The Retina Atf
The Retina Atf
The Retina Atf
com
The Retina
Jason Ryan, MD, MPH
Retina and Macula
• Retina
• Inner layer of eye
• Contain photosensitive cells: rods and cones
• Major blood supply via choroid
• Macula AfraTafreeh.com
• Oval-shaped area near center of retina
• Contains fovea (largest amount of cone cells)
• High-resolution, color vision
• Both structures essential for normal vision
AfraTafreeh.com
AfraTafreeh.com
Ignis/Wikipedia
AfraTafreeh.com
Retinitis Pigmentosa
• Inherited retinal disorder
• Visual loss usually begins in childhood
• Loss of photoreceptors (rods and cones)
• Night and peripheral vision lost progressively
• Constricted visual field
• No cure – most patients legal blind by age 40
Retinitis Pigmentosa
Fundoscopy
AfraTafreeh.com
Christian Hamel
AfraTafreeh.com
Retinitis
• Retinal edema/necrosis
• Floaters, ↓ vision
• Classic cause: Cytomegalovirus (CMV)
• Usually in HIV/AIDS (low CD4 <50)
• Also in transplant patients on immunosuppression
Retinitis
Fundoscopy
• Retinal hemorrhages
• Whitish appearance to retina
AfraTafreeh.com
Wikipedia/Public Domain
AfraTafreeh.com
Diabetic Retinopathy
• Can cause blindness among diabetics
• Pericyte degeneration
• Cells that wrap capillaries
• Microaneurysms
• Rupture → hemorrhage
• Annual screening for prevention
Diabetic Retinopathy
Nonproliferative retinopathy
AfraTafreeh.com
AfraTafreeh.com
Diabetic Retinopathy
Nonproliferative retinopathy
AfraTafreeh.com
Diabetic Retinopathy
Nonproliferative retinopathy
Diabetic Retinopathy
Proliferative retinopathy
Wikipedia/Public Domain
Diabetic Retinopathy
Proliferative retinopathy
• Treatments:
• Photocoagulation (laser → stops vessel growth)
• Vitrectomy (bleeding/debris)
• Anti-VEGF inhibitors (intravitreal injections; ranibizumab)
AfraTafreeh.com
AfraTafreeh.com
Retinal Detachment
• Retina peels away from underlying layer
• Loss of connection to choroid → ischemia
• Photoreceptors (rods/cones) degenerate
• Vision loss (curtain drawn down)
• Surgical emergency
Retinal Detachment
Fundoscopy
AfraTafreeh.com
Retinal Detachment
• Posterior vitreous membrane detachment
• Often precedes retinal detachment
• Vitreous shrinks with age → can pull on retina
• May cause retinal holes/tears
• Floaters (black spots)
• Flashes of light
Wikipedia/Public Domain
Retinal Detachment
Risk Factors
• Myopia (near-sightedness)
• Larger eyes; thinner retinas
• Prior eye surgery or trauma
• Proliferative diabetic retinopathy
AfraTafreeh.com
Wikipedia/Public Domain
AfraTafreeh.com
Wikipedia/Public Domain
Retinal Vein Occlusion
• Branch retinal vein occlusion (BRVO)
• Compression of the branch vein by retinal arterioles
• Occurs at arteriovenous crossing points
• Associated with arteriosclerosis
• Sclerotic arterioles compress veins in an arteriovenous sheath
AfraTafreeh.com
• Central retinal vein occlusion (CRVO)
• Usually a primary thrombus disorder
AfraTafreeh.com
Ku C Yong/Wikipedia
Retinal Artery Occlusion
• Leads to formation of a “cherry red spot”
• Red circular area of macula surrounded by halo
• Also seen in Tay Sachs Disease (lysosomal storage disease)
• Commonly caused by carotid artery atherosclerosis
• Internal carotid → ophthalmic → retinal
AfraTafreeh.com
• Cardiac source (thrombus)
• Giant cell arteritis
Papilledema
• Optic disc swelling
• Due to ↑ intracranial pressure
• i.e. mass effect
• Usually bilateral
• Blurred margins optic disc on fundoscopy
Warfieldian/OptometrusPrime
Macula
AfraTafreeh.com
Macular Degeneration
• Macula = central vision
• Degeneration → visual disruption
• Distortion (metamorphopsia)
• Loss of central vision (central scotomas)
Macular Degeneration
AfraTafreeh.com
Macular Degeneration
• Dry
• More common (80%)
• Slowly progressive symptoms
• Wet
• Less common (10-15%)
• Symptoms may develop rapidly (days/weeks)
Dry Macular Degeneration
• Bruch's membrane
• Innermost layer of the choroid
• Beneath retina
• Retinal pigment epithelium
• Retina layer beneath photoreceptors
AfraTafreeh.com
• Next to choroid (Bruch’s membrane)
AfraTafreeh.com
AfraTafreeh.com
AfraTafreeh.com