Age-related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a chronic and painless disease of the macula that can blur your central vision. The macula is part of the retina, which is the light-sensitive tissue at the back of the eye that mainly controls sharp, detailed vision. AMD is a common condition that causes visual loss in those over 50. As we age, the macula can undergo damage, thinning, or abnormal blood vessel growth, leading to vision loss. 

 

Types

Retinal photographs comparing dry age related macular degeneration and wet age related macular degeneration with visible changes in the macula.

Source:  NEORETINA Eyecare Institute 

There are 2 types of AMD: dry and wet.

Dry AMD, also known as atrophic AMD, affects the majority of AMD patients. It occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye.

A less common kind of AMD that typically results in rapid vision loss is wet AMD, also known as neovascular AMD. It occurs when abnormal blood vessels grow in the back of the eye.

 

Symptoms

  • Difficulty seeing in dim light
  • Blurriness in their central vision
  • Straight lines begin to appear crooked or wavy
  • Hazy patch (blind spot) close to your centre vision
  • Colors appear less bright/saturated 

Side by side comparison of normal vision and vision affected by age related macular degeneration showing a blurred central area.

Source: National Eye Institute, National Institutes of Health

Straight lines looking wavy are a warning sign for late AMD. If you notice this symptom, see your eye doctor right away.

 

Risk factors

People aged 55 and older are more likely to have AMD. The risk for AMD is also higher for those who:

  • Have a family history of AMD
  • Caucasian
  • Women
  • Smoking
  • Lack of physical activity
  • High blood pressure (hypertension) and high cholesterol levels

 

Assessment

  • Dilated eye examination. 
  • Amsler chart. This can detect hazy, wavy or missing lines or areas on the grid.

Amsler Grid Test chart used to detect distorted, blurry or missing areas that may indicate macular degeneration.

Source: Pujashah

  • OCT scan. A non-invasive and painless scan for your retina and macula. 

OCT retinal imaging machine used for detailed scanning of the retina and macula in diagnosing macular degeneration.

 

Treatment

Since there is currently no cure for early AMD, your eye doctor will most likely use routine eye exams to monitor the condition of your eyes. Healthy eating, frequent exercise, and quitting smoking can all be beneficial as well.

Certain dietary supplements, such as vitamins and minerals, may be able to prevent AMD from progressing to the late stage.

On the other hand, if you have wet AMD, there are other treatments that may be able to stop further vision loss:

  • Anti-VEGF injections are the standard treatment involving injections in your eye used to slow the progression of the disease and reduce the damaging effects of these leaky abnormal blood vessels. 
  • Photodynamic therapy (PDT), a combination of injections and laser treatment. A light-sensitive drug is injected into the bloodstream, where it concentrates in abnormal blood vessels below the macula. The drug is then activated by a laser beam that is directed into the eye, resulting in the formation of blood clots, which seal off the abnormal blood vessels. 
  • Laser photocoagulation is used to delay the progression of vision loss by sealing off abnormal blood vessels with a laser. 

Currently, there is no effective treatment to reverse vision loss in late-stage dry AMD, but support is available to help you live with AMD, including help with low vision and lifestyle changes in order to help you have the best quality of life. 

The retinal specialists available in OasisEye Specialists include:

FAQs

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What is Macular Hole?

A macular hole is a small break or tear in the macula, the part of the retina responsible for sharp, central vision. 

 

How a Macular Hole Forms

The most common cause of macular holes is the aging process. As we age, the vitreous, a gel-like substance in the eye, shrinks and separates. If some of the vitreous remains attached to the retina as it shrinks, it can pull a section of the retina away with it, leading to a hole. This process is known as vitreomacular traction. 

  Cross-section diagram of the eye showing the vitreous body pulling on the retina and a comparison between a normal macula and a macular hole.

Source: Retina Center Chicago

Other causes or risk factors of macular holes include:

 

Symptoms

  • Distorted central vision
  • Blurred central vision
  • Dark or blind spot at central vision
  • Difficulty with tasks requiring fine detail, such as recognizing faces or reading small print

Amsler grid examples comparing normal central vision, a missing central area representing a blind spot, and wavy line distortion caused by a macular hole.

