Retinal and macular diseases

The function of the retina and the macula can be impaired due to various diseases, which often occur with advancing age.

If these diseases are detected and treated in good time, the gradual loss of vision can be at least held back in most cases. Sometimes it is even possible to restore the patient’s vision back to their previous acuity again.

The retina 

The retina is located inside the eye. It converts incident light (light hitting the eye) into nerve impulses and transmits this information to the brain. The macula – also known as the yellow spot – is the central area of the retina and is referred to as the site of the sharpest vision. Without the retina, we cannot see light/dark, colours or faces. Due to its high performance and stress, the middle of the retina is particularly sensitive, which is why it also becomes more susceptible to disease with advancing age. 

As soon as light reaches our eyes, the retina converts it into electrical signals. For this purpose, the retina has two different types of light-sensitive cells – on the one hand, more than 110 to 125 million rods for twilight and night vision, and on the other hand, six to seven million cones in the middle of the retina, which are responsible for day vision, high-resolution vision and colour vision. In order to be able to see clearly, the light-sensitive cells need nutrients. The inner seven layers of the retina are supplied by the central artery, while the outer layers are mainly nourished by the choroid. 

Symptoms

Diseases of the retina are summarised under the medical term retinopathy. Today, ophthalmologists are fortunately able to detect a retinal disease – even before the patient themselves notices it – and thus treat it in good time to avoid irreparable damage to the eye. The following signs and complaints indicate a retinal disease: 

  • Blurred vision or deterioration of vision, (partial) loss of vision, distorted vision, seeing waves, flashes of light and flickering in the field of vision 
  • Large dark or black spots in front of the eyes 
  • Shadows in field of vision 
  • Restricted field of vision 
  • Impaired night vision 
  • Difficulties reading, feeling of “fixing” the eyes next to what you are reading in order to read it 
  • Particular sensitivity to light 

Causes

The functioning of the macula and retina can be damaged by numerous diseases. They can be classified as follows: 

  • Age-related retinal diseases (also known as age-related macular degeneration (AMD). This is also referred to as a dry or wet AMD. 
  • Retinal diseases as a consequence of another disease 
  • Inflammation-related retinal diseases 
  • Hereditary retinal diseases 

The most common causes include: 

  • Disease of the retina due to diabetes (diabetic retinopathy)  
  • Eye complications associated with high blood pressure (hypertensive retinopathy). Persistent, untreated high blood pressure can damage the retina. Older people are most affected. 
  • Vascular occlusion and circulatory disorder of the retina or optic nerve 
  • Retinal holes (known as macular holes), retinal detachment or vitreous detachment (retinoschisis)  
  • Central serous chorioretinopathy (also known as manager’s disease): a common disease of the retina, which mainly occurs between the ages of 20 and 50 in men and can be caused by stress. 
  • Retinopathia pigmentosa: a group of genetic retinal diseases in which the optic cells gradually die. The consequences are night blindness, tunnel vision, impaired visual acuity and even blindness.  
  • People with severe nearsightedness experience retinal detachment earlier and more frequently. For this reason, regular retinal check-ups should be a matter of course for very nearsighted people.  

Diagnosis

As many retinal diseases are usually present for a long time without any symptoms, possible diseases are often diagnosed and treated very late. For this reason, regular ophthalmological check-ups are recommended to rule out all eventualities, especially if there is a history of these kinds of problems in the patient’s family. 

Depending on the type of retinal diseases, the disease sooner or later becomes noticeable in the form of visual impairment. In this case: The earlier a pathological change is detected in the eye, the greater the chance of successful treatment. Thanks to modern diagnostics, it is now possible to produce high-resolution images of underlying tissue. This means pathological changes in the retina and macula can be detected at an early stage. The following methods are used to diagnose a retinal disease: 

  • Eye test: may provide information in the case of a possible retinal disease. 
  • Retinal examination: using a slit lamp and a special magnifying glass, an experienced retina specialist can assess the retina well. This allows a targeted decision to be made as to whether further investigations are necessary and, if so, which ones. 
  • Optical coherence tomography (OCT) : this is a non-invasive examination that makes it possible to visualise the macula and the optic nerve in order to detect any damage. The examination works similarly to an ultrasound but with light waves instead of sound waves, where an image is digitally displayed by converting evaluated light pulses) 
  • OCT angiography (OCTA) : this is also a non-invasive examination and makes it possible to visualise the retina’s vessels in order to be able to identify vessels with no or poor blood supply. 
  • Fluorescein angiography: conventional vascular examination using fluorescent dye. It is an invasive ophthalmological examination. A fluorescent dye is introduced into the bloodstream via an access point in a vein in the arm. A special camera detects this dye in the retina. This makes it easy to identify vessels that are not or only poorly supplied with blood. 
  • Ultrasound: ultrasound diagnostics can provide important insights as changes in the interior of the eye can be easily seen and diagnosed. 

Treatments

In addition to surgical therapies, conventional laser therapies and photodynamic therapies are also carried out for retinal diseases.

Various lasers are used for this purpose. Medication is also administered or injected for treatment. 

Aftercare

In the case of diseases of the retina and/or macula, it is advisable to have regular check-ups with an ophthalmologist. Especially after laser or injection therapy, the ophthalmologist should be consulted again to determine whether the drug therapy is actually working.  

FAQs

What is the difference between dry and wet AMD?

In the case of dry macular degeneration, the disease progresses over a longer period of time. Dry AMD can lead to wet macular degeneration. The wet form occurs in 15 to 20% of all patients and can lead to severe visual impairment within a few months. In wet age-related macular degeneration, pathological blood vessels grow into the sensitive zone of the macula, resulting in irreversible cell damage within this retina area. 

How dangerous is a hole in the retina?

If holes or tears appear in the retina, retinal detachment may occur. If left untreated, retinal detachment can lead to blindness within a few days. This is therefore an emergency. 

What are the risk factors for retinal disease?

Different health conditions may affect the health of the retina. As the retina has a particularly fine blood supply and is also made up of sensitive tissue, vascular diseases such as high blood pressure, metabolic disorders and diabetes can have a negative effect on the health of the retina. Furthermore, a disease of the retina can also be hereditary. 

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