Retina

The retina is an inner membrane of the eye, composed of photoreceptors (cones and rods). It receives light signals (like the film in a camera) and transmits them to the optic nerve.

In the centre of the retina is the macula which plays a very important role. It allows precision vision and colour distinction

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The different retinal pathologies

AMD

Age-related macular degeneration (AMD) is a chronic retinal disease that is common from the age of 65. The ageing of the cells of the macula leads to a loss of central vision, which can manifest itself in visual deformities (wavy lines).

Two types of forms:

  • Dry form: the most common. The delicate tissues of the macula become thin and no longer function properly. Progression is usually slow
  • Wet form: characterised by the growth of abnormal blood vessels behind the macula, which distorts it like the roots of a tree distorting a road for example

Common risk factors are smoking, heredity, age, diet, unprotected UV exposure.

The treatment of AMD depends on the form: for the dry form, there is no treatment to date. Some food supplements prescribed by your ophthalmologist will slow down the progression. For the wet form, a treatment of intravitreal injections will be implemented. In rare cases, laser treatment may also be offered.

Diabetic retinopathy

Diabetic retinopathy is caused by damage to the blood vessels of the retina. Poorly controlled blood sugar is the main risk factor. It is one of the complications of diabetes. The damage is very often silent. Symptoms only appear at an advanced stage of the disease.

Early and regular screening with your ophthalmologist and precise monitoring of your diabetes are essential.

The treatment of diabetic retinopathy consists of intravitreal injections and/or laser.

Arterial and venous occlusions

The vascular system of the eye consists of arteries that supply oxygen to the retinal tissues and veins that drain the blood and return it to the heart and lungs.

Retinal occlusions or thrombosis are often caused by high blood pressure, high cholesterol and diabetes.

Sometimes another more general or inflammatory disease can lead to retinal vein thrombosis.

Follow-up is very often done in collaboration with the treating physician. The ophthalmological management of these diseases is above all a regular follow-up and will sometimes be completed by intravitreal injections and/or laser.

Retinal complications linked to myopia

The retina of a myopic patient is thinner and may be weakened by the progressive and abnormal elongation of the eyeball induced by the disease.

The main retinal complication is the proliferation of abnormal blood vessels (also called neovessels).

Common symptoms are the appearance of a patch in the visual field, floating bodies or flying flies and sometimes flashes of light.

Retinal tearing is another complication seen in myopic patients and in rare cases in trauma.

Treatment is usually based on regular follow-up with the ophthalmologist. However, in the case of neovessels, intravitreal injections, lasers or surgery may be necessary.

Uveitis

Uveitis is an inflammation of the uvea, the central part of the eye, consisting of the iris, choroid and ciliary body. It is often characterised by redness in the eye, varying degrees of pain and reduced vision.

The most common causes are autoimmune diseases (arthritis, ankylosing spondylitis, Crohn's disease, etc.) or chronic infections (tuberculosis, chickenpox, etc.). However, the cause of uveitis is often unknown.

Several doctors are involved in the treatment of uveitis: the ophthalmologist, of course, but also the general practitioner, the internist, the rheumatologist, the immunologist or the infectiologist.)

The treatment is often complex and lengthy. If the cause of the uveitis is known, it is important to reduce the inflammation. Treatment is either by instillation of eye drops, orally (tablets), or by intraocular injections (injections directly into the eye).

Central Serous Retinopathy or Chorioretinitis (CRSC)

Central serous retinopathy is a disease of the retina and choroid. It is characterised by the presence of fluid under the retina.

It occurs in young people, most often in men. Stress and the use of corticosteroids is a risk factor.

The most common symptoms are a sudden decrease in vision, a change in colour and size of objects.

Usually, SCCR resolves on its own. Regular follow-up is necessary.

Ocular Imaging

Fundus photography

This examination is a photograph of the retina. It is used to diagnose and monitor the development of retinal diseases. By using various photographic filters, it is possible to visualise the different layers of the retina.

It is often necessary to dilate the pupil with drops before this type of imaging is performed.

OCT (Optical Coherence Tomography)

This examination allows the different layers of the retina to be visualised. A beam of light comes into contact with the fundus and is directly interpreted by the software. This imaging is very common in the diagnosis and monitoring of retinal diseases and is used to establish most indications for medical or surgical treatment of the retina.

Visual field or perimetry

The examination of visual function includes the testing of visual acuity tested on distance or near reading panels and the measurement of vision in the periphery (visual field).

Angiography

This examination requires the insertion of a venous line by a nurse. One or two contrast agents may be injected: a yellow contrast agent that allows better visualization of the vessels of the retina, and a green contrast agent, which makes it possible to study the vessels of the choroid, the deeper vascular layer of the eye located behind the retina.

The medical imaging photographer will respect specific times during the examination. This lasts between 10 and 30 minutes depending on the pathology.

As with any contrast medium, allergic reactions can occur, but they are very rare. It is therefore important to mention to the doctors or nursing staff any known allergies, especially those involving contrast media or iodine.

Treatments

Intravitreal injection or IVT

Intravitreal injection is an injection performed in an operating theatre. It is located in the Medical Retina Unit.

A series of anaesthetic drops are instilled into the patient.

The ophthalmologist injects a drug directly into the eyeball after applying an eyelid retractor and thoroughly disinfecting the eye.

This is a very quick procedure, which very often has to be repeated regularly (sometimes every month) in order to monitor the progress of the disease.

This injection is very often well tolerated and rarely painful. However, a sensation of a foreign body in the eye may occur in the hours following the injection. Moisturising drops are systematically given on discharge to limit this discomfort.

Lasers

Lasers in ophthalmology include several types of laser beam action. They are used for the treatment of various ocular disorders. Lasers that heat the retinal tissue (photocoagulation) are used in certain cases of diseases related to diabetes or thrombosis of the veins of the eye, or to create a barrier around a retinal tear. Some lasers have a cutting action and are useful in cases of frequent implant haze after cataract surgery.

Low vision

Some eye diseases leave deep and irreversible visual consequences. During a low vision consultation, the activities of daily life are studied in order to target visual difficulties. The low vision assessment, which lasts 60 minutes, enables an inventory of the patient's residual vision to be drawn up. A rehabilitation project is then proposed: visual aids, reorganisation of the living space or training of compensatory strategies, all solutions adapted to the wishes and needs of each patient.

This low vision consultation is aimed at patients who :

  • has difficulties in carrying out activities of daily living: writing, reading, putting toothpaste on their toothbrush
  • toothpaste on their toothbrush, etc. ;
  • would like a visual aid: magnifying glasses, reading devices, filters, voice synthesis, etc. ;
  • has : AMD, cone dystrophy, optic neuropathy, glaucoma, retinitis pigmentosa,
  • hemianopia, quadranopia, diabetic retinopathy

Surgery

Depending on the pathology, cataract surgery or vitrectomy may be indicated. These operations cannot be performed on the spot. But your ophthalmologist will give you all the information you need.

Swiss Visio

PD Dr med Aude Ambresin

Specialisation
Ophthalmology, Retina, Retinal and macular diseases, Eye surgery, Cataracts, Eye inflammation, Eye consultations View more

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