Retinal and vitreous diseases: What are the most common diseases?

Retinal and vitreous disorders involve a variety of problems. Their origin may be in the gradual aging of the body, but also as a result of other diseases. They occur long-term (chronically), however, the second group are those that occur acutely, ie suddenly.

Even in this group of diseases, a preventive professional examination is important.

Early diagnosis and detection of difficulties helps with effective treatment. Which can significantly affect the extent of eye damage.

What is the retina and vitreous?

These two structures are close together, neighbors together.

Retina

It is one of the most important parts of the eye. Its task is to capture light rays. Light-sensitive cells, such as rods and suppositories, help her with this.

These capture light.

We know these light-sensitive retinal cells :

1. rods are light-sensitive cells that process light of lower intensity
   • they do not recognize the color
2. suppositories are used to capture the light of different wavelengths, and therefore colors
   • they recognize colors, intensity, color saturation
   • ensure visual acuity
   • the highest number is in the central hole of the yellow spot, the so-called fovea centralis
   • there are approximately 6 million suppositories on the retina

Obraz zachytený sietnicou sa následne zrakovými nervami prenáša do zrakového centra v mozgu. Tu sa zrakový vnem ďalej spracuje a vytvára sa obraz, ktorý aktuálne vidíme.

There is an important macula lutea on the retina, a yellow spot about 5 mm in size. The macula consists of neuroreceptors, mainly suppositories, and at the edge of the rods. It also contains a xanthophilic pigment, which has a typical color, thanks to carotenoids and vitamin A.

Glass

The vitreous makes up  80% of the volume of the eyeball (bulbus oculi) and is, therefore, the largest part of the inside of the eye. In the front, it touches the surface of the lens case. It is clamped at the posterior pole of the eye at the outlet of the optic nerve.

Vitreous is made up of components:

1. water - 98% content
2. collagen, a structural protein
3. hyaluronic acid, a glycoprotein, gives the eye a gel-like consistency
4. chondroitin sulfate

Vitreous, technically also Corpus vitreum, is a transparent clear, colorless jelly-like mass. Its main task is to maintain the intraocular pressure, and thus the shape of the eye, plus it is part of the optical system of the eye.

The site where the vitreous urges the retina is referred to as the vitreoretinal interface .

The vitreous and retina are normally connected in only a few places.
And these are:

• around the target of the optic nerve
• at the site of retinal vessels
• in the vitreous base area

The rest of the vitreous is only loosely attached to the retina.

The most common diseases of the retina and vitreous

The retina and vitreous work closely together. Both can affect different diseases, which in some cases have a common connection. They cause visual impairment.

The table shows the most common diseases of the retina and vitreous

We know various diseases of the retina and vitreous. These two structures are closely adjacent and interact with each other. In the following section, we list some of the diseases that affect them.

Macular degeneration

It is also referred to as age-related macular degeneration or VPDM for short. The disease affects the central part of the retina, and thus the macula, the yellow spot.

The name itself means that old age is a risk factor. However, the exact cause has not yet been fully revealed.

Other risk factors such as genetic predisposition, familial occurrence, the effects of sunlight, smoking, alcoholism, diabetes, and high blood pressure are also attributed to the outbreak of difficulties. The risk of occurrence is also increased by the already present refractive error, especially farsightedness.  

The disease itself is further divided into dry or wet forms.

The dry form represents approximately 90% of cases. It arises as a result of the accumulation of waste products of metabolism in cells. It is manifested by small yellow dots in the retina, which are visible during the examination of the ocular background.

Disability leads to visual impairment and decreased visual acuity. Blurred vision, impaired vision at dusk, and in low light conditions. In the last phase until the loss of vision.

The wet form  is less common in approximately 10% of VPDM cases. It is caused by new blood vessels and peeling of the retina.

Newly formed blood vessels damage the retina, causing bleeding and swelling of the retina. This type occurs suddenly. It causes image distortion and significantly impairs visual acuity.

More information in the article on macular degeneration .

Diabetic retinopathy

It arises as a complication of diabetes. Diabetes in the long run results in various difficulties throughout the human body.

In the case of the eye, this is a negative for the small vessels of the retina. These are damaged, which in the worst case leads to blindness.

It can also occur with uncomplicated diabetes, which is mild.

The vessels of the retina are affected by various changes that cause bleeding, swelling, or heart attack, and thus bloodlessness. The most severe form is proliferative diabetic retinopathy. It is characterized by the formation of new, however, pathological vessels.

Pathological vessels often bleed into the retina or vitreous. As a result, retinal detachment can also occur.

Information on the disease in the article Diabetic Retinopathy .

Hypertensive retinopathy

Like diabetes, high blood pressure has a negative effect on the whole body. In addition to the risk of stroke and heart attack, it also causes other problems.