Source: Pure Optical

 

Diagnosis

An ophthalmologist can diagnose a macular hole through several tests, including:

  • Dilated eye examination
  • Optical coherence tomography (OCT): This non-invasive imaging test provides detailed cross-sections of the retina and can help identify the size and location of the hole.

Side-by-side images of a normal retina and a retina with a macular hole, including OCT scans showing the structural difference in the macula.

Source: NERA

 

Treatment

In many cases, surgical intervention is required to repair a macular hole, especially if it affects vision significantly. Vitrectomy is the procedure in which the surgeon removes the vitreous gel and replaces it with a gas bubble. The patient is asked to maintain a specific head position for a period to ensure the gas bubble presses against the hole, aiding in its closure.

 

Conclusion

It’s important for anyone experiencing symptoms like blurred vision, distorted vision, or central blind spots to seek an eye examination.

The vitreoretinal surgeons available in OasisEye Specialists include:

FAQs

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Understanding Uveitis

An eye condition called uveitis.

Uveitis is the inflammation of the uvea (the middle layer of the eye), which includes the iris, ciliary body, and choroid. It can cause eye pain, redness, blurred vision, light sensitivity and floaters.

Types of Uveitis

Diagram showing anterior, intermediate and posterior uveitis.

Source: Tennessee Retina

Causes of Uveitis

Uveitis can have various causes, which are often classified into the following categories:

1. Autoimmune and Inflammatory Conditions

  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Juvenile idiopathic arthritis 
  • Sarcoidosis

2. Infections

  • Bacterial, viral, fungal, or parasitic

3. Trauma or Injury

  • Direct eye trauma or injury
  • Secondary to eye surgery

4. Other Cause or Risk Factors 

  • Smoking
  • Cancer related
  • Genetics: certain genetic markers, such as HLA-B27 
  • Idiopathic (no identifiable cause)

Symptoms of Uveitis

Symptoms can develop suddenly or gradually and may affect one or both eyes. Common symptoms include:

  • Eye pain (aching or throbbing)
  • Redness in the eye
  • Blurred vision
  • Sensitivity to light (photophobia)
  • Floaters (small dark spots in vision)

Diagnosis of Uveitis

  • Dilated Eye Examination: The doctor will use eye drops to widen your pupils, allowing them to check the structures in the back of your eye.
  • Optical Coherence Tomography (OCT): This imaging technique provides detailed cross-sectional images of the retina, showing the separation of retina layers.

                 OCT scan showing cross-section of the retina.Topcon Triton OCT imaging device for eye scans.

  • Widefield Retinal Imaging: It provides a field of view of 200 degrees or 82% of the retina in a single capture. Besides, using special dyes injected into the bloodstream, Fundus Fluorescein Angiography (FFA) or Indocyanine Green Angiography (ICGA) can help to detect blood vessel leakage or fall out which might be caused by uveitis.
    Optos widefield retinal imaging system.
  • Laboratory Investigations: Several examinations including blood test, ESR, PCR test or Chest X-ray could rule out the underlying autoimmune or infectious causes.

     

    Widefield colour and fluorescein angiography images of the retina.

 

Treatments of Uveitis

The treatment of uveitis depends on the underlying cause, severity, and part of the eye affected (anterior, intermediate, posterior, or panuveitis). Here’s an overview of common treatments:

1. Medications

     A. Corticosteroids (to reduce inflammation)

     B. Immunosuppressive or Biologic Therapy (for non-infectious or autoimmune uveitis)

     C. Antimicrobials (if infection is the cause)

     D. Cycloplegic Drops (to relieve pain and prevent complications)

2. Lifestyle and Supportive Measures

  • Sunglasses – to reduce light sensitivity
  • Regular eye exams – to monitor progress
  • Managing underlying conditions – such as autoimmune diseases

3. Surgery (for severe or refractory cases)

  • Vitrectomy – to remove inflammatory debris or treat complications
  • Cataract or glaucoma surgery – if secondary complications develop

Why Early Diagnosis Matters

If left untreated, uveitis can lead to complications such as glaucoma, cataracts, macular edema, or even permanent vision loss. Early diagnosis and prompt treatment are key to preventing serious outcomes.

