Retinopathy

 

Definition

Retinopathy is any disease of the retina of the eye. The word retinopathy also describes damage to the retina from other diseases, such as diabetes or hypertension.

Retinopathy pronunciation: “ret-in-AH-puh-thee”

Retinopathy symptoms

Depending on the location and severity of retinopathy, it may cause few symptoms or it may result in devastating vision loss.

In most cases, retinopathy causes no pain. Vision loss caused by retinopathy, however, often is permanent and irreparable.

Types of retinopathy

There are several types of retinopathy, depending on the underlying cause. The most common kinds of retinopathy include:

Diabetic retinopathy

Diabetic retinopathy is damage to the retina caused by type 1 or type 2 diabetes. In particular, uncontrolled diabetes damages blood vessels in the retina, which causes them to leak blood and other fluids.

Diabetes can also cause swelling of the central retina — a condition called diabetic macular edema — and other damage to the eye as well. Retinopathy and other damage to the eye caused by diabetes is often referred to as diabetic eye disease.

In its early stages, diabetic retinopathy may cause no noticeable vision problems. But as the disease progresses, it can lead to severe and permanent vision loss and even blindness.

In many cases, successfully managing blood glucose levels with diet, exercise and (if necessary) daily medication can help slow or even stop the progression of diabetic retinopathy.

Hypertensive retinopathy

Another common type of retinal disease is hypertensive retinopathy, which is damage to the retina that’s caused by high blood pressure.

Like diabetic retinopathy, hypertensive retinopathy primarily affects the blood vessels of the retina, causing distinct changes that your eye doctor can see during a comprehensive eye exam even before you notice any vision loss or other symptoms.

High blood pressure is common in the United States and other Western countries. Risk factors include:

• Stress
• Unhealthful diet
• Obesity
• A sedentary lifestyle 

If you have chronic high blood pressure, this can cause the walls of blood vessels throughout your body (including those in the retina of your eye) to thicken. This results in narrowing of the inner channel of blood vessels, restricting blood flow to the retina. 

Over time, an insufficient supply of blood can cause swelling and other damage to the retina, eventually resulting in vision loss. In some cases, hypertensive retinopathy can cause a sudden loss of vision from an eye stroke or damage to the optic nerve. 

Retinopathy of prematurity

This is a special type of retinopathy that affects newborn babies — especially those born prematurely.

According to the National Eye Institute, retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 2.75 pounds (1,250 grams) or less who are born before 31 weeks of gestation. (A full-term pregnancy has a gestation of 38 to 42 weeks). 

The smaller a baby is at birth, the greater the risk of ROP. It usually affects both eyes and is one of the most common causes of permanent vision impairment and blindness in childhood.

Solar retinopathy

Solar retinopathy is damage to the central zone of the retina from staring at the sun. The intense visible and ultraviolet (UV) rays of the sun cause a phototoxic effect on the retinal tissue, typically at the center of the macula. Essentially, it’s like getting a “sunburn” on the most sensitive spot of the retina.

Solar retinopathy can occur quickly. Risks include viewing a solar eclipse without a protective face shield or sunglasses and sungazing (looking directly at the sun during dawn and dusk — sometimes done as part of a spiritual or religious practice).

Other names for solar retinopathy include:

• photic retinopathy
• solar maculopathy
• solar retinitis
• foveomacular retinitis
• eclipse retinopathy

Solar retinopathy often causes mild-to-moderate loss of visual acuity, with or without a central or paracentral blind spot. In some cases, vision may return to normal over a period of three to six months; but it’s also possible for solar retinopathy to cause some degree of permanent vision loss.    

Age-related macular degeneration

Age-related macular degeneration (AMD) is a type of retinopathy that affects the macula. There are two types of macular degeneration: dry AMD and wet AMD.

Dry AMD is more common, causing gradual central vision loss over many years. Wet AMD is caused by leaky blood vessels in the eye. Wet AMD can lead to immediate vision loss in severe cases.

HIV retinopathy

Retinopathy can also be caused by human immunodeficiency virus (HIV) infection and AIDS (acquired immunodeficiency syndrome).

HIV/AIDS has the ability to affect any organ in the body. Researchers have found that up to 70% of HIV-infected patients have retinopathy or other eye signs of the disease, and in many cases, findings in the eye are the first signs of HIV infections.

