Decreased retinal pigment epithelial cell function is linked to age-related macular degeneration. Wet macular degeneration, marked by leakage or bleeding vessels, is more serious than its Dry counterpart.

Ophthalmoscopically, it can be identified by bilateral discrete yellow pigment figures with a rim of retinal pigment epithelial atrophy surrounding them (butterfly pattern dystrophy) that exhibit hyperfluorescence on fluorescein angiography.

Retinal detachment

Retinal detachment occurs when fluid separates the retina from its attachment on the back wall of the eye. Once detached, light from the retina cannot reach the brain for processing; this can lead to permanent blindness if left untreated. If you suspect you have a detached retina, seek medical help immediately – your eye doctor may perform a dilated exam including pushing on outer surface of eye (scleral depression). This allows them to view peripheral retina and identify breaks which require treatment; photographs or optical coherence tomography (OCT) scan may also be performed.

Most retinal detachments can be avoided with prompt treatment. You can help avoid detachment by not rubbing your eyes, wearing glasses as prescribed and following an eye care plan that includes periodic dilated retinal examinations with scleral depression to detect small retinal tears or areas of lattice degeneration that might predispose to rhegmatogenous retinal detachment.

Rhegmatogenous retinal detachment is the most prevalent type of retinal detachment, caused by changes in vitreous humor levels or eye trauma; diabetic retinopathy; high nearsightedness or some forms of surgery like cataract surgery; genetic disorders like Marfan’s Syndrome and Stickler Syndrome may all play a part.

Retinal detachments typically progress rapidly to complete blindness if not repaired within one week of symptoms appearing, often as a result of proliferative vitreoretinopathy (PVR), an accumulation of scar tissue which inhibits re-attachment of retina.

Other causes of retinal detachment may include macular holes, cystoid macular edema and Fuchs spot which typically arise due to degenerative myopia. Foveal Retinoschisis in patients with posterior staphyloma has been associated with increased risks for macular hole development as well as increased rates of retinal detachment recurrence; lacquer cracks in the macula due to choroidal Neovascularization can often result in lacquer cracking which often manifest with subretinal hemorrhages as complication.

Leakage of abnormal blood vessels

Condition in which fluid leaks into the macula of the eye which allows you to see fine details and colors, swelling it up and blurring vision. Left untreated, macular degeneration may eventually lead to blindness permanently if left untreated; typically caused by blood vessel issues such as abnormal ones which leak blood and proteins under the retina – known as wet form of macular degeneration.

For this serious condition to be treated promptly, your doctor must administer drops that dilate (widen) your pupil. They’ll use an instrument called an ophthalmoscope with special lenses called ophthalmoscope to look inside your eye; optical coherence tomography can also help your doctor locate and measure macular edema. In severe cases, focal laser treatment may also be performed; during this procedure several hundred small laser burns are placed strategically over areas of retinal leakage to stop it worsening further while possibly improving vision in some patients.

Some people with diabetes develop proliferative diabetic retinopathy (PDR), the more advanced stage of diabetic eye disease. PDR causes circulation problems to deprive the retina of oxygen and new blood vessels to grow on its surface, eventually leaking blood into the vitreous, an eye gel-like fluid filled with fluid that fills both eyes. As blood leaks into this fluid, this may cause it to swell causing central or color vision loss as well as visual distortion or macular detachments, leading to complete blindness over time.

Retinal detachment is a medical emergency and must be addressed immediately to avoid permanent blindness. Symptoms include sudden, painless vision loss as well as the appearance of a veil or shadow in one area of your visual field, flashes of light or changes to floater appearance can all indicate retinal detachment – its pattern of progression differing even among family members within one household and sometimes over time.

Damage to the retinal pigment epithelium

The retina is a multilayered structure located at the posterior segment of the eye that contains photoreceptors and retinal pigment epithelium (RPE). RPE cells are essential in providing photoreceptors with nourishment and maintain cell structure; under constant oxidative stress they must be balanced through antioxidant enzyme systems regulated by nuclear factor erythroid-2-related factor 2. Genetic and environmental factors increase the risk of age-related macular degeneration, leading to progressive accumulation of lipofuscin as a lipid peroxidation product. At the same time, progressive increases in pleomorphism and concentration decreases of RPE cells are observed, leading to insufficient nutrients being delivered to the retinal pigment epithelium and subsequent degeneration; this process is further hastened by certain genetic mutations.

Damage to the RPE can also be caused by abnormalities in its blood vessels – the choriocapillaris – which provide oxygen to retinal pigment epithelium cells. Such abnormalities could result from vascular diseases like glaucoma, diabetic retinopathy and retinal vein occlusive disease as well as cataracts; otherwise it could even be due to other reasons like cataracts. If left untreated these conditions could become chronic; leading to permanent vision loss due to swelling and bleeding of choriocapillaris vessels called choroidal neovascularization which will become permanently affected and potentially even permanently impaired.

Under DMPP, RPE degradation is hastened by abnormalities in the choriocapillaris. These abnormalities could be the result of diabetic retinopathy or glaucoma or may be secondary to macular hole or trauma-induced cataracts – these abnormalities can be detected using a fundus autofluorescence device that allows retina specialists to observe these areas and examine them in more depth.

Recent studies have demonstrated that geographic atrophy can be significantly slowed by increasing blood flow to the choriocapillaris. This can be achieved using swept-source optical coherence tomography angiography with imaging algorithms which detect regions with deficient blood supply, thus helping identify patients at high risk for developing neovascular macular degeneration.

Retinal fibrosis

The retina, located at the back of each eye, converts light signals into neural messages which are then processed by our brains for interpretation. It plays an essential role in maintaining central vision and high-resolution visual acuity; however, with age comes macular pucker or cellophane maculopathy; a condition which causes distortion or blurred vision and leads to shadowy shapes floating across our field of vision – this condition is most prevalent among people over 50 years old.

This condition results from changes that occur within the macula, leading to an increase in photoreceptor outer segment permeability and accumulation of lipofuscin deposits in retinal pigment epithelium cells, leading to breakdown of their membrane and subsequent degradation.

Initial symptoms for those diagnosed with macular degeneration tend to be minimal or nonexistent, yet are marked by large yellow pigment figures forming at the level of retinal pigment epithelium in central macular area, usually seen through ophthalmoscopy as butterfly or triradiate patterns, often with atrophy rims surrounding these figures which is particularly evident with fluorescein angiography.

At this stage, the lesion is typically symmetric and similar to Best’s disease in children (Figs. 5-6 and 5-7). Vision usually remains normal but electroretinography and dark adaptation testing may show mild abnormalities; fluorescein angiography reveals patchy hyperfluorescence around the lesion.

Vitelliform stage AMD is an intermediate step to subretinal fibrosis or neovascular AMD, with yellow foveal deposits similar to childhood Best’s disease but smaller and having more of an “eggshell” appearance.

Recent research demonstrated that neovascular AMD is associated with subretinal fibrosis and that risk increases with increased choroidal neovascularization. Furthermore, other independent factors associated with subretinal fibrosis – including greater central subfield thickness variation, submacular hemorrhage, and lower baseline visual acuity were identified; however these alone cannot predict its development; rather it appears that combinations of factors are most predictive.