Distortion of vision is usually indicative of a problem with the central vision
As we get older, the macula (the central part of the retina responsible for detailed vision) can begin to break down, causing blurred vision. The macula allows us to see fine detail for activities such as reading, recognising faces, watching television and driving. It also helps us to see colour.
There are two main types of AMD: dry and wet. The extent of the degeneration may be different in each eye and may not progress at the same rate. It is very important to seek early examination and treatment if there is sudden distortion or reduction in vision. There are now some very effective drugs available which can be injected into the eye to stabilise and in some cases improve vision.
Patients with diabetes are more likely to develop eye problems such as cataracts or glaucoma, but the principal threat to vision is through diabetic retinopathy which is damage to the retina. Diabetes is a chronic metabolic disorder characterised by insufficient insulin production or insensitivity to insulin, which leads to too much sugar (glucose) in the blood.
Regulating blood glucose levels is extremely important. Untreated diabetes can result in damage to blood vessels, nerves and organs such as the kidney and the eye. The retina is situated at the back of the eye and responsible for detecting light and transmitting this signal to the brain, resulting in a visual image. Nutrients and oxygen are transported to the retina via numerous blood vessels. These vessels can be damaged by the high blood sugar levels often seen in non-treated diabetes or diabetes that is not completely controlled. This is known as diabetic retinopathy, which has several forms.
Most patients with diabetes will have developed some signs of diabetic change in the retina after 20 years. Treatments range from observation, laser, injections and vitrectomy surgery.
Epiretinal Membrane (ERM) is a condition characterised by the growth of abnormal tissue across the surface of the macula, the central part of the retina. It behaves as a form of scar tissue which, as it contracts, “puckers” the underlying macula causing distortion and visual loss.
The cause of the majority of epiretinal membranes is unknown (idiopathic) but the condition is frequently associated with previous posterior vitreous detachment. It is more common when vitreous detachment has resulted in retinal tearing (requiring laser or freezing therapy) or retinal detachment. Less commonly ERM is associated with previous occlusion of retinal blood vessels or inflammation in the eye.
Common symptoms of epiretinal membrane or macular pucker include distortion of straight lines, blurred central vision and disparity in image size between the two eyes. The procedure to treat this condition involves removal of the scar tissue from the retina. This is known as epiretinal membrane peeling and requires a vitrectomy operation.
Vitreomacular traction occurs when the vitreous jelly inside the eye stays abnormally attached to the macula, pulling on it and affecting central vision.
Symptoms include blurred central vision, distorted or bent straight lines, reduced contrast, and dulled colour vision.
Treatment is a vitrectomy—surgery to remove the vitreous jelly and release the traction, allowing the retina to settle and vision to improve.
This procedure involves removing the vitreous gel (that has caused the retinal tear) from inside the eye. Then to seal the tear the surgeon uses either laser or a freezing probe to make a scar around the tear. A gas or silicone oil bubble is then inserted into the eye to support the retina while it heals. A gas bubble slowly absorbs over 2 to 8 weeks but a silicone oil bubble will need a small operation to remove it at a later date. Your vision will be very blurred initially due to the presence of the gas or oil bubble.
Retinal detachment surgery can be performed under local anaesthetic or general anaesthetic. Under local anaesthetic you will be awake but you will not feel any discomfort as the eye will be numbed with an injection. You will not see the operation and the other eye will be covered. If a general anaesthetic is chosen then you will be fully asleep. The decision as to which type of anaesthesia is most suitable will be made following a discussion between you and your surgeon.
If you have been given any posturing instructions then these should be followed. You can bath or shower, but avoid splashing water near the eye. Generally you may do anything with which you are comfortable. Most people choose not to drive over the first few weeks. You must not fly until the gas bubble has gone and you must inform the anaesthetist if you require a general anaesthetic for any operation while there is gas in your eye.
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