If you experience persistent eye pain, redness, or changes in your vision, don’t wait—consult an eye care professional.

The medical retina & uveitis specialists available in OasisEye Specialists include Dr Wong Hon Seng who is based in Kuala Lumpur; Dr Rajasudha Sawri Rajan who is based in Kuala Lumpur and Puchong.

FAQs

Yes. If not treated properly, uveitis can lead to complications such as:

  • Glaucoma
  • Cataracts
  • Retinal damage or detachment
  • Vision loss or blindness

Early diagnosis and treatment are critical.

Treatment depends on the cause, severity, and type. Options include:

  • Steroid eye drops (mainstay for anterior uveitis)
  • Oral steroids or injectable steroids
  • Immunosuppressive medications (for autoimmune-related cases)
  • Antibiotics or antivirals (for infectious causes)
  • Mydriatic drops (to dilate the pupil and reduce pain)

Treatment aims to control inflammation, prevent complications, and preserve vision.

Yes, recurrence is common, especially in autoimmune-related uveitis. Long-term monitoring is important even after symptoms resolve.

Most forms of uveitis are not contagious, but if caused by an infection like herpes or tuberculosis, the underlying infection might be.

  • Treat underlying conditions properly (autoimmune diseases, infections)
  • Protect your eyes from injury
  • Attend regular eye exams if you have a history of uveitis or autoimmune disease
  • Follow your doctor’s treatment plan to prevent recurrences

See an eye doctor (ophthalmologist) immediately. Early treatment can prevent serious complications.

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Floaters and Flashes: Recognizing Retinal Detachment as an Eye Emergency

Objects blocking vision.

Have you recently noticed sudden flashes of light or floaters in your vision? Are parts of your field of view obscured by a curtain-like shadow? These could be warning signs of retinal detachment, which is a medical emergency condition. 

What are the Risk Factors of Retinal Detachment?

  • Eye injury or trauma: For example, a fall, a sports accident, or a car accident.
  • High myopia (short-sightedness): In high myopia individuals, the eyeball is elongated and stretched, resulting in a higher risk of getting a tear or hole in the retina. 
  • Diabetes: High blood sugar levels can damage the blood vessels, causing bleeding or scarring. The scar tissue can pull on the retina and cause detachment.
  • Previous eye surgery: Undergoing certain types of eye surgery may increase the risk of retinal detachment, particularly if the surgery involves the vitreous or the lens of the eye.

How is Retinal Detachment Diagnosed?

  • Dilated Eye Examination: The doctor will use special drops to widen your pupils, allowing them to see the retina and other structures in the back of your eye.
  • Optical Coherence Tomography (OCT): This imaging technique provides detailed cross-sectional images of the retina, showing the separation of retina layers.

Optical Coherence Tomography (OCT) machine with scan showing cross-sectional image of detached retina.

  • Widefield Retinal Imaging: It provides a field of view of 200 degrees or 82% of the retina in a single capture. It helps to localise the area and the extent of the detachment.

Optos widefield retinal imaging device with ultra-wide view of retina displaying signs of detachment.

  • Ultrasound: If the retina is not clearly visible (for example, due to bleeding), an ultrasound of the eye may be performed.

Ultrasound imaging device showing retinal detachment on screen.

 

Treatment of Retinal Detachment:

Treating retinal detachment quickly is essential for preserving vision. The treatment approach depends on the type and extent of the detachment.

  1. Laser retinopexy: If a retinal tear or hole is present, a laser can be used to seal it and prevent further detachment.
  2. Cryopexy: It uses extreme cold to seal the tear or hole in the retina.
  3. Pneumatic Retinopexy: A gas bubble is injected into the eye to push the retina back into place, followed by laser or cryotherapy to seal the tear.
  4. Scleral Buckling: A small band (buckle) is placed around the eye to gently push the wall of the eye toward the retina, which helps to reattach it.
  5. Vitrectomy: This involves removing the vitreous gel and replacing it with a gas or silicone oil to help hold the retina in place.

