Branch Retinal Vein Occlusion (BRVO)?

Arteries and veins carry blood throughout your body, including your eyes. The eye’s
retina has one main artery and one main vein. When branches of the retinal vein become
blocked, it is called branch retinal vein occlusion (BRVO).

When the vein is blocked, blood and fluid spills out into the retina. The macula can swell
from this fluid, affecting your central vision. Eventually, without blood circulation, nerve
cells in the eye can die and you can lose more vision.

Central Retinal Vein Occlusion (CRVO)?

Arteries and veins carry blood throughout your body, including your eyes. The eye’s retina
has one main artery and one main vein. When the main retinal vein becomes blocked, it is
called central retinal vein occlusion (CRVO).

When the vein is blocked, blood and fluid spills out into the retina. The macula can swell
from this fluid, affecting your central vision. Eventually, without blood circulation, nerve
cells in the eye can die and you can lose more vision.

Central Serous Chorioretinopathy

Central serous chorioretinopathy is when fluid builds up under the retina. This can distort
vision. The fluid leakage comes from a layer of tissue under the retina, called the choroid.
There is another layer of cells called the retinal pigment epithelium (RPE). When the RPE
doesn’t work as it should, fluid builds up under the RPE. As a result, a small detachment
forms under the retina, causing vision to become distorted.

This image from an OCT scan

shows how central serous
retinopathy (also called central
serous choroidopathy) causes a
blister-like swelling in layers of
the retina.
Choroidal Neovascular Membranes
In the eye, a healthy, intact retina is key to clear vision.

Choroidal neovascular membranes (CNVM) are new, damaging blood vessels that grow
beneath the retina. These blood vessels grow in an area called the choroid. They break
through the barrier between the choroid and the retina. When they leak in the retina
they cause vision loss.

CNVM are associated with many serious eye diseases, most commonly wet age-related
macular degeneration. CNVM are also found in patients with histoplasmosis, eye injury, and
myopic macular degeneration.

Cytomegalovirus Retinitis
Cytomegalovirus retinitis (CMV retinitis) is a serious viral eye infection of the retina. The
retina is the light-sensing nerve layer that lines the back of the eye. It is most often found in
people with weakened immune systems.

What are symptoms of CMV retinitis?

CMV retinitis symptoms can begin with a slow onset of floaters with blurred vision over a
few days. This can lead to a loss of peripheral (side) vision. Sometimes the symptoms begin
with a blind spot in the center of vision and can lead to a loss of central vision. The symptoms
usually happen first in one eye but often progress to the other eye. Without treatment or
improvement in the immune system, CMV retinitis destroys the retina and damages the optic
nerve. This results in blindness. People with CMV retinitis will often develop a detached
retina.

What causes CMV retinitis?

CMV retinitis is caused by the cytomegalovirus. This is one of the herpes viruses that infects
most adults. The vast majority of people who have cytomegalovirus have no symptoms of
infection. They will never have any problems because of the virus. But in people with
weakened immune systems, the virus can reactivate and spread to the retina. This can lead to
vision-threatening eye problems.

Who is at risk for CMV retinitis?

CMV retinitis is a significant threat to other people with weak immune systems. This
includes people such as:

 those with HIV/AIDS

 those having immunosuppressive therapy for cancer/leukemia
 recipients of organ transplants.
The earliest symptoms of CMV retinitis are floaters with a shadow appearing in the
peripheral (side) vision as the disease worsens. Ophthalmologists need to check people with
compromised immune systems for the disease.

HIV, AIDS and CMV retinitis

Before highly active antiretroviral therapy, CMV retinitis was a common problem for people
with AIDS. While it is less common now, people with HIV or AIDS still have a higher risk
for CMV retinitis. They should see an ophthalmologist regularly.

How is CMV retinitis diagnosed?

Your ophthalmologist will give you a painless dilated eye examination. In this exam, dilating
eye drops will be placed in your eyes to dilate, or enlarge, your pupils. Your ophthalmologist
will look at areas of your eye, including your retina, for signs of CMV retinitis.

How is CMV retinitis treated?

Strengthening your immune system is an important part of treating CMV retinitis. People
with HIV or AIDS often improve if they are on highly active antiretroviral therapy
(HAART).

There are also specific CMV retinitis treatments. Ganciclovir and other antiviral medicines
can be taken in several ways:

 by mouth
 through a vein
 as an eye injection
 through an implant in the eye that delivers medication over time.

