Conditions We Treat
Our physicians are ophthalmologists who sub-specialize in the treatment of diseases and conditions affecting the eye’s retina and vitreous.
At Associated Retina Consultants we treat all retinal conditions including those listed below, and more.
Age-Related Macular DegenerationAge-related macular degeneration (AMD) is an eye disease that causes vision loss in the center of vision. It is caused by the deterioration of the macula which is located at the back of the eye. AMD is the leading cause of legal blindness in the United States for people over the age of 65. AMD is present in approximately 10% of the population over age 52 and in up to 33% of individuals older than 75.
Types of AMDThere are two types of macular degeneration: Dry AMD and Wet AMD.
- Dry AMD occurs when small clumps of scar tissue called drusen form under the macula. This condition can also occur when the retinal pigment layer under the retina degenerates (this is rare). Geographic Atrophy is an advanced form of dry macular degeneration (AMD) that causes a black spot in central vision.
- Wet AMD occurs when new blood vessels grow under the macula, leaking blood and fluid that cause the macula to blister.
Symptoms of AMDWhile vision loss is typically severe and rapid with Wet AMD, Dry AMD symptoms usually develop gradually in one or both eyes. Symptoms can include:
- Blurry or Hazy Vision
- Difficulty Seeing in Dim Light
- Difficulty Recognizing Faces
- Blind Spot in Central Vision
- Dullness of Colors
- Straight Lines Appear Wavy
Causes of AMDThere is no singular cause of AMD. Some risk factors may include:
- Genetics / Family History of AMD
- Female Gender
- Light-colored Eyes
- Fair Colored Skin
- Poor Nutrition
- High Cholesterol
- Cardiovascular Disease
Treatment of AMDThere is no cure for AMD; however, there are treatments that can slow the progression of the disease. It is also important to stop smoking if you have AMD.
- Dry AMD Treatment: Combination of vitamins with high doses of antioxidants and zinc. We are proud to offer our patients Focus Vitamins.
- Wet AMD Treatment: Injections of anti-angiogenic medications into the eye can prevent development of new blood vessels and reduce leakage from existing blood vessels. Sometimes laser therapy is used to destroy abnormal blood vessels.
Geographic AtrophyGeographic Atrophy is an advanced form of dry macular degeneration (AMD) that causes a black spot in central vision.
Reason for Geographic AtrophyOur eyes need healthy photoreceptor cells (rods and cones) to gather incoming light and transmit images to the brain. In late stage dry AMD, protein deposits (drusen) forming on the macula (the central part of the retina) clump on the photoreceptor cells and cause them to die. When these photoreceptor cells are lost, central vision is lost. This is a slow process that will also begin to affect the visual cells in the retina.
Symptoms of Geographic Atrophy
- Difficulty reading in dim lighting situations
- Central vision loss
- Black spot in central vision
- Slower reading speed
- No change in peripheral vision
Risk Factors for Geographic Atrophy
- Aging (more frequent in a person’s 70s and 80s)
- History of smoking
- High blood pressure
- Light colored iris
Treatment for Geographic AtrophyUnfortunately there is no treatment for this condition. Our Arizona macular degeneration doctors use autofluorescence imaging and high density optical coherence tomography techniques to monitor the progression of this disease to help protect vision for as long as possible. If you are experiencing any change in your central vision, contact our macular degeneration doctors in Arizona to schedule an eye exam to identify the root cause of your vision problems.
Amsler GridThe Amsler grid eye test is used to help macular degeneration patients manage their condition and alert them to any changes in their condition. This is a simple test that can be done at home.
Instructions for Amsler Grid
- Print out the grid.
- Wear your reading glasses, if applicable.
- Hold the grid at reading distance.
- Cover one eye and focus on the black dot in the center of the grid.
- Note any lines in your peripheral vision that appear wavy, crooked or missing.
- Mark the affected lines on the chart.
- Repeat process with other eye.
- Keep track of any changes to your Amsler grid testing.
Central Serous Retinopathy / ChorioretinopathyCentral serous chorioretinopathy, commonly referred to as CSC, is a condition in which fluid accumulates under the retina, causing a serous (fluid-filled) detachment and vision loss. CSC most often occurs in young and middle-aged adults. For unknown reasons, men develop this condition more commonly than women. Vision loss is usually temporary but sometimes can become chronic or recur.
SymptomsBlurry central vision, which often occurs in one eye, is the most common symptom that patients experience; however, careful examination often reveals some involvement in the other eye as well. Depending on the location and amount of sub-retinal fluid, CSC can show no symptoms, especially if the affected areas fall outside of the macula—the part of the retina used to distinguish fine detail for activities like reading and recognizing faces.
CausesThe causes of CSC are not fully understood. It is thought that any systemic exposure to a corticosteroid drug can bring about or worsen CSC. Corticosteroids are found in allergy nose sprays and anti-inflammatory skin creams available over the counter, and are often prescribed to treat a variety of medical conditions. An association has also been made between CSC and patients with emotional distress and/or “type A” personalities. It is possible that the body produces natural corticosteroids in times of stress that may trigger CSC in an individual prone to this condition.