The choice of treatment will depend on the specific circumstances of the detachment, such as its location, size, and the health of the retina.

Symptoms of Retinal Detachment: 

  • Floaters (dark spots or lines that seem to move with your vision)
  • Flashes of light
  • A shadow or curtain-like effect in your vision
  • A sudden loss in vision

It’s important to seek medical attention immediately if one experiences the above symptoms.

The vitreoretinal surgeons available in OasisEye Specialists include Dr Kenneth Fong, Dr Manoharan, Dr Wilson Wong who is based in Kuala Lumpur; Dr Ling Kiet Phang who is based in Johor Bahru; Dr Teh Wee Min who is based in Seremban and also Dato Dr Haslina who is based in Penang.

FAQs

Retinal detachment is a serious eye condition where the retina (the light-sensitive layer at the back of your eye) pulls away from its normal position. This can cause permanent vision loss if not treated promptly.

No, retinal detachment is usually painless, which is why recognizing the visual symptoms early is critical.

Not all cases are preventable, but regular eye check-ups help detect early signs like retinal tears. High-risk patients should have routine retinal screenings.

Retinal detachment is an ocular emergency. Delaying treatment can lead to permanent vision loss. If you experience symptoms, seek immediate care.

A retinal tear is a small rip or hole in the retina, which may lead to fluid passing underneath and causing a retinal detachment. Tears are usually treated early with laser or freezing therapy to prevent detachment.

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Understanding Central Serous Chorioretinopathy: An In-Depth Look

Central Serous Chorioretinopathy (CSCR) is a retinal disorder where fluid accumulates beneath the macula, the area of the retina which is responsible for central vision. The fluid leakage comes from a layer of tissue under the retina, called the choroid. It often results in blurry or distorted central vision.

OCT scan showing macular edema and retinal thickening.

The exact cause of CSCR is not fully understood, but it is believed to involve a combination of factors, including disturbances in the choroidal circulation, stress, and steroid use. The condition is typically unilateral (affecting one eye), although it can sometimes affect both eyes.

Who is at Risk for CSCR?

CSCR is most commonly seen in adults between the ages of 30 and 50, with men being more frequently affected than women. Some risk factors include:

Frustrated person showing stress.

  • Stress
  • Steroid Use. Both systemic and topical steroids are believed to alter the permeability of the blood vessels in the choroid, leading to fluid leakage.
  • Underlying Health Conditions. For example, hypertension.
  • Genetics
  • Age and Gender. CSCR is 6 times more commonly found in men, particularly those in their 30s to 50s.

Symptoms of CSCR

CSCR will affect vision and may make reading, driving, or recognizing faces more challenging. 

  • Blurry vision
  • Visual Distortions. Straight lines may appear curved or wavy.
  • Micropsia. Patients may perceive objects smaller than they actually are.
  • Dark Spots in Vision
  • Color Perception Changes

How Is CSCR Diagnosed?

In OasisEye Specialists, diagnosis of CSCR is aided by the following  procedures:

Optical Coherence Tomography (OCT): This imaging technique provides detailed cross-sectional images of the retina, showing if there is any fluid accumulation. OCT angiography (OCTA) is a high resolution imaging technique that can detect vascular abnormalities, especially in chronic CSCR cases.

Optical Coherence Tomography (OCT) machine for retinal imaging.OCT showing fluid accumulation under the retina.

Fundus Fluorescein Angiography (FFA): A dye is injected into the bloodstream, and a special camera captures images of the retina to detect abnormal blood vessel leakage or areas of fluid buildup.

Optos retinal imaging device for eye diagnosis.Fluorescein angiography showing retinal blood vessels.

Indocyanine Green Angiography (ICGA): Similar to FFA but ICGA focuses on detecting the leakage of fluid in the choroid layer.

Optos retinal imaging device for eye diagnosis.Fluorescein angiography revealing abnormal retinal spots.

