Degenerative Retinal Disease & Retinitis Pigmentosa

What Is the Retina?

The retina is a thin layer of light-sensitive tissue lining the back of the eye. It receives light that has been focused by the cornea and lens, converts that light into electrical signals and sends the information to the brain through the optic nerve. The macula, located near the centre of the retina, provides the detailed central vision used for reading, recognising faces and seeing fine detail.

Because different parts of the retina perform different visual functions, retinal disease can cause very different symptoms. Some conditions develop slowly and may have few early warning signs, while others can cause sudden changes and require urgent treatment.

What Are Retinal Diseases?

Retinal diseases are a broad group of conditions affecting the retina, macula or the blood vessels and supporting structures at the back of the eye. They may be age-related, vascular, inherited, inflammatory, associated with diabetes, or caused by changes in the vitreous gel that fills the eye.

Some retinal conditions primarily affect central vision, while others can affect peripheral vision, night vision or the entire visual field. The correct treatment depends on the specific diagnosis, which is why a detailed retinal examination is important when symptoms occur.

Symptoms of Retinal Disease

Retinal disease symptoms vary depending on the condition and the part of the retina involved. Some people have no symptoms in the early stages. Possible symptoms include:

• Blurred or reduced vision
• Distorted vision, including straight lines appearing bent or wavy
• A dark, blurred or empty patch in central vision
• New spots, cobwebs or floaters in the vision
• Flashes of light
• A shadow or curtain moving across part of the visual field
• Reduced side (peripheral) vision
• Difficulty seeing at night or adapting to dim light
• Changes in colour or contrast sensitivity
• Sudden or gradual loss of vision

Urgent retinal warning signs: Seek urgent medical assessment for new flashes, a sudden shower of floaters, a curtain or shadow, or sudden vision loss. These can indicate a retinal tear or retinal detachment.

Common Retinal Diseases and Conditions

Diabetic Retinopathy

Diabetic retinopathy occurs when diabetes damages the small blood vessels in the retina. Early disease may cause no noticeable symptoms, while more advanced disease can lead to bleeding, swelling of the macula and vision loss. Regular diabetic eye examinations are important because treatment is often most effective before significant vision loss occurs.

Age-Related Macular Degeneration (AMD)

Age-related macular degeneration affects the macula and therefore central, detailed vision. Dry AMD usually progresses more gradually, while wet AMD can cause more rapid distortion or central vision loss because abnormal blood vessels leak fluid or blood beneath the retina. Treatment depends on the type and stage of AMD.

Retinal Tears and Retinal Detachment

A retinal tear is a break in the retina. Fluid can sometimes pass through the tear and separate the retina from the tissues beneath it, causing a retinal detachment. A detachment is a medical emergency. Retinal tears may sometimes be treated with laser or cryotherapy before detachment occurs, while a detached retina often requires surgery.

Flashes, Floaters and Posterior Vitreous Detachment (PVD)

Floaters are small spots, strands or cobweb-like shapes that move through the field of vision. Flashes may look like brief streaks or sparks of light. These symptoms often occur as the vitreous gel inside the eye changes with age and pulls away from the retina, known as posterior vitreous detachment. Most PVDs do not lead to serious problems, but a retinal tear can occasionally occur, so new or suddenly increasing flashes and floaters should be assessed promptly.

Macular Hole

A macular hole is a small opening in the centre of the macula. It may cause blurred or distorted central vision, difficulty reading, or a missing area in the centre of vision. Some macular holes are monitored, while others may require vitreoretinal surgery such as vitrectomy.

Epiretinal Membrane

An epiretinal membrane is a thin layer of scar-like tissue that forms on the surface of the macula. It can wrinkle or pull on the retina and cause distortion, blurred central vision or difficulty reading. Mild cases may only need monitoring; surgery may be considered when symptoms significantly affect vision or daily activities.

Retinal Vein Occlusion

A retinal vein occlusion occurs when a vein carrying blood away from the retina becomes blocked. It can cause sudden blurred or reduced vision and may lead to macular swelling. Management depends on the type and complications and may include observation, control of cardiovascular risk factors, eye injections or laser treatment in selected cases.

