage of the filtering mechanism of the eye causing a form of glaucoma.