Read also articles on:
High blood pressure
Stroke
Myocardial infarction

The problem is especially untreated, poorly or insufficiently treated high blood pressure. At high values ​​of blood pressure, spasms occur - contractions of blood vessels and also the transfer of fluid into space outside the vessels, and thus into the retina or vitreous.

Similarly, in this case, there is bleeding, swelling, or non- bleeding. The damage occurs gradually. As time goes on, difficulties such as deterioration in visual acuity and loss of field of vision gradually add up.

Retinal vascular diseases

There are more common eye diseases that occur acutely and cause significant vision problems.

They are divided into artery or vein occlusions. Arteries are vessels that carry oxygenated blood and veins, which are not oxygenated.

The mechanism of arterial occlusion is the occlusion of small vessels by the embolus. An embolus is a loose blood clot that travels in the body's bloodstream and clogs the smallest blood vessels.

An ischemic stroke, for example, also occurs.

Atherosclerosis is also important for the development of these problems. This results in a narrowing of the lumen of the vessel. The main risk factors involved in the development are hypertension, diabetes, high blood fat, obesity, smoking, and thus a bad lifestyle.

Another mechanism is due to venous occlusions that result from narrowing or complete occlusion of the vessel. The main cause is atherosclerosis of the vessels. Blood accumulates behind this blockage, resulting in swelling and bleeding into the retina.

We know that they arise  due to various risk factors, such as:

• hypertension
• hypercholesterolemia
• old age, over 65, affects up to 50% of the elderly population
• thermocoagulation disorders
• diabetes
• increased intraocular pressure

Retinopathy of prematurity

It is listed as the most common cause of blindness in children.

It occurs in newborns who are born before 32 weeks of pregnancy or in those whose birth weight was less than 1,500 grams.

These children have insufficient breathing and are therefore placed in an incubator for a long time. There they are given oxygen therapy. Where the oxygen concentration is high, above 40%.

During this period, the newborn's eyes are not fully developed, not even the retina or blood vessels. The high concentration of oxygen in the incubator results in the eye getting used to this increased value of the partial pressure of oxygen in the ambient air.

Consequently, outside the incubator, the normal value of the oxygen content in the air is no longer sufficient. There is an increased formation of new blood vessels to ensure a sufficient supply of oxygen. 

These new blood vessels grow through the retina, can pass into the vitreous, and there is a risk of retinal detachment. Similar to macular degeneration.

Retinal detachment

The retina separates from the pigment layer, on which it normally attaches freely. As a result, fluid penetrates between the retina and the pigment layer.

It can be caused by an eye injury, but it is also a complication of other diseases, such as diabetes. In particular, a higher degree of myopia requires increased attention.

Symptoms that occur in this case:

• flashes of light, phosphenes (flickering before the eyes)
• floating flies in the field of view - as if threads, tufts
  • especially when looking at a white wall or sky
• aperture - shielding part of the field of view
  • dark shade on the edge
  • later also in the middle of the field of view
• image distortion
• loss of sensitivity to light
• visual acuity disorder
• up to the loss of vision

Also, read the article on retinal detachment.

Macular hole

The vitreous loosely urges the retina, it is as if attached.

Under normal circumstances, the two structures merge in only three places. And this is the target of the optic nerve, in parts of the course of the retinal vessels and the area of ​​the vitreous base.

The site where the vitreous urges the retina is referred to as the vitreoretinal interface.

As the body ages, changes occur in the area. The vitreous collapses, peeling from the retina.

If the condition is not further complicated, there are only milder difficulties.

There are difficulties such as flying flies in the field of view, also referred to as muches volantes. Possibly occasional  flashes in front of the eyes.

The opposite is the case when complications occur.

If a stronger connection is formed between the vitreous and the retina, the collapsing and peeling vitreous pulls the retina. The retina crouches, lifts.

The result is image distortion, ie metamorphosis, which arises as a result of the pull of photoreceptors.

The retina is the thinnest in the macular area.

In the most severe case, a macular hole is formed.

The macular hole is a defect that affects the entire thickness of the neural layer of the retina, in the macular area. Manifestations are complications and visual disturbances, ie image deformation -  metamorphosis, but also reduced visual acuity or loss of visual field, in the central part (in the middle).

It is actually an opening in the area of ​​the yellow spot, through which the lower structures are visible. The size of the defect - the hole gradually increases. 

However, its cause is not only old age. It occurs as a single disease or as a complication of other eye problems. An example is diabetic retinopathy or a post-traumatic condition.

The overall difficulties that affect a person depend on several factors, such as:

• localization
• the extent of the defect
• duration, ie the time since its inception

Epiretinal membrane

The difficulty is due to the state of an epiretinal membrane (EM), that is, the surface membrane of the retina film with time becomes thicker. The result is its opacity, wrinkling.