TreatmentSeveral therapies have been used to treat chronic CSC, including thermal laser treatments, oral medications, and eye injections. A “cold laser,” called photodynamic therapy, is also effective and often used to focally treat the source of fluid leakage under the retina in chronic CSC. Read More at American Society of Retina Specialists
Detached and Torn Retina'sThe retina is the inner lining of the eye; it is the thin, light-sensitive tissue that generates vision. Tears can form in the retina, creating a risk of retinal detachment and severe loss of vision. Retinal detachment is when the retina (the back of the eye) separates from the back wall of the eye.
SymptomsA patient with an acute retinal tear may experience the sudden onset of black spots or “floaters” in the affected eye. This can have the appearance of someone shaking pepper in your vision. Flashes of light are another common symptom. If there is associated vitreous hemorrhage (bleeding in the clear cavity of the eye) or retinal detachment, additional symptoms can include blurred vision or a shadow as if curtains are closing in from the peripheral (side) vision. However, in some cases, a retinal tear may not manifest any noticeable symptoms. There is typically no pain or discomfort with a retinal detachment. However, if you experience any of these symptoms, contact an ophthalmologist immediately:
- Loss of Peripheral (side) Vision
- Flashes of Light
- Loss of Central Vision
- Feeling of a curtain coming down over vision.
Causes of Retinal DetachmentRetinal detachments often occur when the vitreous gel inside the eye begins to shrink and contract which pulls on the retina and creates a tear in the retina. Natural fluid in the eye can leak through the tear and collect under the retina causing it to become detached. Retinal detachment can be caused by:
- Severe Myopia (nearsightedness)
- Eye Injury
- Eye Disease
- Cataract Surgery
- Family History of Retinal Detachment
- Treatment for Retinal Detachment
Complex Retinal DetachmentProliferative vitreoretinopathy (PVR) is a condition in which retinal scar tissue, or “membranes” form; this may occur with a retinal detachment. A key risk factor for developing PVR is a giant retinal tear—a large tear that involves at least 25% of the retina. When PVR or a giant retinal tear is present, a retinal detachment is classified as “complex.” Read More at ASRS
Choroidal DetachmentThe choroid (pronounced “CORE-oyd”) is a spongy layer of blood vessels that lines the back wall of the eye between the retina and the sclera (or the white part of the eye). It plays an important role in delivering oxygen and nutrients to the outer half of the retina. The choroid is normally directly next to the sclera, but can be displaced by fluid or blood, leading to a choroidal detachment (separation).
SymptomsWhen the choroid is detached from the back wall of the eye, patients may not feel anything at all, or may feel that the eye is achy and sore. In some cases, a choroidal detachment can cause more severe pain. Often, the vision is blurred as well, though the degree of blurring varies and often relates to other eye issues that can accompany a choroidal detachment, such as recent surgery, or high or low pressure in the eye (intraocular pressure).
Retinal Tears and Detachment - Treatment and PrognosisIf a retinal tear is diagnosed promptly before it progresses to retinal detachment, the prognosis is extremely good. Retinal tears are typically treated with laser or a freezing procedure (cryotherapy). Treatment is performed in an office setting and is very effective and quite safe. Retinal Detachment The goal of treatment is to re-attach the retina to the back wall of the eye and seal the tears or holes that caused the retinal detachment. Several approaches can be employed to repair a retinal detachment:
- Scleral buckle—In this surgery, a silicone band is placed outside the eye wall to push the wall of the eye closer to the retinal tear in order to close the tear. The tear is treated with a freezing treatment to induce controlled scarring around the tear and permanently seal it. The fluid under the retina is sometimes removed at the time of surgery.
- Vitrectomy—In this surgery, three small incisions are made in the white part of the eye and fine instruments are manipulated using an operating microscope to remove the vitreous gel that fills the eye and drain the fluid from under the retina. The surgeon may then use a laser or cryopexy to seal the retinal tears or holes. The eye is then filled with a gas bubble to hold the retina in place while it heals.
- Pneumatic retinopexy—In this office-based procedure, a gas bubble is injected into the eye and the patient maintains a specific head posture to position the gas bubble over the retinal tear. The tear itself is sealed either with a freezing treatment at the time of the procedure, or with laser after the retina is re-attached.
- Laser surgery—In certain cases, a retinal detachment can be walled off with laser to prevent the retinal detachment from spreading. This is generally appropriate for small detachments.
Diabetic RetinopathyThe retina (nerves at the back of your eye) needs a continual supply of blood and nutrients to stay healthy. If the blood vessels that supply blood to the retina begin to deteriorate and leak fluid and blood into the retinal tissue, the health of the retina is put in jeopardy. The condition of diabetic retinopathy is a complication of diabetes. It is estimated that over 25% of diabetics have some form of this disease. It is the leading cause of blindness in adults with diabetes.