Retinitis Pigmentosa and Inherited Retinal Diseases

Retinitis pigmentosa is a group of inherited retinal disorders in which light-sensitive retinal cells gradually stop functioning. Symptoms commonly include poor night vision and progressive loss of peripheral vision. Genetic testing, genetic counselling, low-vision support and specialist monitoring may be recommended depending on the diagnosis.

Peripheral Retinal Degeneration

Some changes occur in the outer, or peripheral, retina. One example is lattice degeneration, where areas of the peripheral retina become thinner. These changes often cause no symptoms and do not always require treatment, but in some people they can be associated with retinal tears or detachment. An ophthalmologist can determine whether monitoring or preventive treatment is appropriate.

What Causes Retinal Disease?

There is no single cause of retinal disease. Risk factors and causes depend on the condition and may include:

• Age-related changes in the retina, macula or vitreous
• Diabetes and damage to retinal blood vessels
• High blood pressure and other vascular risk factors
• Significant short-sightedness (myopia)
• Inherited genetic changes
• Eye injury or previous eye surgery
• Inflammation or infection affecting the back of the eye
• Changes in the vitreous that create traction on the retina

Your personal risk depends on your age, medical history, family history, prescription and previous eye conditions or procedures.

How Are Retinal Diseases Diagnosed?

A retinal assessment usually begins with a detailed eye examination and review of your symptoms and medical history. Your ophthalmologist may use dilating eye drops so the retina can be examined through a wider pupil.

Depending on the suspected condition, testing may include:

• Dilated examination of the retina and macula
• Optical coherence tomography (OCT) to create high-resolution cross-sectional images of the retina
• Retinal or fundus photography to document and monitor changes over time
• OCT angiography or dye angiography to assess retinal circulation and abnormal blood vessels when needed
• Ocular ultrasound when the retina cannot be clearly seen through the front of the eye
• Visual field or other specialised testing for selected inherited or peripheral retinal conditions

Retinal Disease Treatment

Retinal disease treatment depends on the diagnosis, how much the condition is affecting vision and whether it is stable or progressing. Some retinal conditions require monitoring only, while others need urgent treatment.

Monitoring and Medical Risk-Factor Management

Some stable retinal conditions can be monitored with regular examinations and OCT imaging. Managing diabetes, blood pressure, cholesterol and smoking can also be important for vascular and macular retinal disease.

Eye Injections

Intravitreal injections place medication into the eye and are commonly used for conditions involving abnormal blood vessels or macular swelling, including wet AMD, diabetic macular oedema and some retinal vein occlusions. The medication and treatment schedule depend on the diagnosis and response to treatment.

Retinal Laser Treatment

Retinal laser may be used to seal selected retinal tears, treat some complications of diabetic retinopathy or retinal vein occlusion, or manage other retinal vascular conditions. Laser treatment is chosen according to the location and nature of the retinal problem.

Vitrectomy and Retinal Surgery

Vitrectomy is surgery that removes the vitreous gel from inside the eye. It may be used for retinal detachment, macular holes, epiretinal membranes, vitreous haemorrhage and other vitreoretinal conditions. Retinal detachment repair may also involve a scleral buckle, gas bubble, laser or cryotherapy depending on the type and severity of the detachment.

Can Retinal Disease Cause Permanent Vision Loss?

Some retinal diseases can cause permanent loss of vision, particularly when the macula or large areas of the retina are damaged. However, the outcome varies considerably between conditions. Early diagnosis and treatment can often preserve vision and, in some conditions, treatment may improve vision as swelling, bleeding or traction is reduced.

If you notice a new or sudden change in vision, do not wait for symptoms to settle on their own. Prompt assessment is particularly important for sudden flashes and floaters, a curtain or shadow, or rapid vision loss.

Book a Retinal Assessment with personalEYES

If you have noticed changes in your vision, have diabetes or another condition that can affect the retina, or have been referred for specialist retinal care, personalEYES can assess your eye health and explain the next steps. Our ophthalmologists provide assessment and management for a range of medical and surgical retinal conditions across NSW and the ACT.

Book an appointment online or call personalEYES on 1300 68 3937.