Amsler Grid Test: Patients may be asked to look at a grid of straight lines. Distorted lines or blind spots can help diagnose visual disturbances caused by CSCR.

Amsler grid showing distortion, a symptom of macular degeneration.

Treatment Options for CSCR

In most cases, CSCR resolves on its own without the need for medical intervention. However, in persistent or recurrent cases, treatment may be necessary to reduce the risk of long-term vision damage. Some treatment options include:

  • Steroid Avoidance.
  • Laser Photocoagulation: This technique could seal the leakage point and hastens the resolution of subretinal fluid.
  • Photodynamic Therapy (PDT): This treatment uses a light-sensitive drug called verteporfin and laser to activate the drug. It can close abnormal blood vessels in the choroid and reduce fluid buildup.
  • Anti-VEGF Therapy: In some cases, drugs that block vascular endothelial growth factor (VEGF), which promotes abnormal blood vessel growth, may be used to reduce fluid accumulation.

Prevention of CSCR

While there is no guaranteed way to prevent CSCR, there are several strategies to reduce risk:

  • Stress Management. Regular exercises are recommended.
  • Avoid Steroids.
  • Maintain a Healthy Lifestyle. For example, a balanced diet. 

Conclusion

Central Serous Chorioretinopathy is a serious yet often manageable eye condition that can impact vision. If you experience symptoms like blurred or distorted vision, it’s important to seek the advice of an eye care professional to ensure early intervention and preserve your vision. 

The Retina Specialists in OasisEye Specialists include Dr Kenneth Fong Choong Sian, Dr Manoharan Shunmugam, Dr Wilson Wong Jun Jie, Dr Wong Hon Seng and Dr Rajasudha Sawri Rajan from Kuala Lumpur; Dr Teh Wee Min from Seremban; Dr Ling Kiet Phang from Johor Bahru; and Dato’ Dr Haslina Binti Mohd Ali (D.S.D.K) from Penang.

FAQs

Most cases are temporary and resolve on their own within 1 to 3 months. However, chronic or recurrent CSCR can lead to permanent vision damage if not managed properly.

Yes. Recurrence is common, especially in those with ongoing stress, steroid use, or poor sleep hygiene. Repeated episodes may lead to vision loss.

Total blindness is very rare, but central vision loss or permanent visual distortion can occur in chronic or untreated cases.

No. CSCR is typically painless. Any pain should be investigated further, as it may indicate a different condition.

CSCR is not directly inherited, but genetic susceptibility may play a role. Having a first-degree relative with CSCR may slightly increase your risk.

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What is Ocular Toxoplasmosis?

Toxoplasmosis is an infection caused by the intracellular protozoan parasite known as Toxoplasma gondii. The infection may be acquired or congenital, whereby the foetus acquires it from the mother while in the womb. Most people contract toxoplasmosis by eating raw or undercooked meat, vegetables or dairy products, or by coming into contact with infected cats, contaminated sandboxes or cat litter boxes – all of which have been contaminated with cat faeces. Although most parasite-infected individuals do not exhibit any symptoms, some people may experience flu-like symptoms, such as fever, headache and muscle aches. Infants and those with low immune systems are most frequently affected by serious forms of this disease. Toxoplasmosis during pregnancy may cause miscarriage and birth abnormalities.

Ocular toxoplasmosis occurs in the eye, where Toxoplasma gondii can cause inflammation. Frequently, ocular toxoplasmosis results from the reactivation of a congenital infection, although an acquired infection is now regarded to be more common. The parasite typically affects the retina causing eye pain, blurred vision and possibly permanent damage, including blindness.

Fundus images showing ocular toxoplasmosis with retinal lesions marked by arrows, indicating areas of inflammation and damage in the eye.

What investigations are involved?

Ocular toxoplasmosis can look like other eye diseases that cause inflammation in the back of the eye (posterior and panuveitis). The doctor will look at the signs and symptoms to aid in coming to a diagnosis, which is based on clinical findings. If it’s not clear, a test called polymerase chain reaction (PCR) can be done to look for Toxoplasma DNA in the fluid from the eye and blood samples.
There are two imaging tests called Fundus Fluorescein Angiography (FFA) and Indocyanine Green (ICG) that can be used to visualize blood flow in the eye, which may help diagnose ocular toxoplasmosis.

