AMD, glaucoma, diabetes:
what they change for your surgery

What is it?

AMD is a degeneration of the macula, the central area of the retina responsible for fine vision, the vision you use to read or recognise a face. It takes two forms, which sometimes coexist: the atrophic or “dry” form, in which the cells at the centre of the retina slowly disappear; and the exudative or “wet” form, in which abnormal blood vessels from the choroid grow into the retina and destroy it, much more quickly.

The first sign is a distortion of straight lines, called metamorphopsia, followed by a permanent central blind spot. Peripheral vision stays intact: AMD does not make you blind, but it takes away your ability to read.

Risk factors and prevention

Age outweighs every other factor. Next come heredity, which multiplies the risk by four, smoking, exposure to ultraviolet light, cardiovascular disease and obesity.

Three measures have proven their worth: stopping smoking, a diet rich in green vegetables and oily fish, and wearing sunglasses. Self-monitoring with the Amsler grid, one eye at a time, helps you spot a new distortion between two consultations.

Treatment

The exudative form is treated with intravitreal anti-VEGF injections, repeated according to a personalised schedule. The earlier treatment starts, the better vision is preserved. There is not yet a curative treatment for the atrophic form; care relies on suitable nutritional supplements, low-vision rehabilitation and optical aids.

Follow-up of your AMD (injections, check-ups, adjustment of visual aids) continues at the Rueil Ma Vision practice.

What is it?

Glaucoma is the leading cause of irreversible blindness in France. It is a progressive degeneration of the optic nerve, most often linked to excessive pressure inside the eye. The fibres that are lost do not grow back.

Its most common form is chronic open-angle glaucoma. There are also angle-closure glaucomas, normal-pressure glaucomas, and glaucomas secondary to another condition or to a treatment, long-term corticosteroids in particular.

Why screening is the only way

The visual field narrows first at the periphery, where we pay no attention, and the second eye compensates for the first. Central vision stays normal for a very long time. By the time the patient notices a problem, the loss is already considerable, and permanent.

A simple examination is enough to detect it: pressure measurement, examination of the optic nerve and, if needed, a visual field test and OCT. After forty, a check every two years is justified; every year if there is a family history, high myopia, or African or Caribbean origin.

Treatment

Treatment aims to lower the pressure, the only factor we can act on. It relies first on daily eye drops, and using them consistently determines the whole result. SLT laser is an alternative or an addition. Surgery is reserved for forms that are not controlled or that are progressing.

Screening, visual field monitoring and adjustment of treatment take place at the Rueil Ma Vision practice.

What is it?

Diabetes damages small blood vessels, and those of the retina are among the finest in the body. The result is diabetic retinopathy: microaneurysms, haemorrhages, then at an advanced stage the growth of abnormal vessels, with a risk of vitreous haemorrhage or detachment. On top of this comes macular oedema, the main cause of loss of vision, which can occur at any stage.

The eye is also a window on the rest of the body: the fundus examination shows the state of the microcirculation throughout the body.

How often to be checked

A dilated eye examination, or retinal photography, every two years if there is no retinopathy and the diabetes is well controlled. Every year, or more often, as soon as there is any damage, or in case of poor control, associated high blood pressure, pregnancy or a rapid intensification of treatment.

The key point: retinopathy cannot be seen or felt until it is advanced. Regular check-ups are worth more than any symptom.

Treatment

The first treatment is still good control of diabetes and blood pressure. Macular oedema is treated with intravitreal injections; proliferative retinopathy with panretinal laser; complicated forms with vitreoretinal surgery.

Annual screening and follow-up of your retinopathy take place at the Rueil Ma Vision practice.

What is it?

The retina lines the back of the eye like the film in a camera. A detachment occurs when a tear lets the fluid that fills the eye seep under this film, which lifts away. The detached area no longer transmits an image, and the cells it contains deteriorate within a few days.

It is a surgical emergency. No medical treatment can reattach a retina.

Warning signs

Flashes of light, especially at the edge of your vision and in the dark. A shower of black spots appearing suddenly. Then a dark curtain or fixed shadow spreading over part of the visual field.

None of this hurts. The absence of pain is exactly what makes people lose time. If you notice these signs, seek care the same day, without waiting.

Those most at risk are people with high myopia, patients who have already had surgery on one eye, those with a family history, and people who have had an eye injury.

Treatment

The operation closes the tear and puts the retina back in place, either from outside the eye or by vitrectomy, sometimes with a gas or silicone oil tamponade that requires strict head positioning after surgery. The outcome depends above all on how quickly it is treated, and on whether the macula is affected.

Retinal detachment surgery is the work of a vitreoretinal surgeon: I refer you to the appropriate team without delay.