Frequently Asked Questions
No. Transplantation of retinal cells is an active area of research, but it has yet to be successful in improving vision to any significant degree. Another area of research is aimed at developing an electronic “chip” which is implanted in the eye to serve as an artificial retina. Again, it may be years before this technology proves to be successful. Transplantation of the whole eye is a complex idea which is not realistic at this point in time. Many people have undergone successful cornea transplantation, but this would be of no benefit to someone with retinal disease.
The Age Related Eye Disease Study (AREDS) has now shown that vitamin supplementation is important in slowing the progression of macular degeneration in patients with moderate dry macular degeneration or patients with more advanced disease in one eye only. The most benefit was derived from a combination of antioxidants and zinc, in the following daily doses:
|Beta Carotene||15 mg|
|Vitamin C||500 mg|
|Vitamin E||400 IU|
|Zinc||80 mg (as zinc oxide)|
|Copper||2 mg (as cupric oxide)|
Consult with your physician, however, before taking such supplements. There is evidence that beta carotene supplementation actually increases the risk of lung cancer in smokers, so current or recent smokers (within the past 5 years, or with a history of heavy smoking) should probably avoid beta carotene. Vitamin E supplementation may also have a negative impact on the effect of cholesterol-lowering drugs known as statins. A limitation of the AREDS study is that carotenoids, such as lutein, were not studied. Lutein is a dietary carotenoid found in highest amounts in dark green leafy vegetables, such as spinach, kale, and collard greens. It seems that lutein may benefit patients with macular degeneration based on various pieces of evidence, but no trial has been performed to assess the safety or efficacy of lutein supplementation. Even with vitamin supplementation, a good healthy diet, low in fat, and rich in fruits and vegetables, is likely to play an important part in macular degeneration prevention. Regular exercise and avoidance of smoking are other ways to improve overall health and prevent various eye diseases.
There is also evidence that patients with retinitis pigmentosa (RP) benefit from vitamin A supplementation. 15,000 IU of Vitamin A palmitate daily has been shown to slow the loss of retinal function in typical RP. High dose vitamin A supplementation may be associated with liver damage and birth defects, though, so your physician should be involved in such a treatment, and regular blood testing is recommended during treatment.
Many people are concerned that using their eyes may make diseases of the eye worse. This is generally not true. You cannot harm the eyes by using them. Even eye fatigue caused by extensive computer use does not damage the eyes. Visual activities are temporarily restricted in some patients with certain conditions, and your doctor will tell you if this is the case.
There is evidence that sunlight exposure plays a role in certain eye diseases, such as cataract, macular degeneration, and eyelid cancer. It is a good idea to wear sunglasses with protection against ultraviolet light. Patients with or at risk for macular degeneration may also benefit from lenses which block blue wavelengths, such as yellow or amber lenses.
Posterior Vitreous Separation Questions
The floaters which occur following vitreous separation, as well as the flashes, tend to clear or become less noticeable within a few months, but some patients will have persistent symptoms. Even then, the floaters are usually only noticeable in certain lighting conditions or against light backgrounds. People tend to get used to the floaters they have, and there is rarely any impact on visual function. A new increase in flashes or floaters may indicate a retinal tear or some other process, though, and should be reported to your doctor. Vitrectomy surgery can remove floaters, but, because of the risks of the surgery, is only rarely performed for this purpose.
Retinal Detachment Questions
There is a slight chance that the retina can become detached again despite successful surgery. The risk is greatest during the weeks to months immediately following the surgery.
Diabetic Retinopathy Questions
Focal laser treatment of diabetic macular edema is best performed before central vision is affected. Once the center of the macula is swollen, laser often results in some improvement, but the vision may be permanently impaired to some degree. This is why regular retinal exams are important. Additionally, poor blood flow (ischemia) in the macula often damages the vision. There is no treatment for macular ischemia. Good medical control of the blood sugar and blood pressure is the only way to slow the progression of retinopathy and avoid this complication. Patients with proliferative diabetic retinopathy often develop hemorrhage into the vitreous gel, and panretinal laser photocoagulation is indicated. This laser treatment helps to prevent further neovascularization, hemorrhage, and retinal detachment. But it does not affect the vitreous hemorrhage which has already occurred. Blood within the vitreous must be cleared by the body, and may take several months to go away. If vitreous hemorrhage affecting the vision does not clear in a reasonable amount of time, vitrectomy surgery might be indicated.
Macular Degeneration Questions
Typical age-related macular degeneration is a bilateral disease. One eye may have severe visual loss due to the wet form of the disease, but the other probably also has dry macular degeneration, even if the vision is good. If someone has developed the wet form of the disease in one eye, then there is a significant chance that the other eye will also progress to the wet form. Use of an Amsler grid and regular retinal exams are important in detecting any such progression early, when treatment is most likely to preserve vision.
The terms “dry” and “wet” macular degeneration have nothing to do with dry eyes, tearing, or other problems with the tear film or surface of the eye. We use these terms to indicate whether or not abnormal blood vessels are growing beneath the retina, which leads to bleeding and leakage of fluid (the “wet” form).
There are some other conditions which share features with age-related macular degeneration, but occur in younger patients. Hereditary retinal degenerations, severe nearsightedness (myopic degeneration), and certain infectious or inflammatory eye diseases are sometimes referred to as “macular degeneration”, but they are distinct disorders.
Macular Hole Questions
Many patients find it helpful to obtain special equipment, such as massage furniture, which allows for more comfortable positioning. There are many sources for this equipment, and it may be covered by your insurance company. You can read or even watch TV in a face-down position; put the TV on the floor facing upward, or use a mirror to look at the TV. Other patients prefer the radio or books on tape. A dedicated space where the patient can remain in a face down position and have easy access to telephone, tissues, drops, drinking straws, etc. is a good idea. Nevertheless, some patients will have difficulty maintaining this position. In some cases, your doctor may relax these requirements. For patients who cannot position, silicone oil may be used instead of intraocular gas. Silicone oil is a clear viscous fluid that is used to fill the vitreous cavity. It must be removed at a later date in another operative procedure.
It is very uncommon for macular holes to lead to total blindness. Most patients have central distortion and vision loss, but maintain peripheral vision. Occasionally, macular holes are associated with retinal detachment, which can result in more extensive visual loss.
Many patients with macular hole will develop a macular hole in their other eye at some point. The risk is about 1% per year. The likelihood is greatly reduced, however, if the vitreous gel has already separated in the other eye.
Macular Pucker Questions
Macular pucker surgery, when indicated, improves the vision, and lessens the distortion of vision, in most patients. Some residual blurring or distortion is common, though, and does not necessarily mean that the membrane is still present or has re-grown (this occurs in only a small percentage of patients). Persistent visual changes are probably more likely if the macular pucker is chronic or if surgery is delayed for a long time.