Often your ophthalmologist will need to perform laser surgery. This will strengthen the retina
where CMV damage has occurred.

Although treatments are available, you cannot get back vision lost because of CMV
retinitis. Even with treatment, the disease may still progress. Recurrence of CMV retinitis is
common, so regular checkups with an ophthalmologist are important.

Cytomegalovirus retinitis (CMV retinitis) is a serious viral eye infection of the retina. The
retina is the light-sensing nerve layer that lines the back of the eye. It is most often found in
people with weakened immune systems.

What are symptoms of CMV retinitis?

CMV retinitis symptoms can begin with a slow onset of floaters with blurred vision over a
few days. This can lead to a loss of peripheral (side) vision. Sometimes the symptoms begin
with a blind spot in the center of vision and can lead to a loss of central vision. The symptoms
usually happen first in one eye but often progress to the other eye. Without treatment or
improvement in the immune system, CMV retinitis destroys the retina and damages the optic
nerve. This results in blindness. People with CMV retinitis will often develop a detached
retina.

What causes CMV retinitis?

CMV retinitis is caused by the cytomegalovirus. This is one of the herpes viruses that infects
most adults. The vast majority of people who have cytomegalovirus have no symptoms of
infection. They will never have any problems because of the virus. But in people with
weakened immune systems, the virus can reactivate and spread to the retina. This can lead to
vision-threatening eye problems.

Who is at risk for CMV retinitis?

CMV retinitis is a significant threat to other people with weak immune systems. This
includes people such as:

 those with HIV/AIDS

 those having immunosuppressive therapy for cancer/leukemia
 recipients of organ transplants.

The earliest symptoms of CMV retinitis are floaters with a shadow appearing in the
peripheral (side) vision as the disease worsens. Ophthalmologists need to check people with
compromised immune systems for the disease.

HIV, AIDS and CMV retinitis

Before highly active antiretroviral therapy, CMV retinitis was a common problem for people
with AIDS. While it is less common now, people with HIV or AIDS still have a higher risk
for CMV retinitis. They should see an ophthalmologist regularly.

How is CMV retinitis diagnosed?

Your ophthalmologist will give you a painless dilated eye examination. In this exam, dilating
eye drops will be placed in your eyes to dilate, or enlarge, your pupils. Your ophthalmologist
will look at areas of your eye, including your retina, for signs of CMV retinitis.

How is CMV retinitis treated?

Strengthening your immune system is an important part of treating CMV retinitis. People
with HIV or AIDS often improve if they are on highly active antiretroviral therapy
(HAART).

There are also specific CMV retinitis treatments. Ganciclovir and other antiviral medicines
can be taken in several ways:

 by mouth
 through a vein
 as an eye injection
 through an implant in the eye that delivers medication over time.
Often your ophthalmologist will need to perform laser surgery. This will strengthen the retina
where CMV damage has occurred.

Although treatments are available, you cannot get back vision lost because of CMV
retinitis. Even with treatment, the disease may still progress. Recurrence of CMV retinitis is
common, so regular checkups with an ophthalmologist are important.

Stages of Diabetic Eye Disease

There are two main stages of diabetic eye disease.

NPDR (non-proliferative diabetic retinopathy)

This is the early stage of diabetic eye disease. Many people with diabetes have it.

With NPDR, tiny blood vessels leak, making the retina swell. When the macula swells, it is
called macular edema. This is the most common reason why people with diabetes lose their
vision.

Also with NPDR, blood vessels in the retina can close off. This is called macular ischemia.
When that happens, blood cannot reach the macula. Sometimes tiny particles called exudates
can form in the retina. These can affect your vision too.

If you have NPDR, your vision will be blurry.

PDR (proliferative diabetic retinopathy)

PDR is the more advanced stage of diabetic eye disease. It happens when the retina starts
growing new blood vessels. This is called neovascularization. These fragile new vessels often
bleed into the vitreous. If they only bleed a little, you might see a few dark floaters. If they
bleed a lot, it might block all vision.

These new blood vessels can form scar tissue. Scar tissue can cause problems with the
macula or lead to a detached retina.

PDR is very serious, and can steal both your central and peripheral (side) vision.

