Vitreomacular Traction Syndrome

VMT is very similar to macular pucker and causes the same changes to your vision.

Vitreomacular traction (VMT) is a complication that arises from a normal process. That normal process is posterior vitreous detachment (PVD) and it happens to everyone as they age. By about age 40 or 50 the vitreous gel that fills the eye begins to change. It begins to shrink and lose fluid and strands of the gel can drift through the eye. These strands can be seen as dark strings or spots that float around in your field of view and are called floaters.

The vitreous gel eventually completely separates from the retina. This is perfectly normal and happens to most people by the age of 70, that is, a PVD is a completely normal event.

Problems arise only if the vitreous gel is strongly attached to the retina, specifically at the macula. If that is the case then when the vitreous gel shrinks it can pull on the retina.

That sticking process is called vitreomacular traction and is very similar to an epiretinal membrane.

The pulling and tugging on the center of the retina where the macula is located can damage the macula and cause vision loss if left untreated.

In healthy eyes, VMT is not common. Certain eye conditions or diseases put people at a higher risk of developing VMT. Those conditions and diseases include:

  • High myopia which is extreme nearsightedness
  • Age-related macular degeneration which is a breakdown of the tissues in the back of the eye
  • Diabetic eye disease which affects the blood vessels in the back of the eye
  • Retinal vein occlusion which is a blockage of veins in the retina

Symptoms

The most common symptoms of VMT include:

  • Distorted vision that makes straight lines appear wavy, blurry or have blank spots
  • Seeing lots of flashes of light in your vision
  • Seeing objects as smaller than their actual size

It is important to see an ophthalmologist for an evaluation when you first notice any of these symptoms.

Diagnosis

To diagnose vitreomacular traction (VMT) your ophthalmologist will use tests such as optical coherence tomography (OCT) which uses light waves to take pictures of the various layers of the retina and will show any damage to the macula.

Fluorescein angiography may also be used. This is an imaging test to view how well the blood is circulating inside the retina and to find any macula swelling. It uses a medical imaging dye injected into the arm that circulates inside the retina while a special camera photographs the progress of the dye as it moves through the blood vessels in the eye.

An ultrasound scan may also be used so your ophthalmologist can get a better view of the location of the sticking point between the vitreous and the macula.

Treatment

Some cases do not require treatment and will resolve on their own, but you will be asked to monitor your vision at home with a grid of lines to make sure the VMT does not progress. If the lines on the grid begin to appear wavy or have missing areas then you will most likely require treatment.

Surgery to remove the vitreous and replace it with a saline solution may be needed to prevent macular holes, puckers or macular swelling from developing or worsening.

Some people are candidates for medication treatments. A medication that dissolves the proteins that link the vitreous to the macula can be injected into the eye. Usually only one injection is needed.

Prognosis

Most patients with VMT maintain good visual acuity in the affected eye even if treatment is required.

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

What is a Choroidal Nevus?

A freckle in your is usually benign, but there is a concern about choroidal nevi.

A choroidal nevus is the fancy term for a freckle in the retina.

A nevus is the medical term for mole. Nevi is the plural of nevus. A nevus can appear on your skin, the surface of the eye or inside the eye. 

When a nevus is inside the eye it is called a choroidal nevus because those types are found under the retina in the layer of tissue called the choroid.

A nevus is a cluster of melanocytes—the cells that produce melanin. They are the pigment that colors hair, skin, and eyes. They are much more common in people with lighter skin tones.

They are often referred to as eye freckles and the ones that appear inside the eye are discovered during routine eye exams and are usually harmless and most of them won’t affect your vision or cause any problems and they require no treatment except monitoring the nevus for changes.

Three Types of Eye Nevi

  • A nevus in the white part of your eye, conjunctival nevus, are common and range from yellow to brown and can lighten or darken over time. 
  • Nevi in the iris (the colored part of your eye) are tiny, dark brown flecks on the surface of the iris and can grow larger over time but are usually harmless and usually do not become melanomas. 
  • A choroidal nevus is typically gray, but can be brown, yellow, or variably pigmented. They are also mostly harmless.  