Management / Treatment

Ocular toxoplasmosis requires personalized care, meaning that treatment will vary from person to person depending on factors such as the location of the infection, the severity of inflammation, and the patient’s immune system. If someone with a healthy immune system gets an ocular infection, it will usually go away on its own. However, if the infection affects certain parts of the eye, treatment may be necessary. People with weakened immune systems, such as those who have had transplants or are HIV-positive, may need long-term treatment.
There are several drugs available to treat ocular toxoplasmosis, and doctors often use a combination of drugs to help patients recover quickly and with minimal damage to their eyes. These drugs can kill the parasite responsible for the infection, but they work best when used together. In some cases, surgery may be necessary to treat complications like retinal detachment, cataract and choroidal or epiretinal neovascular membranes involving the macula.

It’s common for ocular toxoplasmosis to recur after someone has had it before, but relapses are not contagious and do not pose a risk to others. Relapses don’t pose a threat to an unborn child if the mother is pregnant.

Prevention

Preventive measures include thoroughly cleaning and washing fruits and vegetables, cooking meat adequately to destroy any harbored cysts, and avoiding contact with cat litter pans during pregnancy. Women of childbearing age must take adequate contraceptive measures for six months following primary toxoplasmosis infection.

In conclusion, preventing toxoplasmosis is crucial for maintaining healthy eyes, and early diagnosis and treatment are essential for managing the infection. At OasisEye Specialists, we offer comprehensive eye care services, including diagnosis and treatment of uveitis caused by toxoplasmosis. Our experienced team of eye specialists is committed to providing personalized care and innovative treatments to preserve and improve our patients’ vision. Contact us today to schedule a consultation and take the first step towards optimal eye health.

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Retinitis Pigmentosa

What is Retinitis Pigmentosa?

Retinitis Pigmentosa, also known as RP, is a group of eye conditions that affect the retina. This condition can alter how the retina responds to light, making it difficult for people with RP to see. Essentially, RP causes changes to the cells in the retina known as photoreceptors, which do not work properly and can result in poor vision. The photoreceptors contain rods and cones cells, with rods being affected first in RP patients, causing difficulty seeing at night and loss of peripheral vision. RP causes a slow loss of vision over time, although most people do not become completely blind. RP usually affects both eyes and is often inherited from parents to their children.

Symptoms of Retinitis Pigmentosa

One of the most common early symptoms that retinitis pigmentosa patients experience is night blindness, which makes it difficult to adjust to darkness and see in low light conditions. Patients may also bump into objects in the dark. As the disease progresses, patients gradually lose their peripheral visual field, making it difficult to see objects to the side. In some cases, patients may also experience a loss of central vision in the later stages of the disease.

What Causes Retinitis Pigmentosa?

In most cases, Retinitis Pigmentosa is caused by changes in genes that control the cells in the retina. RP is usually due to genetic inheritance and can be linked to many genes in our body. It can also occur as part of other genetic conditions, such as Usher syndrome, which causes both vision and hearing loss and can lead to difficulty in balancing.

How is Retinitis Pigmentosa diagnosed?

A comprehensive dilated eye examination is required in order to diagnose Retinitis Pigmentosa. Clinical tests such as visual field, electroretinography (ERG), optical coherence tomography (OCT), and fundus autofluorescence imaging (AF) can also be used to diagnose RP. Genetic testing can also be done to determine the type of RP a patient has, which is important for family planning since RP is a genetic inherited disorder.

Treatment for Retinitis Pigmentosa

Unfortunately, there is currently no cure for Retinitis Pigmentosa. However, low vision aids and visual rehabilitation programs provided by low vision specialists can help RP patients improve their quality of life. Researchers are studying gene and cell therapies as potential future treatments for RP.

If you are experiencing any symptoms related to Retinitis Pigmentosa, we recommend visiting a retinal specialist at our centre. A retinal specialist will be able to determine if any diagnostic tests are necessary to rule out any abnormalities. Additionally, we offer genetic testing at our centre.

