By Dr. Saralyn Notaro-Rietz
There are many conditions that one’s eyes as they age, including three of the most common ones that affect the “back of the eye,” or retina.
1.) Posterior vitreous detachments,
2.) macular degeneration, and
3.) diabetic eye disease.
A posterior vitreous detachment is a common occurrence as one ages. In fact, one can be found in the majority of people older than 70 years of age. The vitreous is the “jelly” that fills our eyeballs. When we are born, it is attached to the back wall of the eye, or retina. As we age, the jelly “liquifies,” and separates itself from the retina. When the vitreous separates, if often causes one to note strings or floaters. These floaters are often larger and more noticeable that every day floaters that many people notice when looking at a fluorescent light, for example.
When the vitreous gel separates, it can also cause one to see flashes of light.That is because it pulls on the retina, which is an electrical tissue. If the pulling motion is excessive, rips or tears can form in the retina. If tears in the retina form and are left untreated, persons may develop retinal detachments. For these reasons, vitreous detachments are common, but they deserve special attention. A retina specialist in uniquely qualified to examine eyes for retina tears, and this consultation should be sought if one develops noticeable floaters or flashes, or changes to a usual floater pattern.
Macular degeneration is a disease that affects millions of people and is the largest cause of visual loss in folks older than 50 years of age in the Western world. Simply put, macular degeneration means that the center part (macula) of the back of the eye is getting old. The degenerative process can present with a number of abnormal findings, all of which can be detected by a retina specialist. Visual loss from these abnormalities can range from very mild to extremely severe.
In general, there are two varieties of macular degeneration. These are referred to as WET and DRY degeneration. Symptoms are similar for both types and include blurred vision, wavy vision or blank spots in vision.
Dry disease is more prevalent and may take on many forms. Vision may range from very good to very poor. To date, there is no proven treatment for dry degeneration, but consistent follow up is needed to measure disease progression and to observe for conversion to wet disease.
Wet macular degeneration is the second major variety of disease. It is far less common than its dry counterpart, but generally felt to have a more significant effect on visual acuity. By labeling the disease “wet,” it is implied that abnormal blood or fluid has seeped into the back of the eye. The good news is that there is treatment that can be offered for wet disease, if diagnosed early. Treatment generally consists of depositing medicine into the eye, and is an office procedure that can be performed by a retina specialist. Laser treatments can also be given in an office setting.
Diabetic eye disease, while not a disease of the aged per se, does tend to occur in those with diabetes mellitus who have had their condition for many years. Diabetes affects blood vessels throughout the body, and the back of the eye is no exception. Generally speaking, blood vessels become leaky. In some situations, blood vessels can close, thereby robbing the back of the eye of adequate blood and oxygen. Leaky blood vessels can deposit blood, fluid and protein into the back of the eye. When this happens in the center of the eye, reading vision can become blurred and distorted. More advanced disease can bring large hemorrhages, which can blur the entire eye for long periods of time. Even more serious is the possible development of retinal detachment from diabetic disease.
Like most conditions, the earlier that diabetic disease is diagnosed, the better the treatment outcome. A retina specialist has received extra training to diagnose and treat all aspects of diabetic eye disease.
There is little to do to prevent the above named conditions from developing, but there are some lifestyle modifications that may decrease one’s risk.
For example, in age-related macular degeneration, we know that smoking, sun exposure, high blood pressure and increased body mass index are such risk factors. Each of these can be modified (ie, don’t smoke, wear sunglasses, control blood pressure, don’t be overweight, etc.) Similar modifiable risks can be addressed for diabetic eye disease … to a point. For example, weight control can reduce one’s risk of developing diabetes, and therefore diabetic eye disease.
Dr. Saralyn Notaro-Rietz is an ophthalmologist with specialty training in diseases and surgery of the retina. She has served Western New York for nearly 20 years and has offices in Amherst and North Tonawanda. Visit her website at http://www.backoftheeyemd.com/