Age-related macular degeneration (AMD) is a retinal degeneration and is the most common cause of blindness in people over 65 in industrialised countries. Research into the causes is ongoing, but factors such as genetic makeup, smoking, cardiovascular problems and diet are related to this condition.
AMD affects the central part of the retina, called the macula. This part is responsible for the fine sign which is a visual disturbance in the central field of vision. The main symptom is a progressive loss of central vision, noticed by blurred central vision or a central blind spot.
Two types of ageing macular degeneration exist, wet macular degeneration and dry macular degeneration. Most people start with dry degeneration and develop wet macular degeneration in one or two years later.
Inherited retinal conditions now represent the most common cause of severe visual loss in the working age population in the UK. They are a very variable group of conditions, which require specialist retinal expertise to establish an accurate timely diagnosis with appropriate examination and investigations, in order to provide reliable advice, information on prognosis and offer appropriate genetic counselling. Inherited Retinal Diseases include Retinitis Pigmentosa, Stargardt´s Disease, Leber’s Congenital Amaurosis, Cone Dystrophies, Usher’s Syndrome, Achromatopsia, Choroideremia, and Juvenile X-Linked Retinoschisis.
Paediatric retinal disease
Paediatric retinal conditions are variable and have multiple underlying causes including inherited, inflammatory, infectious and congenital. Specialist expertise is required both in retinal disease, paediatric ophthalmology, electrophysiology and retinal imaging to be able to establish the diagnosis in a timely fashion and provide appropriate advice and management. It is not uncommon that unexplained visual loss is due to retinal disease.
The blood vessels of the retina are very fine and vulnerable to blockage, which can profoundly affect vision.
A retinal artery occlusion can cause sudden painless loss of vision and blood flow must be restored rapidly for the retina to regain its function. Medical treatment can potentially help re-establish the circulation. The causes include Giant Cell Arteritis, a condition which should be checked for and can be treated. A cardiovascular workup may also be necessary since blood pressure and diabetes are often associated.
A retinal vein occlusion commonly causes painless loss of vision. The causes include high blood pressure, diabetes, high cholesterol, smoking, glaucoma. Treatment options include intravitreal anti-VEGF injections and other modalities.
Diabetic retinopathy is one of the most common causes of blindness in industrialised countries, affecting the retina of diabetic patients. See Eye Anatomy drawing here to see where the retina is:
Diabetes affects up to 3% of the world population. Diabetic retinopathy is related to the duration of diabetes and the metabolic control of the patients; patients that control their diabetes poorly can develop retinopathy within a few years whilst patients that control their diabetes well may not develop retinopathy at all.
In diabetic retinopathy, the tiny blood vessels at the back of the eye (capillaries) leak fluid which causes the retina to swell and not function well, especially if at the macula, called diabetic macula oedema. New blood vessels can grow and bleed suddenly in severe diabetic retinopathy.