Other

Epiretinal Membrane or ERM (a.k.a. Macular Pucker or Cellophane Retinopathy or Surface Wrinkling Retinopathy)

 

The retina is a layer of light-sensing cells lining the back of your eye. As light rays enter your eye, the retina converts the rays into signals that are sent through the optic nerve to your brain, where they are recognized as images.

The macula is the small area at the center of your retina that allows you to see fine details. The macula normally lies flat against the back of the eye, like film lining the back of a camera. As you age, the clear, gel-like substance that fills the middle of your eye begins to shrink and pull away from the retina. In some cases, a thin scar tissue or membrane can grow on the surface of the macula. When wrinkles, creases, or bulges form on the macula due to this scar tissue, this is known as an epiretinal membrane (ERM) or macular pucker. Damage to your macula causes blurred central vision, making it difficult to perform tasks such as reading small print or threading a needle. Peripheral (side) vision is not affected.

Symptoms, which can be mild or severe and affect one or both eyes, may include:

  • blurred detail vision;
  • distorted or wavy vision (straight objects appear crooked);
  • gray or cloudy area in central vision; and
  • blind spot in central vision.

Dr. Haas detects an epiretinal membrane by examination and special photographic techniques. If your symptoms are mild, no treatment may be necessary. Updating your eyeglass prescription or wearing bifocals may improve your vision sufficiently. If you have more severe symptoms that interfere with your daily routine, he may refer you for vitrectomy surgery by a retinal specialist to peel and remove the abnormal scar tissue. During this outpatient procedure, tiny instruments are used to remove the wrinkled tissue. Vision often improves though may not be 100% normal.

Be sure to discuss your options Dr. Haas. If surgery is recommended, you should be aware that as with any surgical procedure, rare complications can occur, including infection, bleeding, retinal detachment, recurrence of the epiretinal membrane, and earlier onset of cataract.

Lattice Degeneration

Lattice degeneration is a condition that causes thinning and weakening of the peripheral retina, the light-sensitive layer of cells lining the back of the eye, which can lead to a retinal tear.

The vitreous, a clear, gel-like substance that fills the inside of the eye, is contained in a sac loosely attached to the retina. Over time, the vitreous takes on a more fluid consistency, and the sac sometimes separates from the retina. In lattice degeneration, there are places where the sac is strongly attached to the retina and pulls on it.

This pulling weakens the retina and creates lattice lesions, which look like white, crisscrossing lines on the retina.

If part of the vitreous sac becomes detached from the retina, the friction and pulling at the attachment site can create a tear in the retina. Lattice degeneration can sometimes cause retinal detachments when holes or tears in the lattice formation permit vitreous fluid to flow under the retina.

Fortunately, most people with lattice degeneration do not develop a retinal detachment. Preventive treatment of lattice degeneration is indicated in some cases, but usually Dr. Haas will only need to monitor the condition. If you have a history of lattice degeneration, you should be aware of the symptoms of retinal tears and detachment.  A yearly check is also needed.

Macular Hole

The macula is the part of the retina responsible for acute central vision, the vision you use for reading, watching television, and recognizing faces. A macular hole is a small, round opening in the macula. The hole causes a blind spot or blurred area directly in the center of your vision.

Most macular holes occur in the elderly. When the vitreous (the gel-like substance inside the eye) ages and shrinks, it can pull on the thin tissue of the macula, causing a tear that can eventually form a small hole. Sometimes injury or long-term swelling can cause a macular hole. No specific medical problem is known to cause macular holes.

Vitrectomy surgery,
the only treatment for a macular hole, removes the vitreous gel and scar tissue pulling on the macula and keeping the hole open. The eye is then filled with a special gas bubble to push against the macula and close the hole. The gas bubble will gradually dissolve, but the patient must maintain a face-down position for one to two weeks to keep the gas bubble in contact with the macula. Success of the surgery often depends on how well the position is maintained.
With treatment, most macular holes shrink, and some or most of the lost central vision can slowly return. The amount of visual improvement typically depends on the length of time the hole was present.


Retinitis Pigmentosa

Retinitis pigmentosa (RP) describes a group of related diseases that tend to run in families and cause a slow but progressive loss of vision. RP affects the rods and cones of the retina, the light-sensitive nerve layer at the back of the eye, and results in a decline in vision in both eyes. RP usually affects both eyes equally, with severity ranging from no visual problems in some families to blindness at an early age in others. RP gets its name from the fact that one of the symptoms is a clumping of the retinal pigment that can be seen during an eye exam.