As with other types of retinal disease, early detection and treatment of HIV retinopathy and the underlying systemic disease is essential to reduce the risk of permanent vision loss.

Sickle cell retinopathy

Sickle cell retinopathy is a form of retinal disease that occurs in some patients with sickle cell disease — an inherited group of disorders that affect red blood cells (RBCs).

In sickle cell retinopathy, altered RBCs cause blockage of blood vessels in the retina, resulting in abnormal blood vessel growth and thinning of the retina that causes vision loss.

Hydroxychloroquine retinopathy

Hydroxychloroquine (brand name: Plaquenil) is a medication used to manage a variety of autoimmune disorders, including lupus. The drug has been proven effective, but it’s not without side effects. 

Long-term use of hydroxychloroquine (HCQ) has been associated with irreversible visual loss due to retinal toxicity. 

Research has shown hydroxychloroquine retinopathy (also called Plaquenil retinopathy)  occurring in 7.5% of patients taking HCQ for more than five years, and among almost 20% after 20 years of treatment.

Hydroxychloroquine has been in the news recently because some have suggested it might be an effective treatment for COVID-19.

Valsalva retinopathy

Valsalva retinopathy is an interesting retinal condition that can occur in healthy people of any age. It is caused by a sudden increase in pressure within the chest or abdomen that occurs with physical exertion while you are holding your breath. (When this is done intentionally, such an action is called the Valsalva maneuver.)

When this pressure increase occurs, it can cause small blood vessels in the retina to break, leading to bleeding inside the eye and vision loss from Valsalva retinopathy. The retinopathy can occur in one or both eyes.

Common activities and conditions that can increase your risk of Valsalva retinopathy include:

• Weight lifting
• Vomiting
• Coughing
• Sneezing
• Aerobic exercise
• Constipation
• Straining
• Sexual intercourse

Use of blood thinners (prescribed to reduce stroke risk) has been shown to be a risk factor for valsalva retinopathy.

In most cases, vision loss from Valsalva retinopathy self-resolves within several weeks to a few months. Strenuous activities should be avoided during this recovery time until vision has cleared.

The same conditions that produce Valsalva retinopathy also can cause tiny blood vessels on the surface of the eye to break open and bleed, leading to a condition called subconjunctival hemorrhage. 

Retinopathy symptoms

Retinopathy symptoms depend on the type and severity of the underlying condition. For some types of retina disease, vision loss is the only symptom.

Other symptoms of retinopathy can include:

• Blurry vision
• Reduced visual acuity (sharpness)
• Floaters or spots in vision
• The appearance of flashing lights
• Difficulty seeing small details or text

In almost all cases, retinopathy does not produce eye pain or discomfort. Some types of retinopathy increase the risk of a retinal detachment, which is a medical emergency that requires prompt surgical treatment to avoid permanent vision loss. 

Diagnosis

Retinopathy is detected and diagnosed by your eye doctor during a comprehensive eye exam. Early diagnosis is one of the best ways to reduce or eliminate the vision loss associated with advanced retinal damage.

Your eye doctor will closely examine your retina during a procedure called ophthalmoscopy (or a fundoscopic exam).

If abnormalities are seen in the blood vessels of your retina, you may be referred to a retina specialist for further testing and treatment.

Retinopathy treatment

Treatment options for retinopathy vary depending on the type and severity of retina disease you have. 

Sometimes retinopathy will go away on its own, while being monitored by an eye doctor. Other forms of retinopathy don’t cause symptoms in their early stages and only need to be monitored.

Treatment may be suggested when retina disease progresses to the point at which it could damage your vision. Methods of treatment may include:

• Oral medications
• Laser therapy to slow blood vessel swelling
• Freezing therapy (cryotherapy) to slow blood vessel swelling
• Injecting special medications directly into the eye
• Removing and replacing the fluid inside the eye (vitrectomy)

See an eye doctor

If you experience a sudden decrease in visual acuity, visual field loss, increased eye floaters or other symptoms of retinopathy, schedule a comprehensive eye exam with your eye doctor.

Only an eye doctor can determine if your vision problem is due to retinal disease and what type of retinopathy treatment is needed. 

CONTACT US AT PREMIUM OPTICALS AND EYE CLINIC FOR MORE INFORMATION.