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Signals are transmitted through other cells in the retina, and eventually travel via the optic nerve to parts of the brain connected with vision. These brain regions process features like colour, shape and movement and this allows us to see.

The list of conditions that can affect the retina fills multiple textbook volumes. Below is some information on common problems.

Treatment can slow, stop or reverse vision damage caused by retinal disease.

Left untreated, some retinal diseases can lead to severe loss of vision or even blindness.

Common retinal conditions

St George’s Eye Care ophthalmologist Dr Oliver Comyn is a specialist vitreoretinal surgeon, with years of experience operating on the retina. Dr Comyn’s expertise in this area means we can assess and treat all of the following conditions, offering our patients a comprehensive retinal service that extends beyond standard medical treatments.

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Occurs when the retina separates from the inside wall of the eye. The most common reason for this is a hole or tear in the retina (known as rhegmatogenous retinal detachment). This is usually due to ageing in the vitreous but can also be caused by severe diabetic eye disease or, rarely, an injury (trauma). Retinal detachments typically lead to loss of vision, but in many cases surgery can lead to full restoration of vision.
Can occur on its own, without going on to cause a retinal detachment. As we age, the vitreous jelly filling the eye degenerates and, as it shrinks, it can pull away and separate from the retina. This is called posterior vitreous detachment (PVD). Sometimes this can lead to a tear in the retina (imagine peeling sticky tape from a thin sheet of tissue paper).
Occurs when the vitreous doesn’t separate properly from the macula (the central part of the retina that we use for seeing faces and reading). This can lead to other problems, but sometimes resolves on its own.
Can occur as part of posterior vitreous detachment. The vitreous tries to separate from the retina, but as it does so it leads to a small hole in the central macula, which can cause distorted vision. Very rarely this can be the result of an injury. It usually occurs in just one eye but can occur in both. A retinal specialist can assess the risk to the other eye if you have a macular hole.
A fine layer of scar tissue that grows over the surface of the macula. It can become thick enough to contract and pull the retina out of shape, leading to distorted and blurred vision. Sometimes epiretinal membranes follow a posterior vitreous detachment, but they can also accompany any of the conditions listed here, or result from diabetes.

Bleeding into the vitreous gel due to a retinal tear, detachment, or diabetic eye disease. In severe cases, surgery might be required to clear it before the cause can be found.

An age-related disease where the macula breaks down, leading to blurring and gradual loss of central vision.

Read more from Macular Degeneration New Zealand: https://www.mdnz.org.nz/

Leakage and swelling in the central part of the retina, the macula, that is responsible for fine, detailed vision. It has many causes, including diabetes, vein obstruction, uveitis (eye inflammation) and can also occur as a result of cataract surgery.
A common condition where the veins draining blood from the retina become blocked, leading to back pressure and leakage from small vessels in the eye which causes macular oedema (fluid retention). This typically leads to sudden reduction in vision. It is often associated with high blood pressure. Retinal vein occlusion can be treated, and often vision can be preserved.
Typically occurs in people who have had diabetes for several years, and often develops without causing symptoms. High blood sugar levels slowly damage the delicate capillaries in the retina, which can then leak and cause macular oedema. Diabetic screening aims to detect diabetic retinopathy before this happens. With advanced diabetic retinopathy, fragile new blood vessels may develop which easily bleed and lead to vitreous haemorrhage.
A condition that can cause a central blurred patch of vision. It occurs when the supporting cells beneath the retina start to leak fluid, which accumulates between the two layers. It can be a result of high stress levels, or in association with steroids (such as skin creams, inhalers or nasal sprays). Frequently it gets better on its own, especially if the trigger can be stopped safely.

When light-sensitive photoreceptor cells degenerate and die. International researchers are investigating gene therapy and cell-replacement therapies using stem cells as possible treatments and so far one gene therapy treatment has been approved for use in the United States, parts of Europe and Australia.

Read more: https://www.vision2020australi...

Symptoms of retinal diseases and conditions

Many retinal diseases share common symptoms such as floaters (moving spots in your vision), blurred or distorted vision, or loss of vision (partial or complete).

You should seek immediate medical attention if you experience the sudden appearance of floaters, flashes of light or reduced vision, as these may be indicators of potentially serious retinal disease.

Symptoms alone won’t identify retina conditions, as blurred vision and distortion are common to almost all of them. This is why it is important to see a retinal specialist for assessment and diagnosis.

  • Retinal tear and retinal detachment symptoms

New floaters or flashing lights often indicate the start of a posterior vitreous detachment, which may lead to retinal tears or a detachment. Floaters can look like black dots, inky swirls, or like there is an insect in your vision. Flashing lights are typically bright white and occur in peripheral vision, usually on the outside. They are brief, rather like a camera flash and are different from the often coloured flickering lights that can be seen for several minutes in a migraine attack. A retinal specialist can help distinguish between different causes of visual disturbance. Seeing a shadow obscuring your vision can indicate retinal detachment. This shadow might be grey, or dark, but typically stays in the same place and it’s not possible to see beyond it. Sometimes it is just in the periphery of vision, but may also involve central vision as it progresses

  • Vitreomacular traction, macular hole and epiretinal membrane symptoms

These conditions cause a disturbance in central vision, leaving peripheral vision unaffected. Vision might be blurred (fuzzy, or not as sharp as usual) or distorted (where the shape of objects is altered). Letters may appear pulled out of shape, a computer spreadsheet grid might not look straight, or the Amsler Grid may be abnormal.

  • Vitreous haemorrhage symptoms

With a vitreous haemorrhage, in addition to some of the symptoms noted above like flashing lights and floaters, you might see dark swirls in your vision (like ink), or it might be completely dark.