The retina under the membrane deforms and deforms.

In a more severe stage, the pull persists and a macular hole is formed.

Manifestations are :

• decrease in visual acuity
  • primarily into the distance
  • later also a problem with reading
• image distortion - wavy lines
• significant decrease in vision
• up to a failure of the central field of view

Other vitreous changes, vitreous opacities or eye flies

As we already know, the vitreous makes up 80% of the intraocular environment. It reaches a volume of approximately 4 milliliters. From 98% it consists of water. The rest consists of collagen, hyaluronic acid, and chondroitin sulfate.

The vitreous insists on the lens at the front and the retina at the back. Towards the edges of the vitreous, its gel-like mass is denser. This part is also referred to as the base, it has a front and a back part.

The higher density is formed by the increased concentration of hyalocytes, which are cells that makeup collagen and hyaluronic acid.

Because the vitreous and retina are closely related, pathological changes in the vitreous also affect the retina. As above.

The vitreous itself can be affected by turbidity, for various reasons :

1. due to age, ie involutional changes
2. degenerative changes
3. bleeding
4. inflammation

1. Age-related vitreous changes

The vitreous has a homogeneous, uniform structure from birth. However, changes in its structure gradually begin in the second decade of life.

The table shows some age-related changes in vitreous

2. Degenerative vitreous changes

This category includes those changes that are not caused by the aging of the body, and therefore the eye.

The table shows the degenerative changes of the vitreous

3. Vitreous blood flow

Vitreous hemorrhage is caused by various causes. It's not just after an accident.

Causes of vitreous hemorrhage:

• after the injury, however, the eye may not be directly injured
• in retinal vascular diseases, such as diabetic retinopathy, retinal vessel occlusion
• in other general diseases
  • high blood pressure
  • leukemia
  • blood clotting disorders
  • during long-term treatment with anticoagulants, ie anticoagulants

There are various difficulties in bleeding into the vitreous. For example, seeing falling shadows in the field of view, decreased visual acuity, or the feeling of a veil in front of the eye.

4. Inflammatory changes of the vitreous

In inflammation of the vitreous, inflammatory cells as well as proteins from the blood penetrate.

Inflammation is caused by standard bacteria, viruses, fungi, fungi or parasites.

Inflammation is in most cases from the external environment after the injury, but also after eye surgery. Intraocular inflammation is uncommon. The reason for this type is usually blood transmission, the so-called hematogenous spread in other infectious diseases.

The vitreous is turbid by various particles, which may be pale or yellow. Which depends mainly on the cause of the infection. Inflammation is usually fast, the worst complication is loss of vision, ie blindness.

Eye floaters - muches volantes

This refers to small floating features in the field of view, which are visible especially on a bright, pale surface. For example, when reading or driving. They have the shape of dots, threads, or  tufts. 

Flies, such as vitreous turbidity, can be the cause of increasing age, they also occur in myopia, injury, inflammation, cataract surgery or diabetes.

However, the reason for their occurrence may be m

How the individual diseases manifest themselves is influenced by the place of disability, the extent, and duration. The difficulties concern the eye, and therefore the vision.

Here are some of the symptoms that are part of them:

• decrease in visual acuity
• the problem may be initially with remote image viewing
• reading also makes it a problem later
• eye floaters, ie  muches volantes
  • floating formations in the field of view
  • they have different shape and size
  • better visible on a white wall or sky
  • they change position when moving the eyes
  • dots
  • nite
  • cobwebs
  • clumps
  • spots
• flashes
• falling soot
• shadow or aperture, shielding of the field of view
• visual field failure
• deformation of lines and image, metamorphopsia

Today, various diagnostic options are available. An ophthalmologist, ie an ophthalmologist, examines visual acuity, the back of the eye. The anamnesis and clinical difficulties described by man are important.

If necessary, an examination of the image deformation on the Amsler grid is added, photo documentation, OCT is created.

OCT, an ocular tomography, but also optical coherence tomography, is a non-invasive non-contact examination. More information about the examination can be found on Wikipedia.

This method is suitable mainly because it shows the individual structures of the eye in detail. The team is involved in the diagnosis of various eye problems. Distinguishes stage, development, and the exact type of difficulties.

Methods such as the Watzke-Allen test, the laser beam test or autofluorescence, microperimetry are also known for the examination of these diseases. Or the Gass hole classification.

It is an important differential diagnosis and determines the exact cause of the problem.

In particular, people with other general illnesses should have an eye examination at least once a year.
Others should not forget about important preventive check-ups.

A wide range of diseases can have a diverse course. It is important to remember that if the problem occurs suddenly, acutely, ie quickly from full health, an immediate examination by a specialist is necessary. In this case, it is an ophthalmologist, ie an ophthalmologist.

Beware of the rapid onset of difficulties!