Most nevi do not need to be treated and will not affect your vision or lead to any other health problems. The only reason you might need treatment is if your doctor suspects the nevus might be a melanoma.

What Causes a Nevus?

The cause of eye nevi is not known, but there are associations between eye nevi and UV light. Wearing sunglasses to protect your eyes from ultraviolet light is always recommended.

A Choroida Nevus can be Suspicious for Cancer

A very small percentage of choroidal nevi have features that make them at a higher risk of growing into a melanoma. Those choroidal nevi should be monitored by your doctor through regular eye exams. Very rarely, a choroidal nevus may leak fluid or be linked to abnormal blood vessel growth.

There are five factors that signal the choroidal nevus should be closely monitored:

  • Thickness of greater than 2.00 mm
  • Subretinal fluid
  • Visual symptoms
  • Orange pigment of the nevus
  • A part of the nevus touching the optic nerve

Very often, suspicious cases are referred to a retina specialist or ocular oncologist for further evaluation.

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

Should You Be Taking Vitamins for AMD?

Are these vitamins for you? Here’s who benefits the most and who shoujld be taking them.

Do you take vitamins for AMD?

The National Eye Institute conducted the Age-Related Eye Disease Study (AREDS) and AREDS2 to study both cataract and age-related macular degeneration (AMD). The study followed participants for five years and tested whether taking nutritional supplements (vitamins for AMD) could prevent or slow these two eye diseases.

AREDS Results

At the end of the five-year study, the scientists found that people at high risk for developing advanced AMD—those with intermediate AMD, and those with advanced AMD in one eye only—reduced their risk of developing advanced by about 25 percent when treated with the combination of antioxidants and zinc + copper. 

The AREDS formula also reduced the risk of central vision loss by 19% in the same group. None of the formulations decreased cataract risk.

Who Benefits the Most?

The study found that those who benefit most from taking vitamins for AMD are people at high risk for developing macular degeneration and who meet these two conditions:

  • Intermediate AMD in one or both eyes
  • Advanced AMD in only one eye

AREDS Vitamins for AMD

The AREDS 2 vitamins do not contain beta carotene because in the study researchers found that beta carotene in high amounts was associated with an increased risk of lung cancer in current and former smokers.

You can purchase AREDS 2 vitamins or take the supplements separately. The following is the AREDS 2 formulation:

  •  Vitamin C (ascorbic acid) 500 mg
  • Vitamin E 400 international units (IU)
  • Lutein 10 mg
  • Zeaxanthin 2 mg
  • Zinc (as zinc oxide) 80 mg 
  • Copper (as cupric oxide) 2 mg

Healthy Foods

Taking vitamins is just one step in creating a healthy environment for your eyes. Eating a healthy diet is an essential second step. Include lots of dark leafy greens, like spinach and kale, along with other colorful vegetables and fruits. Colorful vegetables and fruits provide a wide range of phytonutrients along with carotenoids that your body converts into vitamin A.  

Smoking puts you at a higher risk for AMD, so if you smoke, then stopping will be another step toward eye health.

Consult Your Doctor

Talk with your eye doctor about your primary care physician about how taking the AREDS or AREDS 2 vitamins will affect you.  

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

If you would like to schedule an appointment, please call us (877) 245.2020.

Saving Your Vision: Diabetic Retinopathy

November is National Diabetes Awareness month.

If you have diabetes, take a few minutes to learn about diabetic retinopathy and how you can take steps to help keep your eyes healthy.

Diabetic retinopathy is the most common cause of vision impairment and blindness among working-age adults in the U.S. It occurs when high blood glucose levels damage the blood vessels at the back of the eye causing them to become weak and leaky and damage the retina.

If not found and treated early, diabetic retinopathy can cause permanent vision loss. That’s why it is important to manage your diabetes and stay alert to the early signs and symptoms of diabetic retinopathy.

Types of Diabetic Retinopathy

There are two main types of diabetic retinopathy—NPDR (non-proliferative diabetic retinopathy) and PDR (proliferative diabetic retinopathy). The “proliferative” refers to new blood vessel growth, so in non-proliferative, there is not yet new blood vessel growth.   

