Medical & Surgical Retina

Q: What is the retina?

A: The retina is the layer at the back of the eye responsible for converting light entering the eye into electrical signals that are relayed to the brain.

Q: What conditions affect the retina?

A: A large number of conditions can affect the retina and its function. These include age-related macular degeneration, diabetic retinopathy, retinal vein occlusion, retinal detachment, macular hole, epiretinal membrane, and inherited diseases such as retinitis pigmentosa.

Q: What is the difference between medical and surgical retina?

A: The distinction depends on whether the treatment for the condition is medical (i.e. observation or medical treatments) or surgical (i.e. managed with a surgical operation). There are some overlap between the two, whereby some conditions might have both medical and surgical treatments. At the London Lauriston Clinic, our consultant retinal specialists lead this service, and many are able to assist you with either medical or surgical retinal conditions.

Q: What is the macula?

A: The macula is the small area at the centre of the retina which is responsible for central vision and fine detail. Conditions that affect the macula can cause problems with activities such as fine central vision, reading, seeing faces and watching television. Conditions that affect the macula include age-related macular degeneration, diabetic retinopathy and retinal vein occlusion.

Q: What is age-related macular degeneration?

A: Age-related macular degeneration (AMD) is the leading cause of irreversible and progressive loss of vision in people over the age of 50 in developed nations. There are two types – ‘wet’ and ‘dry’, both of which can affect sight. They affect the central vision, with the peripheral vision being less severely affected.

Early signs of disease can include drusen or changes in pigmentation of the macula, known as the ‘dry’ type. This can result in more light being required to read. Dry AMD tends to progress slowly, but can result in severe loss of vision over time. Approximately 10% have the wet (neovascular) form of the disease which is clinically more destructive and aggressive, but also more amenable to treatment. In wet AMD, abnormal blood vessels grow under the retina resulting in bleeding and fluid leakage which affects vision. Eventually, scarring tends to occur resulting in severe loss of sight.

Q: What treatments are available for age-related macular degeneration?

A: London Lauriston Clinic provides a complete range of diagnostics and treatments for AMD including the latest intravitreal injections into the eye for wet AMD. These drugs target vascular growth factors in the eye which are one of the driving processes causing the disease. Treatment is delivered with a course of injections into the eyeball (initially monthly) with regular check-ups to assess response to treatment. These injections cause minimal pain, and involve a very fine needle being placed into the vitreous cavity of the eye after it has been numbed.

There is a lot of research ongoing into both types of AMD, with new treatments in the pipeline for both ‘wet’ and ‘dry’ types. Consultant retinal clinicians at the London Lauriston Clinic are well placed to advise you about current and future treatments.

Q: What is diabetic retinopathy?

A: Diabetic retinopathy is when the retina becomes damaged due to abnormal glucose levels in diabetic patients. There is a wide spectrum of disease ranging from small haemorrhages to areas with loss of blood supply, fibrotic changes and the development of abnormal new vessels. Severe diabetic retinopathy can cause irreversible loss of sight.

In the UK, there is a yearly eye screening programme for all people with diabetes. This means signs of diabetic retinopathy can be detected early and if necessary, referred to retinal experts. In some patients, observation and improvement in diabetic control can stabilise diabetic retinopathy. However, more severe disease can require injections in the eye, laser to the retina or even retinal surgery. Consultant retinal clinicians at the London Lauriston Clinic are highly experienced in managing patients with diabetes and ensuring treatment is commenced at the right time to stabilise vision and reduce the likelihood of severe sight loss.

Q: What is retinal vein occlusion?

Retinal vein occlusions are blockages in the veins of the retina. They tend to be caused by vascular risk factors such as high blood pressure, diabetes, high cholesterol and smoking. Sometimes they do not cause any significant visual problems, but they need to be monitored carefully for sight threatening complications such as fluid leakage in the retina and the development of abnormal blood vessels, which can bleed and reduce vision. Some patients require injections in the eye, laser to the retina or even retinal surgery. Retinal consultants at the London Lauriston Clinic have expertise in managing patients with retinal vein occlusions.

Q: What is retinal detachment?

A: Retinal detachment means the retinal layer detaches from the inside wall of your eye usually due to a tear in the retina. Early signs can include floaters, flashing lights and a shadow in your peripheral vision. Treatment at an early stage has a high chance of preserving long-term sight. However, if diagnosis is delayed, or disease progression is rapid, the vision can become irreversibly reduced by retinal detachment.

Risk factors for retinal detachment include myopia (short-sightedness), recent eye surgery and trauma. If you suspect retinal detachment, you should immediately seek an emergency appointment with one of our retinal consultant surgeons as this condition needs to be diagnosed as quickly as possible and usually surgery performed urgently. We are highly experienced at managing patients with retinal detachment and our clinicians regularly present research on this condition internationally.

Q: What is macular hole?

A: A macular hole is a hole in the macula region of the retina causing reduced central vision. It tends to occur due traction on the macula from the vitreous gel, and is more common in women. In the early stages, macular holes are small and have a high chance of being treated successfully with surgery. If the diagnosis is delayed, the macular hole tends to increase in size which can reduce the likelihood of surgical success and result in long-term reduced vision. The London Lauriston Clinic has clinicians who have published extensive research on this subject and are highly experienced in the management of macular holes.

Q: What is epiretinal membrane?

A: Epiretinal membrane is where a sheet of fibrotic tissue forms over the macula. In some cases, they do not cause any symptoms, but with time, they tend to result in reduced and distorted vision. Retinal surgery can be performed to stabilise and improve vision.

Q: What is retinitis pigmentosa?

A: Retinitis pigmentosa (RP) is an inherited retinal disease affecting the light sensing cells of the retina. There are different types of RP, which result in different timing of disease onset and disease severity. Early symptoms can be reduced peripheral and night vision.