Retinal Conditions

The retina is made up of cells called rods and cones that sends visual information via the optic nerve to the brain. The centre of your retina, the macula, provides the sharp, detailed vision used by your central vision, and the outer retina provides your peripheral vision.

Most retinal conditions will cause symptoms (e.g. a shadow in your peripheral vision or distortion in your central vision), however some are slowly progressing and can only be detected via an eye examination.

Retinal vein occlusion

MetWest is able to offer patients prompt and up-to-date management for RVO including laser and intravitreal therapy.

The management of RVO is mainly the identification and management of the risk factors, and treating the complications such as macular swelling (oedema). The decision to actively treat macula oedema depends on the patient’s vision, amount of oedema and vision in the other eye. Treatment options eye injections and laser. In clinical trials, on average, patient gained an increase of 11 – 17 letters from presentation with eye injections.

It is important that patients understand that it is often a “course” of injections to manage the macular oedema, with multiple or ongoing injections several weeks apart.

What is retinal vein occlusion?

Retinal vein occlusions (RVO) are the second most common retinal vascular disorder after diabetic retinopathy, and are an important cause of visual loss. The occlusion (blockage) can occur in one of several different veins, and are referred to as “branch”, “central” or “hemi” retinal vein occlusions.

Retinal vein occlusion occurs when the blood vessels supplying the eye are blocked.

Who is at risk of retinal vein occlusion?

RVOs most commonly occur in people in their 50’s and 60’s and affect both genders equally. Risk factors for RVOs include increased age, hypertension, cardiovascular disease, high BMI, hyperlipidaemia and smoking. High intraocular pressure (glaucoma) is an additional risk factor for CRVOs.

What are the symptoms of retinal vein occlusion?

People typically notice a painless decrease in vision or may notice the part of their vision is greyed out / missing. Symptoms of RVO can vary widely from a spectacular sudden loss of vision involving central vision, to not noticing anything at all and the occlusion being detected at an eye examination.

How is a retinal vein occlusion assessed?

The diagnosis of RVO is usually made with testing including fluorescein angiography (FFA) and optical coherence tomography (OCT). OCT is important for detecting macula swelling and monitoring the response to treatment.

Specialised imaging known as OCT is used in the assessment of retinal vein occlusion

Central serous chorioretinopathy

Central Serous Chorioretinopathy (CSCR or CSR) is a common condition that affects young people between the ages of 20-50. It is more common in males.

What are the symptoms of central serous chorioretinopathy?

Fluid accumulates underneath the retina and if this occurs at the central macular it results in blurred vision. Patients usually present with central distortion or blurred vision in one eye. Colours may appear washed out and there can be a central scotoma. Symptoms are usually unilateral. Metamorphopsia and image size distortion are common. There is a 5% prevalence in Cushing’s syndrome.

In most cases, a cause is never identified. However, stress and use of steroid medications are thought to be associated in certain cases.

How is central serous chorioretinopathy treated?

In most cases CSCR resolves spontaneously and no treatment is required. Over 90% of patients return to normal or near normal vision within 3-4 months. Occasionally patients continue to have reduced colour vision, night vision or distortion.

Some patients with non-resolving CSCR require laser treatment after 4-6 months. Photodynamic therapy is also emerging as a possible treatment option in certain patients. Other newer treatments that can be considered for some patients include oral medications that block mineralocorticoid receptors.

Macular hole

The macula is an area at the centre of the retina, where light focuses to produce your clear, coloured, detailed vision. When a defect occurs through this area it is referred to as a macular hole.

What are the symptoms of a macular hole?

The most common symptoms are blurring, distortion or a dark/grey spot in the central vision.

How is a macular hole assessed?

An OCT scan of the area assists the Ophthalmologist in diagnosing the macular hole and determining if it is full thickness (affects each layer of the retina).

What is the treatment for a macular hole?

The most common treatment is a vitrectomy, which is a surgical procedure that removes the gel in the eye and places a gas bubble at the edges of the macular hole until it heals.

Epiretinal membrane

An epiretinal membrane is a thin membrane that forms on the inner surface of the retina. Typically they cause minimal symptoms and can be observed, however in some cases they can cause a loss of vision and distortion. It is only when an epiretinal membrane becomes symptomatic that treatment is required, prior to this it can be monitored.

Treatment for the membrane involves surgery with a vitreo-retinal surgery, who peels the membrane to reduce the pucker that it has caused at the retina.

Naevi and melanoma

Similar to your skin, your retina can get freckles and pigmentation. Some of these are referred to as naevi or moles, and are monitored over time to see if there is any change.

It is also possible to have a melanoma grow on your retina – initially these may be difficult to distinguish from a naevus, but if the ophthalmologist notices changes over time or it has features that concern them, then treatment can be necessary.