Medicine, laser and surgery effective in managing retinal disorders.
A 42-year-old Michigan native, Jordan* works nearly 20 hours a day managing the gas station he owns in Port Orange. But two years ago, Jordan’s long hours were hampered by changes in his vision. He experienced blurred vision, severe eye fatigue, and his eyes were generally uncomfortable.
“When I went for my annual eye exam, the doctor there told me I needed to see a specialist,” Jordan relates. “It turned out I had diabetes. It was damaging the retinas in my eyes.”
Diabetes is a condition that results when the body can’t use or store sugar properly. Over time, consistently high sugar levels in the bloodstream damage the body’s blood vessels.
When the retina’s blood vessels are affected, it damages the light-gathering cells called rods and cones. This results in blurred vision and sometimes loss of vision. Damage to retinal blood vessels due to diabetes is called diabetic retinopathy.
The specialist Jordan was referred to is William J. Dunn, MD. He is a board-certified, fellowship-trained retina specialist at Florida Retina Institute who explains that there are two main types of diabetic retinopathy.
“There’s non-proliferative diabetic retinopathy, or NPDR, and proliferative diabetic retinopathy, or PDR,” the doctor educates. “NPDR is the early form, and PDR is the more advanced form.”
NPDR results in two problematic conditions. One is macular edema, which is swelling of the tissue at the center of the retina, called the macula. The other is macular ischemia, which occurs when the blood vessels become compromised and can’t supply enough blood to the retina. This results in starvation of the retinal cells and subsequent loss of vision.
“Due to the progressive ischemia and loss of healthy blood vessels that occur with PDR, the body begins to build new blood vessels through a process called neovascularization,” Dr. Dunn notes. “Unfortunately, these new blood vessels are incompetent. They leak fluid and blood, which can lead to scar tissue formation.”
This scar tissue can pull on the retina and cause a tractional retinal detachment, which can result in sudden vision loss. PDR can also result in a vitreous hemorrhage. That is what occurs when those fragile new blood vessels tear and bleed into the center part of the eye called the vitreous cavity, which is filled with thick fluid called vitreous.
“Eye floaters develop as blood mixes with the vitreous,” Dr. Dunn says. “This can also lead to retinal detachment.”
NPDR and PDR can be treated medically, with a laser or with surgery. Medical treatment involves injections into the eye of anti-vascular endothelial growth factor, or anti-VEGF, drugs.
These medications promote healing of the abnormal blood vessels and the return of the retina’s normal mechanisms for reabsorbing fluid. This results in vision stabilization and, in many cases, improvement in vision.
“Another method of treatment is laser photocoagulation,” Dr. Dunn adds. “During this process, we use a highly focused beam of very intense energy to cauterize the leaks in the blood vessels. We can perform this treatment focally, which is when we treat the blood vessels directly, or panretinally, when we treat the entire retina outside of the macula.
Kinks in the Hose
“The third method of treatment is surgery, which is a pars plana vitrectomy. During this procedure, we remove the diseased vitreous, which contains the floaters and scar tissue that impact the sight of a patient with diabetic retinopathy.”
During his examination of Jordan, Dr. Dunn performed tests and scans on Jordan’s eyes and discovered a blockage in the veins in Jordan’s retina, a condition called retinal vein occlusion.
Retinal vein occlusion is the more common of the two conditions associated with vascular occlusive disease. The other is retinal artery occlusion.
“Retinal vein occlusion occurs when veins, the blood vessels that drain the retina of blood to return it to the heart, become blocked and blood backs up,” Dr. Dunn explains. “That causes retinal hemorrhaging and macular edema, similar to what happens with diabetic retinopathy.
“We generally divide retinal vein occlusion into two types: branch vein occlusion and central vein occlusion. Branch vein occlusion involves the upper or lower branches of the retinal veins.”
With central vein occlusion, the central retinal vein, or macular vein, becomes occluded, or blocked, and causes the hemorrhaging and macular edema.
“My right eye is now 20/20, and my left eye is 20/25.” – Jordan
“Diabetes definitely plays a role in the development of retinal vein occlusion, as does high blood pressure,” Dr. Dunn reports. “High blood pressure causes hardening of the arteries, or atherosclerosis.
“When atherosclerosis occurs in the retina, the hardened retinal arteries rest very close to the retinal veins, either the branches of the retinal veins or the central macular vein. Think of a lead pipe sitting on a garden hose. The artery kinks the vein, causing turbulent blood flow and resulting in a blockage in the vein.
“The symptoms of retinal vein occlusion are similar to those of diabetic retinopathy, mainly blurred vision and, in some cases, vision loss. Retinal vein occlusion causes macular edema, macular ischemia and abnormal blood vessel growth, just like PDR.”
Treatment depends on the severity of the condition. In many cases, retina specialists simply observe patients with retinal vein occlusion because it can resolve on its own, Dr. Dunn notes. But if the condition is more complex, doctors may perform laser photocoagulation on the occluded veins.
“Through experience, we’ve found that anti-VEGF drugs also help with vascular occlusive disease,” Dr. Dunn observes. “We can use the injections along with laser photocoagulation to provide visual stabilization and, oftentimes, improvement in vision.
“Jordan came to us with retinal vein occlusion. He was experiencing macular edema and new blood vessel formation. He underwent anti-VEGF injections along with laser photocoagulation. We used multifocal laser treatment and peripheral panretinal photocoagulation. Following this treatment, Jordan experienced a decrease in his macular edema, control of neovascularization and improvement in his vision.”
Complete Trust
Jordan reports that his eyes remain slightly fatigued, but that symptom significantly improved after his treatment at Florida Retina Institute.
“My vision is much better than it was before as well,” he enthuses. “My right eye is now 20/20, and my left eye is 20/25.”
While treatment for Jordan’s retinal vein occlusion is now completed, he still visits Dr. Dunn regularly for follow-up care. The doctor reminds Jordan to monitor his diabetes closely and keep his blood sugar under control to manage any ongoing problems with his retinas.
“Dr. Dunn is an excellent doctor,” Jordan says. “He was very thorough with his examination of me and explained everything from A to Z. And he took his time with me. He wasn’t in a rush like some doctors.
“He performed tests and scans of my eyes, diagnosed the blockage of the veins in my retina and recommended injections and laser procedures to treat it. He’s very professional, and I trust him completely.
“And I want to add that everyone at Florida Retina Institute is nice, thorough and professional. They take good care of me, and I wholeheartedly recommend them.”
