“Floaters,” “cobwebs,” or “flies” are the most common symptoms of vitreous degeneration in the eye. The vitreous or vitreous body is a gelatinous substance that fills the eyeball. Over time, it loses its fluidity, or to put it simply, it dries out, and its irregularities are seen as floaters, spots, or cobwebs. This is a natural degenerative process, which mostly occurs in older individuals, but in young people with myopia, it can appear much earlier. It does not require any treatment, just regular patient monitoring. In some cases, if this particularly bothers patients, a deep operation to remove the vitreous, called vitrectomy, can be performed.
It is important to note that although this is a normal process in the eye, regular monitoring of patients with changes in the vitreous is necessary, as it is possible that as the vitreous shrinks and detaches from the retina, a rupture may occur, which can lead to retinal detachment. Symptoms indicating this type of damage are, in addition to usual floaters or cobwebs in front of the eyes, a sudden increase in their number, flashes with closed eyes or at dusk, or a curtain covering the field of vision. In such cases, it is imperative to see an ophthalmologist immediately who, if a rupture exists, will perform outpatient laser treatment, or in the worst case of retinal detachment, will plan an urgent surgical procedure.
Distortion of lines represents a condition called macular degeneration, a disease of the macula, the yellow spot that is the center of vision on the retina. There are two forms of macular degeneration, dry and wet. The dry form progresses more slowly, but the spreading process can only be slowed down by taking vitamin complexes. The wet degeneration can be treated with injections of Avastin or Lucentis, i.e., so-called anti-VEGF therapy, which reduces the permeability of diseased blood vessels and prevents the accumulation of fluid in the macula.
The danger of bleeding from blood vessels at the back of the eye primarily depends on the location of the bleeding itself. If the bleeding is away from the optic nerve and macula and is small and sporadically present, then monitoring and normalizing blood sugar levels is advised. If the bleeding is near or in the macula itself, then it is important to approach treatment with laser photocoagulation, or the application of anti-VEGF therapy.
Diabetes is a chronic and progressive disease that damages the blood vessels of the retina in the eye. Properly performed laser photocoagulation “welds” the areas that leak fluid and blood, preventing further deterioration of the disease. However, laser therapy cannot cure the underlying disease. If not well-regulated, diabetes can still damage the eyes despite laser treatment.
Avastin and Lucentis are drugs used in the treatment of the wet form of macular degeneration. They belong to the group of anti-VEGF antibodies (vascular endothelial growth factor), reducing permeability and growth of newly formed blood vessels. Avastin was originally developed for the treatment of metastatic colorectal cancer, however, in ophthalmology, it is in off-label use worldwide. Lucentis was developed solely for ocular use, and its molecular structure is smaller than Avastin’s. So far, no difference in their effects is known, and studies comparing both drugs are underway. Eylea is the most modern drug in this group of therapeutics, and it differs from the previous two in its molecular approach to treating macular diseases and a lesser need for repeated administration. It’s important to know that it is always possible to switch from one drug to another and vice versa during treatment.
Depending on the extent to which thrombosis is present, the symptoms vary. With ocular vein thrombosis, there’s usually an accumulation of fluid and swelling (edema) of the macula or the yellow spot. Today, the standard therapy for this disease is anti-VEGF therapy with Avastin, Lucentis, or Eylea, injections given every 1-3 months. The earlier the therapy starts, the better the chances for recovery. A new addition to the world and to the Special Hospital for Ophthalmology “Dr. Kozomara” is the new Ozurdex injection, a slow-release corticosteroid with effects lasting up to 6 months.
Considering the age, it is most likely a case of central serous retinopathy (CSR). It usually occurs in young men. The cause is unknown, but among other things, it is associated with stress. Treatment is supplemented with dorzolamide tablets (Diamox) and diclofenac drops (Naclof) as the most common, but modifications are also possible. The disease usually goes away on its own within a month without leaving visual consequences. However, in some cases, the disease can become chronic, and then more aggressive therapy (laser, anti-VEGF) is applied, as in such cases the disease can cause more permanent visual damage.
This is also a disease of the macula, the yellow spot in the eye, where the front limiting membrane, a thin structure that resembles cellophane (hence the name), “wrinkles” the macula, and vision weakens. The only way to treat this is through vitrectomy surgery, where access to the back of the eye is gained through small holes in the sclera, and the membrane is delicately peeled off the surface of the macula using microsurgical instruments. Recovery of visual acuity depends on the duration of the disease, i.e., the shorter the duration, the greater the chances for complete recovery of visual acuity.
Air is typically used in uncomplicated surgeries such as the removal of blood from the eye. It usually remains in the eye for a week or two, then gradually leaves the eye on its own. If a patient has air in their eye, they are advised not to fly for two weeks due to the potential for increased eye pressure. Gas is used in cases involving diabetes, uncomplicated retinal detachments, superficial macular diseases such as macular ruptures, etc. It remains in the eye for about a month. It’s important to know that the patient will not see as long as there is gas or air in the eye. Similar to air, with gas, a patient should not travel by plane for a month for the same reasons.
Silicone oil is used when strong tamponade is needed, usually in more severe retinal detachments and in patients with proliferative diabetic retinopathy. The advantage is that the patient can see immediately, but the disadvantage is that the oil has to be removed in a second operation. Moreover, of all the mentioned methods, tamponade with oil has the highest risk of developing cataracts, so sometimes cataract surgery is recommended alongside the vitrectomy in the same operation. Other complications, such as increased eye pressure, are also possible.
At the “Dr. Kozomara” Special Hospital for Ophthalmology, we currently do not implant bionic eyes as they are still in the experimental phase. However, we are in regular contact with institutions abroad that are researching bionic eyes, and we communicate all new information to our patients. As of now, you would not be a candidate. Patients with a bionic eye need to be completely blind but with a preserved optic nerve. The bionic eye currently delivers modest results, such as differentiating between light and darkness and recognizing the shape of objects.