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Epiretinal Membrane (ERM)

An epiretinal membrane (ERM) is an eye condition where a thin, clear, and transparent fibrous cellular material forms on the surface of the retina. It commonly occurs, affecting the posterior pole of the retina over the macula. The cause is unknown, but some research shows that it can be secondary to trauma, post-intraocular surgery, chronic ocular diseases, and so on.

Optical coherence tomography (OCT) scan of the retina showing epiretinal membrane (ERM) with red arrows indicating areas of retinal surface distortion and thickening.

Symptoms:

ERMs usually cause several symptoms, such as:

  • Difficulty in seeing fine details and recognizing faces when the central part of the retina is affected.
  • Blurred and distorted vision.
  • Straight lines appear wavy.
  • Decreased vision and loss of central vision.
  • Double vision.

Causes:

Epiretinal membranes can occur as a result of the normal aging process in the eyes. It is common in individuals over the age of 50. One reason for this condition is when the vitreous gel peels away from the retina. ERM may also form following retinal or eye surgery.

Diagnosis:

An epiretinal membrane can be diagnosed during a routine eye examination for mild cases where the symptoms do not affect the individual. During the eye examination, an optometrist or ophthalmologist may use a non-invasive imaging technique called Optical Coherence Tomography (OCT) to visualize the layers of the retina. In some patients, an ophthalmologist will request additional tests such as fluorescein angiography to determine any other underlying problem that might have caused this problem. The test involves the use of dye to light up areas in the retina.

Treatment:

In many cases, mild membranes are monitored over time for progression. Aside from surgery, there are no other available treatments for epiretinal membranes. Eyeglasses, contact lenses, and prescription eye drops are generally not effective treatments for epiretinal membrane.

Surgery is considered and recommended when the patient’s vision or perception of visual distortion starts to affect their quality of life, for example, when the vision is worse than 20/40 (6/12). To preserve the anatomic integrity of the retina, the membrane removal must be executed with extreme caution. The surgeon will make a tiny cut around 4 mm and remove the fluid from inside the eye. Then, the surgeon will hold and gently peel the epiretinal membrane from the retina and replace the fluid in the eye. The surgery is performed under local anesthesia.

Therefore, it is advisable to visit an ophthalmologist for a detailed eye examination if you experience any unusual symptoms related to an epiretinal membrane (ERM). Moreover, an eye screening can also be beneficial for the early detection of any retinal disorder.

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Hypertensive Retinopathy

The retina is the clear photosensitive tissue that is located at the back of the eyes. It helps to process and transform light into nerve signals. The nerve signals will be interpreted in the brain, providing visions. Serious medical conditions could affect the retina, such as high blood pressure (hypertension).

Hypertensive retinopathy (HR) is an eye disease in the retina due to complications of high blood pressure (hypertension). Poor control of high blood pressure may cause vascular disease changes without being aware of it. As a result, the retina’s blood vessel walls will thicken, causing the blood vessels to become narrow and restrict the blood flow reaching the retina. Over time, high blood pressure can limit the functioning of the retina by putting pressure on the optic nerve. Eventually, it can cause vision problems. For this reason, it is essential for patients with high blood pressure to have a regular eye check.

Older people are at a higher risk of developing high blood pressure and, therefore, most likely to develop hypertensive retinopathy. The following conditions can also increase your risk of hypertensive retinopathy: They include prolonged high blood pressure, heart diseases, atherosclerosis, diabetes, smoking, high cholesterol, obesity, having an unhealthy diet, having a family history of high blood pressure, and heavy alcohol consumption.

Fundus image of hypertensive retinopathy showing retinal hemorrhages, cotton wool spots, and optic disc swelling.

Symptoms and signs

Generally, a person with mild hypertensive retinopathy might not experience any or very mild symptoms. The patient usually becomes more symptomatic as it progresses and in the late stages. However, an ophthalmologist can detect early stages by identifying vascular changes during fundus examination.