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Treatment for retinal disease

Treatment depends on the type of retinal disease, and how advanced it is. At St George’s Eye Care we offer a range of surgical and medical treatment options.

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Vitrectomy is an operation that allows access to the retina and treatment of most surgical retina conditions. You may need a vitrectomy to treat retinal detachment, vitreomacular traction, macular hole or epiretinal membrane. Retinal tears can often be treated without surgery, but if vitreous haemorrhage is present an operation may be required. There are numerous different treatments for diabetic retinopathy but in its advanced stages a vitrectomy allows treatment of severe disease.In a vitrectomy, the vitreous (the clear jelly inside the eye) is removed to allow access to the retina. From this point, the retina can be reattached, membranes can be peeled away, and laser or freezing treatment (cryotherapy) can address holes and tears in the retina. This is a day surgery procedure routinely performed at St George’s Eye Care by Dr Oliver Comyn, who is a specialist vitreoretinal surgeon.The modern vitreoretinal surgical techniques used at St George’s Eye Care are minimally invasive with very small incisions made under local anaesthetic – often not even requiring any stitches. Patients are usually very comfortable during the procedure, with most able to return home soon afterwards.Vision after retinal surgery is very variable and depends on the exact procedure undertaken. One very common reason for poor vision after retinal surgery is the use of a temporary gas bubble inside the eye. The human eye is not designed to see through gas, so vision is very reduced until the gas bubble has been absorbed. Most people manage to cope very well.
Some types of retinal detachment are best repaired using a scleral buckle procedure where a plastic strap is fixed to the outside of the eye. When combined with freezing treatment (cryotherapy), it can allow the retina to reattach. Scleral buckle surgery is done under general anaesthetic.
Since the early 2000s, retinal specialists have routinely and safely delivered drugs into the eye by injection to treat macular degeneration, retinal vein occlusion and diabetic retinopathy. Although this sounds daunting, the combination of local anaesthetic and very tiny needle used means minimal discomfort. Just as you might need to take a daily tablet to control a long-term disease, retinal conditions need repeated treatment as well, although usually no more often than monthly.
Lasers have been used for many years to treat retinal disease and still have a role to play. Retinal tears that have not caused a retinal detachment can be treated by using the laser to create a seal around them. Lasers are also used to treat diabetic retinopathy, either to treat macular oedema or to manage the growth of new blood vessels in the retina. The lasers used for treating retinal disease are completely different from the lasers used to correct long- or short-sightedness. Laser treatment is usually straightforward and safe, is performed in our consulting rooms, and you can go home almost immediately afterwards.

Your ophthalmologist will discuss which treatment option is best for you, based on the type of retinal disease and your individual needs.

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Who is at risk of retinal disease?

People at any stage of life can develop retinal disease, although some diseases are more common at different ages.

Risk factors for retinal diseases include:

  • Ageing
  • Smoking
  • Diabetes or other diseases
  • Myopia (short-sightedness)
  • Eye trauma
  • A family history of retinal diseases

Nyctalopia (problems with night vision), is associated with inherited retinal diseases.

The diagnosis of retinal disease starts with a comprehensive eye examination by your optometrist. If they are concerned about findings in your retina, you will be referred to an ophthalmologist for further assessment, including specialist testing, to confirm the diagnosis and discuss treatment options.

Why choose St George’s Eye Care for my retina treatment?

St George’s Eye Care ophthalmologist Dr Oliver Comyn specialises in medical and surgical treatment of retinal diseases.

After completing a first vitreoretinal fellowship at the Sussex Eye Hospital in Brighton, he was selected for a vitreoretinal fellowship at the world-renowned Moorfields Eye Hospital in London. He completed a research degree at the UCL Institute of Ophthalmology by carrying out two separate trials investigating the effects of a new treatment for diabetic retinopathy.

Dr Comyn has delivered presentations about retinal diseases at international conferences and has had his work published in ophthalmic journals. He is regularly involved in clinical research, and is a Principal Investigator for a multinational clinical trial of a new treatment for a type of macular degeneration – geographic atrophy. Patients at St George’s Eye Care benefit from Dr Comyn’s specialist expertise in this area.

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What is a retinal specialist?

Almost all ophthalmologists perform cataract surgery but most also have an additional sub-specialist interest. A retinal specialist is an ophthalmologist who has completed additional sub-specialist fellowship training in the field of retina. That training focuses on diseases of the retina that are treated medically, with injections or lasers, but also for some involves additional surgical training to become a vitreoretinal surgeon – a retinal specialist who operates on the retina itself.

FAQ

Common questions about retina treatment

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Retinal surgery is usually performed under local anaesthetic, which means you will be awake for the procedure but feel no pain. Sometimes a small amount of sedative is given to help relaxation. Occasionally a general anaesthetic is needed – this will be discussed fully with you beforehand.
No. Retinal surgery is performed as day surgery in one of our St George’s Hospital operating theatres. It takes a minimum of 40 minutes, but can be as long as two hours, depending on the type of retinal disease. You will need to have someone drive you to and from hospital on the day of surgery.
You might experience mild discomfort for a few days after retinal surgery, however this is usually controlled with over-the-counter pain relief. You may be asked to wear an eye patch to protect your eye while it recovers. You’ll need to avoid air travel for a period of time after retinal surgery, because of the temporary gas or air bubble left in the eye. With increasing altitude, this can expand, increase pressure within the eye and cause complications.
St George’s Eye Care is well-equipped to respond to urgent referrals for retinal detachments, requiring prompt surgical treatment. Our state-of-the-art operating theatres are located onsite at St George’s Hospital, and can be accessed very quickly when required.
At St George's Eye Care

We encourage you to play an active role in your treatment plan, and we take a personalised approach. You will see the same ophthalmologist before, during and after your treatment, and we work directly with your GP or optometrist as part of your long-term eye care team.

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