The earliest symptom of retinitis pigmentosa, usually noticed in childhood, is night blindness or difficulty with night vision. People with normal vision adjust to the dark quickly, but people with night blindness adjust very slowly or not at all. A loss of side vision, known as tunnel vision, is also common as RP progresses. Unfortunately, the combination of night blindness and the loss of peripheral vision can be severe and can lead to legal blindness in many people.

While there is a pattern of inheritance for RP, 40% of RP patients have no known previous family history. Learning more about RP in your family can help predict how RP will affect you.

Usher™s syndrome
, a condition that causes both deafness and blindness, is a form of RP. The incidence of Usher™s syndrome is difficult to determine, but surveys of patients suggest up to 10% of RP patients are deaf. The incidence of Usher™s syndrome is three cases per 100,000. It is the most frequent cause of combined deafness and blindness in adults.

Considerable research is being done to find the hereditary cause of RP. As hereditary defects are discovered, it may be possible to develop treatments to prevent progression of the disease. While developments are on the horizon, particularly in the area of genetic research, there is currently no cure for retinitis pigmentosa.
Nutritional supplements may be of benefit in RP. It has been reported that vitamin A can slow the progression of RP. Large doses of vitamin A are harmful to the body, and supplements of vitamin E alone may make RP worse. Vitamin E is not harmful if taken along with vitamin A or in the presence of a normal diet.

Despite visual impairment, people with RP can maintain active and rewarding lives through the wide variety of rehabilitative services that are available today. Until there is a cure, periodic examinations by your ophthalmologist will keep you informed of legitimate scientific discoveries as they develop.


Retinoblastoma

Retinoblastoma, a malignant tumor that grows in the retina, the layer of light-sensing cells in the back of the eye, can destroy a child™s vision and be fatal.

Retinoblastoma can occur in one or both eyes, and usually develops in the first year or two of life. It affects children of all races, and occurs in boys and girls equally.
The most common sign is a change in the color of the pupil, which can appear white in reflected light. This phenomenon is referred to as a cat™s eye reflex. Sometimes the affected eye will cross or turn outward. Retinoblastoma can be hereditary and is more likely to develop in children with a family history of the disease.

With early diagnosis, retinoblastoma treatment is remarkably effective. More than 90% of children survive and many eyes are saved with a combination of medications, radiation therapy, and heat, freezing, or laser treatments. In severe cases, the affected eye is removed.

If a child has had retinoblastoma, there is an increased chance for a second cancer to develop. Children with retinoblastoma should have regular examinations by a retinal and/or pediatric ophthalmologist (Eye M.D.), and a pediatric oncologist. Regular lifelong physical exams are also important as patients who survive retinoblastoma have a higher risk of other soft tissue tumors throughout their lives.


Retinopathy of Prematurity

Retinopathy of Prematurity (ROP) damages premature babies™ retinas, the layer of light-sensitive cells lining the back of the eye. ROP usually occurs in both eyes, though one may be more severely affected.

The last 12 weeks of a full-term pregnancy are an especially active time for the growth of the eye. When a baby is born prematurely, blood vessels are not ready to supply blood to the retina. At birth, abnormal new blood vessels form and cause scarring or detachment of the retina. The condition is especially common in very small babies. It is more likely to occur in babies weighing one or two pounds than in babies weighing three pounds or more.

Despite improved medical care, the disease is becoming more common because smaller and sicker infants are surviving. Supplemental oxygen given to premature babies may be part of the cause of ROP, but it is not the only factor as was once thought.

In severe cases, the retina may be extremely scarred and detached. Many cases get better without treatment and only a small number of children go blind. Cryotherapy (freezing) or laser treatments can prevent progression of the disease.

Children with ROP are more likely to develop nearsightedness and amblyopia (lazy eye). Eyeglasses, patching, and eye muscle surgery can help these associated problems. Follow-up examinations of severely affected children should continue periodically.

Retinopathy of Prematurity (ROP) exams must be performed by ophthalmology subspecialists (either pediatric ophthalmology and/or retinal specialists).  Though Dr. Haas does not perform these exams, he is happy to help you find an ophthalmologist who wil