Diabetic Retinopathy Symptoms

You can have diabetic retinopathy and not know it. This is because it often has no symptoms
in its early stages. As diabetic retinopathy gets worse, you will notice symptoms such as:

 seeing an increasing number of floaters,

 having blurry vision,
 having vision that changes sometimes from blurry to clear,
 seeing blank or dark areas in your field of vision,
 having poor night vision, and
 noticing colors appear faded or washed out losing vision.
Diabetic retinopathy symptoms usually affect both eyes.

Macular Degeneration?
Leer en Español:
¿Qué es la degeneración macular relacionada con la edad?
Written By: Kierstan Boyd
Reviewed By: Robert H Janigian Jr MD
May. 17, 2018

Age-related macular degeneration (AMD) is a problem with your retina. It happens when a
part of the retina called the macula is damaged. With AMD you lose your central vision. You
cannot see fine details, whether you are looking at something close or far. But your peripheral
(side) vision will still be normal. For instance, imagine you are looking at a clock with hands.
With AMD, you might see the clock’s numbers but not the hands.

Two types of AMD

Dry AMD

This form is quite common. About 80% (8 out of 10) of people who have AMD have the dry
form. Dry AMD is when parts of the macula get thinner with age and tiny clumps of protein
called drusen grow. You slowly lose central vision. There is no way to treat dry AMD yet.

Wet AMD

This form is less common but much more serious. Wet AMD is when new, abnormal blood
vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring
of the macula. You lose vision faster with wet AMD than with dry AMD.

Many people don’t realize they have AMD until their vision is very blurry. This is why it is
important to have regular visits to an ophthalmologist. He or she can look for early signs of
AMD before you have any vision problems.

Who Is at Risk for AMD?

You are more likely to develop AMD if you:

 eat a diet high in saturated fat (found in foods like meat, butter, and cheese)
 are overweight
 smoke cigarettes
 are over 50 years old
 have a family history of AMD
 are Caucasian (white)

Having heart disease is another risk factor for AMD, as is having high cholesterol levels.

Macular Edema
Macular edema occurs when fluid builds up in the retina—the light sensitive tissue in the
back of the eye. This causes swelling and can distort vision. The macula, in the center of the
retina, helps us see fine detail and color—it delivers images to us at a higher resolution than
any camera or screen.

With macular edema, vision can resemble the screen of an older model TV set—with washed
out colors and a blurry picture. Without treatment, it can even lead to permanent vision loss.

Macular Hole
Macular hole is when a tear or opening forms in your macula. As the hole forms, things in
your central vision will look blurry, wavy or distorted. As the hole grows, a dark or blind spot
appears in your central vision. A macular hole does not affect your peripheral (side) vision.

What Causes a Macular Hole?

Age is the most common cause of macular hole. As you get older, the vitreous begins to
shrink and pull away from the retina. Usually the vitreous pulls away with no problems. But
sometimes the vitreous can stick to the retina. This causes the macula to stretch and a hole to
form.

Sometimes a macular hole can form when the macula swells from other eye disease. Or it can
be caused by an eye injury.

Macular Pucker
Macular pucker happens when wrinkles, creases or bulges form on your macula. The macula
must lie flat against the back of your eye to work properly. When the macula wrinkles or
bulges, your central vision is affected.

With macular pucker, things can look wavy, or you may have trouble seeing details. You
might notice a gray or cloudy area in your central vision. You may even have a blank spot in
your central vision. Macular pucker will not affect your peripheral (side) vision.

Macular Telangiectasia
Macular telangiectasia (MacTel) is a disease affecting the macula, causing loss of central
vision. MacTel develops when there are problems with the tiny blood vessels around the
fovea.

There are two types of MacTel, and each affects the blood vessels differently.

Type 2 MacTel

The most common form is Type 2 MacTel. The tiny blood vessels around the fovea leak,
become dilated (widen), or both. In some cases, new blood vessels form under the retina and
they can also break or leak. Fluid from leaking blood vessels causes the macula to swell or
thicken. This is a condition called macular edema, which affects your central vision. Also,
scar tissue can sometimes form over the macula and the fovea, causing loss of detail vision.
Type 2 affects both eyes but not necessarily with the same severity.

Type 1 MacTel

In Type 1 MacTel, the blood vessels become dilated. This forms tiny aneurysms, causing
swelling and damaging macular cells. The disease almost always occurs in one eye, which
differentiates it from Type 2.