Our retina team is highly experienced in treating vitreoretinal diseases including diabetic retinopathy, macular degeneration, retinal detachment, macular hole, and other vitreoretinal disorders. As part of our mission to provide patients with life-changing vision, St. Luke’s at The Villages is proud to offer retina eye care.
Our retina specialist, Dr. Remington Horesh, is a fellowship-trained vitreoretinal surgeon who specializes in the medical and surgical treatment of retinal disorders. Dr. Horesh, along with the rest of our retina team, is here to take care of all of your retina-related concerns and conditions and to get you one step closer to preserving your vision.
Diabetes is a disease that can affect both children and adults, and it occurs when the pancreas does not produce enough insulin or when the body is unable to process insulin properly. Insulin is the hormone responsible for regulating the level of sugar (glucose) in the blood. Patients with diabetes are more susceptible to developing eye problems such as cataracts and glaucoma. However, the effect that diabetes has on the retina—known as diabetic retinopathy— is the main threat to vision.
Diabetic retinopathy is when high blood sugar levels result in damage to blood vessels in the retina. The high blood sugar levels can cause these blood vessels to swell, leak, and even close, which stops blood from passing through. This condition can develop in anyone with type 1 or type 2 diabetes. The longer one has diabetes and the less controlled their blood sugar is, the most likely they are to develop diabetic retinopathy.
In the early stages of diabetic retinopathy, many people do not usually experience symptoms, although some people do notice changes in their vision like difficulty reading. In the later stages of this disease, blood vessels in the retina can start to bleed into the vitreous, which is the gel-like fluid that fills the eye. This can lead to seeing dark, floating spots or streaks that resemble cobwebs. These spots can sometimes go away on their own but without treatment, the bleeding can occur again, worsen, or lead to scarring.
As diabetic retinopathy progress, one may experience:
- Blurred vision
- Floaters (spots or dark strings floating in their line of vision)
- Fluctuating vision (vision changes from blurry to clear and vice versa)
- Dark or empty spots in their vision
- Loss of vision
There are two types of diabetic retinopathy:
Early Diabetic Retinopathy
Often called nonproliferative diabetic retinopathy (NPDR), is the most common form of this condition. Here, new blood vessels are not growing but the blood vessels in the retina begin to weaken. With NPDR, tiny blood vessels leak, leading to swelling of the retina, which can lead to loss of vision.
Advanced Diabetic Retinopathy
Known as proliferative diabetic retinopathy is the more severe form of the condition. Here, the damaged blood vessels in the retina close off, leading to new, abnormal blood vessels growing in the retina. These new blood vessels are weak and can potentially leak in the eye’s vitreous. After some time, scar tissue from the growth of the new blood vessels can lead to the retina detaching from the back of the eye. The new blood vessels can also get in the way of the normal flow of fluid from the eye, leading to a buildup of pressure in the eyeball. This buildup of pressure can potentially damage the optic nerve, which is the nerve responsible for carrying images from the eye to the brain, which can lead to glaucoma.
Treatment greatly depends on the form of diabetic retinopathy that one has, as well as the severity of it.
- Early diabetic retinopathy may not require treatment right away but must monitor the condition to determine when treatment is necessary. Controlled, low blood sugar levels can work to slow the progression of the condition in this early stage.
- With advanced diabetic retinopathy, immediate treatment is necessary. Potential treatment options include:
- Anti-vascular endothelial growth factor inhibitors (anti-VEGF) medications that get injected directly into the eye. These medications help to stop the growth and formation of abnormal blood vessels and decrease fluid buildup.
- Injectable steroids can be used to reduce macular swelling.
- Laser treatments can be used to reduce swelling in the retina and to make blood vessels shrink and stop leaking.
- A vitrectomy, a type of eye surgery, may be used to remove vitreous gel and blood from leaking vessels in the retina.
Age-Related Macular Degeneration (AMD) is an age-related, degenerative issue with the retina. It occurs when the center of the retina is damaged, resulting in central vision problems. It happens when the macula— the part of the eye located near the center of the retina that controls sharp, straight-ahead vision—is damaged due to aging. The damage to the central vision leads to difficulty reading, seeing fine details, and recognizing faces. AMD does not impact one’s peripheral (side) vision, but rather is a disease that affects the center of one’s vision.