  • Common symptoms include:
  • Blurred vision
  • Subconjunctival haemorrhage (bleeding in the white part of the eye)
  • Double vision accompanied by a headache

Controlling high blood pressure is the only way to treat hypertensive retinopathy. Therefore, lifestyle changes that include quitting smoking, exercising regularly, losing weight, dietary changes, and reducing alcohol intake help to reduce the risk of this disease.

However, individuals with hypertensive retinopathy are at risk of developing various complications. This includes the following:-

  • Retinal artery occlusion: It occurs when blood clots block the arteries that carry blood to the retina. This results in insufficient oxygen or blood supply in the retina, which may cause loss of vision.
  • Retinal vein occlusion: This condition occurs when a blockage in the retinal veins prevents blood from being carried away from the retina. A blood clot in the veins causes it.
  • Ischemic optic neuropathy: This condition occurs when high blood pressure blocks normal blood flow within the eyes and leads to damage to the optic nerve, which responsibly transmits images to the brain.
  • Malignant hypertension: This condition occurs when a sudden increase in blood pressure interferes with vision, causing sudden vision loss. However, this condition rarely happens but it could be potentially life-threatening.

Hypertensive retinopathy is also associated with an increased risk of stroke and heart attack. Prevention of hypertensive retinopathy is possible by carefully managing high blood pressure and related conditions like diabetes. Lifestyle changes such as quitting smoking, losing weight, exercising regularly, and having a healthy diet could also help prevent hypertensive retinopathy. People with high blood pressure should monitor their blood pressure regularly and have an annual eye screening. It is urged to visit an ophthalmologist as soon as possible if there is a significant sign and symptom of hypertensive retinopathy.

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Macular Hole

Macular hole occurs when there is a tear or hole that develops in the central part of your vision known as the macula. Macula is the small area of the retina where light is sharply focused which allows you to see colour and detailed vision. The common symptoms of a macular hole are distortion of vision (straight lines appear wavy), blurred vision or a dark spot in your central vision. You may not notice these symptoms with both eyes open. You should close one eye (better eye) and then you will notice straight lines appearing wavy and also a dark spot in the center of your vision. It is important to schedule an appointment with an Ophthalmologist as soon as possible if any of these symptoms occur. A special imaging test known as optical coherence tomography (OCT) which gives a cross sectional view of the retina will be performed by your eye doctor to diagnose the macular hole.

Fundus image of an eye with a macular hole, marked by a white arrow, showing central retinal damage.

Age is the most common cause for macular hole. As you get older, the vitreous starts to shrink and pull away from the retina. Usually the vitreous pulls away without causing any problems. Sometimes, the vitreous can stick to the retina and this causes the macula to stretch and a hole to form.

Comparison of normal retina and retina with a macular hole using fundus photos and OCT scans.

Treatment for macular hole

The treatment for a macula hole is by a surgery known as vitrectomy. Vitrectomy surgery is done by making three incisions into the sclera. The first incision is to make a hole for the infusion cannula where fluid is injected into the eye to keep the eyeball in shape. The second incision is for the light pipe to allow surgeons to see inside the eye. The last incision is for the vitrectomy cutter where it functions to remove and suck out the vitreous jelly from the eye. Vitrectomy is done by removing the vitreous jelly inside the eye that is pulling on your macula and filling the eye with a gas bubble. The bubble helps to flatten the macula hole and hold it in place until the eye heals. You should not fly or go uphill with a gas bubble in the eye until the gas dissipates on its own and is replaced by natural eye fluids. You will need to maintain a face-down position for several days to keep the gas bubble in place and help close the hole.

The complications of vitrectomy surgery are rare. Some complications include infections, bleeding, retinal detachment or recurrence of a macula hole. These complications can be easily treated. This operation is successful about 90-95% to close the hole. However, as the retina is a nerve tissue, it can take quite a few months to heal completely. People who have had a macular hole in one eye have about 10-15 percent chance of developing a macular hole in another eye over a lifetime. If you have symptoms such as blurred or distorted vision, do consult your eye care professional immediately. A relatively early treatment may give a better outcome in terms of improvement in your vision.

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