NPDR is the early stage of diabetic retinopathy. At this stage, high glucose levels have weakened the blood vessels and, in time, may cause bulges in the weakened vessels (microaneurysms) that may leak fluid into the retina and the leakage may swell the macula or some blood vessels may begin to close. So this is an ongoing disease cycle that can be slowed or stopped if caught early.

PDR is the more advanced stage of diabetic retinopathy. The NPDR has weakened the blood vessels or closed them, so new blood vessels have grown in an attempt to supply oxygen to the retina, but these new vessels are fragile, and they leak and damage the retina. 

PDR can lead to vitreous hemorrhage, traction retinal detachment, or neovascular glaucoma.

Stay Alert

Anyone with type 1 or type 2 diabetes, or women who have gestational diabetes during pregnancy, can develop diabetic retinopathy. The risk increases when blood sugar, blood pressure, and cholesterol levels are not under control.

In the early stages diabetic retinopathy may not have symptoms, so it’s important to have a comprehensive dilated eye exam once a year. That way diabetic retinopathy can be diagnosed and treated before symptoms appear.   

Symptoms that indicate diabetic retinopathy has progressed are:

  • Blurry vision
  • Vision that goes from blurry to clear
  • Increased number of floaters
  • Poor night vision
  • Spots or blank areas in your central vision
  • Colors appear faded

Diabetic Retinopathy Treatment

The best treatment happens before you develop symptoms. Strict control of your blood sugar will significantly reduce your risk of vision loss from diabetic retinopathy. If you have high blood pressure and kidney problems, make sure those are kept under control too.

Injections in the eye of anti-VEGF medication can stop the growth of new blood vessels. VEGF stands for vascular endothelial growth factor, and it is a signal protein your body produces that stimulates new blood vessel formation, but the new vessels are weak and leaking vessels that damage your eyes, and anti-VEGF injections will stop that abnormal blood vessel growth.

Laser surgery and vitrectomy are other treatments for advanced PDR. But the most important thing to remember if you have diabetes, is that control of your blood sugar and early diagnosis and treatment of diabetic retinopathy are the best protections against vision loss.

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

Eating Carrots to Improve Your Eye Health

Do carrots really help your vision? Here’s how carrots improve your eye health.

Getting enough vitamin A is essential to maintain eye health and carrots are an excellent natural source of vitamin A, but eating a diet overloaded with carrots or other sources of vitamin A won’t improve your eyesight.

Eye health and good eyesight are different things. Healthy eyes can still need glasses to clearly focus on near or far objects because the shape of the cornea or the eyeball causes nearsightedness, farsightedness, or astigmatism.  No amount of vitamin A will change that.

Vitamin A and Eye Health

Vitamin A is converted into rhodopsin, the photopigment in the rods of your retina that enable vision in low-light. In humans and many animals rhodopsin is required for vision in dim light. 

Rhodopsin converts light into electrical nerve signals within the photoreceptor rods and those electrical signals are sent to the brain via the optic nerve. 

Vitamin A also supports the healthy functioning of the eye’s conjunctival membranes and the corneas.

Vitamin A deficiencies are rare in the U.S. and other developed countries. Most diets in developed countries contain adequate amounts of vitamin A and vitamin A can be stored by the body in the liver. 

Excellent Sources of Vitamin A

Sweet potatoes, spinach, pumpkin, carrots, milk, cheese, cantaloupe, mangos, eggs, and sweet red peppers are all excellent sources of vitamin A.

Vitamins and Oxidative Stress

The human body produces oxygen-derived free radicals as part of the metabolic process, part of breathing and burning energy, and free radicals are essential to life, but their number must be balanced out with antioxidants for optimal health.

A diet rich in antioxidants such as vitamins A, E, and carotenoids such as beta carotene, lycopene, and lutein will help your body scavenge free radicals, terminating their chain reactions before they cause cellular damage.

There is a peptide (glutathione) and some antioxidant enzymes produced by the body specifically to scavenge free radicals, but consuming a diet of antioxidant-rich fruits and vegetables, will also be a diet low in saturated fat and cholesterol, so eating lots of high-antioxidant fruits and vegetables will not only add to your body’s antioxidant levels, but give your overall health a boost.  

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL