Retina

The retina is the inner layer of the eye, composed of nervous cells; just like the camera film, it collects images and transform them into nervous signals that are then transmitted to the brain via the optic nerve.

Retina alteration are spotted very well with the exam of the bottom of the eye.

The retina is the only tissue where arteries and veins can be examined directly and their conditions give precious informations on the patient’s health condition. If there are lesions on the retinal vessels, it is probable that there will be similar ones in other arterial or venous districts.

Retinopathies can involve macula or peripheral retinal areas.

The medical case varies depending on the area that has been affected; if the lesion is on the macula, there is a distortion of straight lines, central vision acuity loss and alterations in color perceptions.

If that affects other retinal areas (non macular lesions), there can be alterations in a portions of the field of vision (scotoma) or, in cases where huge parts of the retina are affected, complete blindness (amaurosis).

Hypertensive retinopathy – Retinal thrombosis

The main retinopathies caused by alterations of retinal circulation are listed below. They can happen in the middle of general diseases.

• Hypertensive retinopathy
  Hypertension is a pathology that affects every place where vessels are, included the ones in the retin; the exam of the bottom of the eye can show how much the disease ha developed (there are four evolution phases). Symptoms can be absent for a long time; sometimes however, they are spotted as brief moments of foggy vision. There is no therapy for hypertensive retinopathy: hypertension has to be treated, retinopathy is an avoidable complication.
• Retinal heart attack
  It is caused by a sudden occlusion of the central retinal artery.
  The most recognizable symptom is the sudden blindness of the affected eye (amaurosis), almost always painless; it cannot be noticed immediately (if that happens while asleep, it can only be discovered the next day).
  
  The sooner it starts, the more successful therapy can be, because after a short period of time, retinal lesions become irreversible.
• Retinal central vein occlusion
  
  It’s the most frequent vascular pathology. It can happen during hypertension, diabetes (spontaneously or in case of glaucoma) and as a consequence of traumatic brain or eye injuries. The main symptom usually is, not blindness, but a quick loss of vision, without pain. Recovery is slow and gradual; in case of younger patient there can also be a complete recovery.
  
  

Diabetic retinopathy

Diabetic retinopathy is a pretty common form of retinopathy since it is frequent to see retinal lesions in diabetic patients. Today, thanks to ultimely therapy and risk factors control, it is possible to keep under control the development of the retinal damage. Diabetic retinopathy can be considered to have a vascular nature. Eye diabetes determines alterations of the wall of the retinal vessels, with consequent irreversible damages (retinal vessels dilate, break, and so several exudated and hemorrages appear).

Symptoms can vary from light vision discomforts to a complete vision deterioration. During the initial phase, there can be a light vision reduction, or foggy vision, and the appearance of spots in the field of vision.

Over time, a serious proliferative form can take place: this can cause retinal detachment and blindness.

All people affected by diabetes should undergo an ophthalmologic exam every year, in order to achieve an early diagnosis and being able to treat injuries immediately.

Therapy relies onto laser photocoagulation and can prevent or slow down loss of vision. Other therapies, recently discovered, are available for more serious cases. It is always best to ask for help to specialized retinopathy centers, in order to keep this disease under control. dr. Badalà periodically organizes retinopathy screenings in Milan and Catania.

Retinal detachment

Retinal detachment consists in the retina lifting up from the underlying layer, followed by a nutritional and functional deficit. It can be primary, that is linked to alterations of the retina’s anatomical structure, or secondary of other pathologies (like diabetic retinopathy’s complications; after eye trauma, underlying masses, inflammatory processes, or linked to high degree myopia, that changes the globe and ocular bottom’s size).

The consequence of retinal detachment is a more or less serious vision reduction.
Often it is announced by the subjective appeareance of mobile formations in the field of vision: these formations are mostly dot shaped, of several sizes, dark grey or black (myodesopsia). There can also be light flashes (phosphene). At this stage there is still no real detachment, so laser photocoagulation can still block the, not only achieving lesion’s healing, but also a good functional recovery.

When the retina lifts up completely from the underlying layer, there is an area of complete blindness, or a sector of the field of vision (scotoma).

Another common symptom is the perception of deformed images (metamorphopsia), caused by the irregularity of the lifted retinal surface. If there is already a complete detachment, the only available therapy is surgery, with the scleral buckle process, or vitrectomy that Dr. Badalà performs in Milan and Catania.

Vitrectomy is usually limited to older patients , while scleral buckle is more suitable for younger patients.