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Central vision is critical for many daily activities ranging from reading to driving. Clear vision requires light be focused on a transparent tissue in the back of the eye called the retina. The retina has different regions, but the portion of the retina responsible for our central vision is known as the macula, and within the macula, the finest acuity is provided by a specialized portion known as the fovea. The fovea is where light is focused in our eyes to allow us to see fine details in the world around us. Diseases involving the fovea affect our ability to perform our day to day activities. One such condition is macular hole formation. Macular holes develop when the clear gel inside the eye (the vitreous) tugs abnormally on the retina. This tugging creates a hole. In rare cases, macular holes can develop after injury to the eye. Most of the time, it occurs because some people are born with abnormal attachments between the vitreous and the retina. As we age, the vitreous naturally liquefies and pulls away from the retina. In people born with abnormal attachments to the fovea, the gel does not peel away easily from the fovea, so when it pulls away it leaves a hole. Unfortunately, there is no way to predict who will develop a macular hole. When a hole develops, the central vision becomes blurry. If one does not check vision in each eye individually, the effects of a macular hole in one eye can go unnoticed for weeks or even months. Without intervention, the hole can enlarge, and more central vision can be affected. Most of the time, this occurs in only one eye, but 1 out of 5 patients can have this occur in both eyes.
Age-related macular degeneration (AMD) is a common cause of vision loss in people 50 years and older. The single-most important factor in this condition is age, and the longer we live, the more common this condition becomes. A lot of progress has been made in the last ten years in the treatment of AMD with more innovative alternatives in trial today that will decrease the burden of treatment and increase its effectiveness.
Diabetes is a condition that can affect vision. This has become a health epidemic due to the increasing number of people with this disease. The result of diabetic changes in the eye do not always cause a noticeable change in vision. Diabetes can lead to anything from a mild blur in one’s vision to severe loss of vision. Remarkably, one cannot rely on their vision as an accurate predictor of one’s disease severity, as blindness can quickly develop in someone with previously normal vision. The fact that symptoms can be so unreliable in diabetic eye disease is the reason it is so important everyone with diabetes be evaluated by an eye doctor at regular intervals. Fortunately, many of the changes that occur in diabetes can be reversed, and as treatment options continue to expand and improve; the extent to which vision loss is permanent or is irreversible from diabetes is decreasing. The instances in which diabetes changes are not reversible can be due to interruption of blood flow to the retina or optic nerve. Since the retina and optic nerve are neural tissue, they do not tolerate lasting interruptions in blood flow.