AMD is a very common condition in people over the age of 60 and is a leading cause of vision loss for older adults. It often affects both eyes, however, one eye may be more affected than the other. The severity of the disease varies greatly, as some people who have the disease may not notice any changes at all. It is a condition that develops very slowly in some people, and much faster in others.
There are two types of AMD: Dry and Wet.
The majority of people with AMD have dry AMD, also known as atrophic AMD. Dry AMD makes up about 90% of the cases of AMD. With this type of AMD, the macula thins as one ages. Those with this type of AMD may have yellow deposits, known as drusen, in the macula. A few small drusen may not have an impact on your vision, but as they get bigger and become more numerous, they can distort or dim your vision and can cause central vision loss. Dry AMD occurs in 3 stages: early, intermediate, and late. It usually slowly progresses over several years.
Wet AMD, also known as neovascular AMD, is a less common and more serious type of late AMD. Only about 10% of people with macular degeneration have this form. In this type of AMD, abnormal blood vessels grow under the macula, bleed, and leak fluid into the retina. This can cause vision to become distorted, can create blind spots, and lead to a loss of central vision. These blood vessels are like weeds growing through cracks and eventually, they form a scar which can lead to permanent loss of central vision. Any stage of dry AMD can turn into wet AMD, but wet AMD is always the late stage of this condition.
Compared to dry AMD, wet AMD progresses much quicker and can cause patients to experience a more significant loss of vision. However, if caught early enough, there are treatment options that can stabilize a patient’s vision and lower the risk of experiencing further vision loss.
Treatment Options For AMD
There are currently no treatments for dry AMD, but there are steps you can take, such as consuming specially formulated vitamins, to decrease the risk of the condition progressing into its most advanced form.
To treat wet AMD, anti-VEGF medications are commonly used. This form of treatment is injected directly into the eye and works to reduce the number of abnormal blood vessels in the retina.
The retina is a light-sensitive membrane that is located at the back of the eye. When light passes through the eye, the lens focuses an image on the retina. The retina then converts that image into signals that are sent to your brain through the optic nerve. The retina works with the lens, cornea, and other parts of the eye and brain in order to produce normal vision.
What causes retinal detachment?
When the retina separates from the back of the eye, retinal detachment occurs. This detachment can cause either a partial or a total loss of vision, all depending on how much of the retina is detached. When the retina becomes detached, it is pulled from the tiny blood vessels (known as choroids) that supply it with both oxygen and nutrients. The retinal cells may become severely deprived of oxygen, which increases the risk of suffering from permanent loss of vision. The longer these cells are separated from the retina, the more likely a person is to experience a permanent loss of vision. Retinal detachment is a medical emergency—contact St. Luke’s at The Villages immediately if you begin to experience any sudden vision changes.
Potential risk factors for retinal detachment include:
- Posterior vitreous detachment, which is common in older adults
- Extreme nearsightedness, which is known to cause more strain on the eye
- A family history of retinal detachment
- Prior history of retinal detachment or tear
- A history of glaucoma (an eye disease related to eye pressure)
- A history of weak area in your retina (known as lattice degeneration and has been seen by your eye doctor in previous exams)
- Trauma to the eye
- Prior serious eye injuries
- Being over the age of 50
- Previously undergoing cataract surgery
- Complications following cataract-removal surgery
- Diabetes mellitus
- Nearsightedness (requiring glasses to see far away)
Notify Dr. Remington Horesh immediately if you notice any of the above.
There is no pain related to retinal detachment, but there is usually some discomfort and symptoms prior to the retina becoming detached.
Primary symptoms of the condition include:
- Blurred vision
- Partial vision loss, which makes it seem as though a curtain has been pulled across your field of vision, giving off a dark, shadowing effect
- Sudden flashes of light that appear in your peripheral vision (when looking to the side)
- Suddenly seeing floaters, which are tiny pieces of debris that look like black flecks or strings floating before your eye
- An increase in flashes or floaters
There are three types of retinal detachment:
- Rhegmatogenous Retinal Detachment: Rhegmatogenous retinal detachment means that one has a tear or hole in their retina. The tear or hole allows for fluid from inside the eye to slip through the opening and get behind the retina. The fluid separates the retina from the retinal pigment epithelium, the membrane that provides the retina with nourishment and oxygen, which causes the retina to detach. Rhegmatogenous retinal detachment is the most common type of retinal detachment.
- Tractional Retinal Detachment: When scar tissue on the retina’s surface tightens, it causes the retina to pull away from the back of the eyes, leading to tractional retinal detachment. This type of detachment is less common than other types, and typically affects people with diabetes mellitus. When diabetes mellitus is inadequately controlled or improperly taken care of, it can lead to issues with the retinal vascular system. This vascular damage can eventually lead to the accumulation of scar tissue in the eye that could cause retinal detachment.
- Exudative Detachment: In cases of exudative detachment, there are no tears or breaks in the retina. Rather, retinal diseases such as the following cause this type of detachment:
- An inflammatory disorder that causes fluid to build up behind your retina
- Cancer behind your retina
- Coats’ disease, which causes abnormal development in the blood vessels leading to leaking proteins building up behind the retina
Treatment for Retinal Detachment
In most cases, surgery is the necessary form of treatment to repair a detached retina. However, for minor retinal detachments or tears, a simple procedure may be done in our surgical center at St Luke’s at The Villages Sumter Landing. Having said that, surgery is almost always used to repair a retinal tear, hole, or detachment, and there are several techniques available:
- Photocoagulation-If there is a hole or tear in the retina but the retina is still attached, your doctor may use a laser to perform a procedure called photocoagulation. The laser burns around the tear site, and the resulting scarring attaches your retina to the back of your eye.
- Cryopexy- Cryopexy, which uses intense cold to freeze an area of your eye, is another option. In this treatment, your doctor applies a freezing probe to the outside of your eye in the area over the retinal tear site, and the resulting scarring helps keep your retina in place.
- Pneumatic Retinopexy– Pneumatic retinopexy is an option to repair minor detachments that can be done in the office. In this procedure, your doctor places a gas bubble inside your eye to help your retina move back into place up against the eye’s wall. The gas bubble acts as a splint. After this procedure, it is imperative to keep your head positioned in a specific way for a few days to allow the bubble to remain in the right spot. The gas bubble goes away on its own over the course of a few weeks as your eye heals.
- Scleral buckling– More severe detachments will require you to have eye surgery in a hospital. Your doctor may recommend scleral buckling, which involves placing a band around the outside of the eye to push the wall of the eye into the retina, getting it back into place for proper healing. Scleral buckling may be done in combination with a vitrectomy, and a cryopexy or retinopexy is performed during the scleral buckle procedure.
- Vitrectomy Surgery- Another treatment option is a vitrectomy, which is used for larger tears. This procedure involves anesthesia and is often performed in an operating room as an outpatient procedure. However, it may require an overnight stay in the hospital. Here, your doctor will use small tools to remove vitreous, the gel-like fluid that fills your eyes, and abnormal vascular or scar tissue from your retina. The doctor will then put your retina back into its proper place, which is usually done with a gas bubble. A Cryopexy or retinopexy is performed during the vitrectomy procedure.
“The field of Vitreoretinal Surgery is complexly detailed, innovative, and vital to preserving and restoring your vision. I am enthusiastic to join the expert team at St. Luke’s as your vitreoretinal surgeon. I look forward to providing my patients in The Villages with the most personalized and advanced retinal care in the world.” – Remington Horesh, DO
In addition to his formal training, Dr. Horesh’s past and present experiences at the forefront of therapeutic advancements in retinal disease have been remarkably advantageous to his knowledge and expertise in the field. He has served as a treating physician in large-scale clinical trials aimed at discovering new and effective treatments for age-related macular degeneration.
If you or someone you know is struggling with AMD or any retinal-related eye diseases and needs an expert opinion, call 352-775-0080 to schedule a consultation.