Conditions and Diseases The Eye and How we See: Click to view an interactive diagram of the eye. Click to learn more about how the eye operates. Central serous chorioretinopathy (CSR or CSCR) This is a disease that causes fluid to build up under the retina and is thought to be secondary to leakage from choroidal blood vessels. The choroid is the layer under the retina. Men tend to be affected more often than women. The average age of onset is around age 45, but anyone can be affected. Though the exact cause of this disease is not fully understood, steroid use is a well-documented cause of central serous retinopathy. Stress appears to be a risk factor as well. Some early studies found that people with type A personalities, otherwise defined as competitive with self-critical attributes, may be more likely to develop central serous retinopathy. Symptoms include: Distortion of lines in the affected eye Blurred spot in the central vision Although the majority of cases clear up without treatment within few months, patients with more severe leakage and vision loss can possibly be treated. Treatment consists of a cold-laser called photodynamic therapy to seal the leak and attempt to restore vision. Most patients however do not need treatment as vision is eventually spontaneously restored. Central serous chorioretinopathy Diabetic Eye Disease Diabetes is a leading cause of blindness in the Unites States. Prompt recognition and treatment is essential to prevent such end stage complications. It is crucial for all diabetic patients to regularly follow with their eye care specialists. The image below illustrates the vision of a person with diabetic retinopathy. Diabetic retinopathy weakens the small blood vessels in the retina causing them to break down, leak, or become blocked. If left untreated, it could affect vision and even cause blindness. See image below. Flashes and Floaters Flashes are bright white lights, often flickering, that may suddenly occur. A sudden onset of flashes may indicate a retinal tear or retinal detachment and warrant urgent care. Floaters are small spots, threads or cobwebs that you may occasionally perceive. A sudden influx of floaters, often described as a shower of floaters, may indicate an urgent problem such as a vitreous hemorrhage or a retinal tear or detachment and warrant urgent care. The image below illustrates the vision of a person with flashes and floaters. Macular Degeneration Macular degeneration, also called age related macular degeneration (AMD), is a disease that affects the central part of the retina and may cause blurring or loss of central vision. It is typically diagnosed on clinical examination by an eye care professional and usually followed by a retina specialist. Dry AMD (Click image to enlarge) Wet AMD (Click image to enlarge) The image below illustrates the vision of a person with age-related macular degeneration. Macular Hole The retina is the light sensitive tissue in the back of the eye that allows us to see. The central part of the retina is called the macula and is responsible for our central vision. If a small break occurs in the macula, it is referred to as a macular hole. This painless event often occurs without any precipitating etiology. It is most commonly associated with a vitreous detachment (see above) and aging. Traumatic events, even remote, have also been linked to the formation of a macular hole. Rarely does a macular hole close spontaneously and in the vast majority of cases a surgical repair is indicated. This is most commonly done in an outpatient setting, by removing the vitreous with a microscopic mechanical cutter (the procedure is called a vitrectomy) and the use of a gas bubble to fill the vitreous cavity. A face-down positioning is often required postoperatively. Macular Pucker Macular pucker, also called epiretinal membrane, refer to scar tissue that forms over the central part of the retina called the macula. When symptomatic, it causes central visual distortion and wavy lines, called metamorphopsia. Typically, this is a chronic problem that does not require urgent intervention. Surgical repair is indicated when symptoms cause decrease in central visual acuity and interfere with your activities of daily living. For more information, please talk to a retina specialist. Macular pucker (Click image to enlarge) Retinal Detachment The retina is the light-sensitive layer inside the eye that allows us to see. The retina receives the images and sends them to the brain through the optic nerve. When the retina detaches, it separates itself from its underlying structures, and if not treated promptly is permanently damaged. This may then lead to permanent vision loss. There are different types of retinal detachments. Most commonly a retinal detachment may be due to a retinal tear or hole. A tractional retinal detachment is yet a separate type of retinal detachment that is seen in severe diabetic retinal diseases. Retinal detachment Retinal Vascular Occlusion The retina is the light sensitive tissue in the back of the eye that allows us to see. If the retinal blood circulation is interrupted by either a retinal artery or retinal vein occlusion, permanent visual loss may occur. This loss of vision typically occurs abruptly and is painless. Any loss of vision, even if not accompanied by pain, should therefore be promptly evaluated. The interruption of the retinal blood circulation is often referred to as a stroke in the eye. Your eye care specialist may initiate a systemic work-up to investigate potential risk factors or refer you to your primary doctor for additional testing. Secondary complications may occur after such vascular occlusions that may result in further loss of vision, and or development of pain. For these reasons, you may be asked to follow-up closely with your eye care specialist. Branch retinal artery occlusion Vitreous Detachment The central posterior cavity of your eye is filled with a gel-like substance called the vitreous. It typically abuts the surface of the retina. As we age the vitreous shrinks and separates itself from the retina. This is called a vitreous detachment or posterior vitreous detachment (PVD). In most cases, this is not sight threatening and requires no further intervention. Some concerning symptoms would include a sudden onset of floaters, flashes or peripheral visual changes (such as a shade or curtain blocking part of your vision). These latter symptoms should prompt you to seek your eye care specialist on an urgent basis. Photos courtesy of National Eye Institute