Symptoms of Diabetic RetinopathyIn the early stages, a patient with diabetic retinopathy may not know that damage is occurring because there are no outward symptoms. This increases the importance for diabetics to have regular eye exams that will identify these silent diseases; treatment can then be started that can slow progression of the disease. In the later stages, diabetic retinopathy can cause:
- Vision Loss
- Blurry Vision
- Color Perception Difficulties
- Retinal Detachment
- Vitreous Hemorrhage (the jelly-like substance that fills the eye)
- Dark spots, strings or floaters in the vision.
Causes of Diabetic RetinopathyElevated blood sugar levels can damage or even completely block the blood vessels that nourish the retina. This can occur in either Type I or Type II diabetics in Phoenix. Other risk factors for diabetic retinopathy include high blood pressure, high cholesterol, tobacco usage and pregnancy.
Treatment for Diabetic RetinopathyLifestyle changes to control blood sugar levels will dramatically reduce the risk of developing diabetic retinopathy. It can also help to slow the progression of the disease. If you have been diagnosed with the disease, treatment will depend on the severity of your condition. Treatment may include:
- Vitrectomy to remove blood from the vitreous area of the eye.
- Focal laser treatment to slow or halt the leakage of blood in the eye.
- Scatter laser treatment to shrink abnormal blood vessels.
Posterior Vitreous Detachment
- Floaters (mobile blurry shadows that obscure the vision)
- Flashes (streaks of light, usually at the side of the vision)
Treatment and PrognosisNo specific treatment is needed for PVD. That said, complications of PVD are rare but can be serious and require urgent treatment, such as laser for a retinal tear or surgery for a retinal detachment. For this reason, one or more checkups are recommended within 3 months after the onset of PVD. In rare cases, the floaters from PVD persist, and vitrectomy surgery to remove the floaters is effective; you and your doctor may consider this after discussing the risks and benefits of surgery. Read More at ASRS.org
Inherited Retinal ConditionsVision loss and eye diseases can often affect multiple generations of a family. Genetic factors play a role in many kinds of eye disease, including those diseases that are the leading cause of blindness among infants, children and adults. To help you understand your vision changes and protect your sight, we offer sophisticated testing and treatment for the management of retinal diseases. Our variety of retinal electrophysiology and visual function tests get to the root of vision problems by differentiating between retinal and optic nerve conditions. If you are suffering from an inherited retinal condition, visit our Inherited Retinal Disease and Visual Function Clinic to learn more about how we test for and treat the various rare diseases, including:
Stargardt DiseaseStargardt disease is an inherited disorder of the retina – the tissue at the back of the eye that senses light. The disease typically causes vision loss during childhood or adolescence, although in some forms, vision loss may not be noticed until later in adulthood. It is rare for people with the disease to become completely blind. For most people, vision loss progresses slowly over time to 20/200 or worse. (Normal vision is 20/20).
Best Macular DystrophyBest’s disease, also known as vitelliform macular dystrophy, is a genetic eye disorder that can cause progressive vision loss. This disorder affects the retina, the specialized light-sensitive tissue that lines the back of the eye. Specifically, vitelliform macular dystrophy disrupts cells in a small area near the center of the retina called the macula. The macula is responsible for sharp central vision, which is needed for detailed tasks such as reading, driving, and recognizing faces.
Retinitis PigmentosaRetinitis pigmentosa (RP) is a group of rare, genetic disorders that involve a breakdown and loss of cells in the retina—which is the light sensitive tissue that lines the back of the eye. Common symptoms include difficulty seeing at night and a loss of side (peripheral) vision.
Usher SyndromeUsher syndrome is the most common condition that affects both hearing and vision; sometimes it also affects balance. The major symptoms of Usher syndrome are deafness or hearing loss and an eye disease called retinitis pigmentosa (RP). Deafness or hearing loss in Usher syndrome is caused by abnormal development of hair cells (sound receptor cells) in the inner ear. Most children with Usher syndrome are born with moderate to profound hearing loss, depending on the type. Less commonly, hearing loss from Usher syndrome appears during adolescence or later. Usher syndrome can also cause severe balance problems due to abnormal development of the vestibular hair cells, sensory cells that detect gravity and head movement. RP initially causes night-blindness and a loss of peripheral (side) vision through the progressive degeneration of cells in the retina. The retina is the light-sensitive tissue at the back of the eye and is crucial for vision. As RP progresses, the field of vision narrows until only central vision remains, a condition called tunnel vision. Macular holes (small breaks in the macula, the central part of the retina) and cataracts (clouding of the lens) can sometimes cause an early decline in central vision in people with Usher syndrome.
Leber Congenital Amaurosis, LCALeber congenital amaurosis (LCA) is an inherited retinal disease that causes severe visual impairment in infancy or early childhood. Current research on a gene transfer therapy may offer hope to people with a form of this disease.
Macular EdemaMacular edema develops when blood vessels in the retina are leaking fluids. The macula does not function properly when it is swollen. Vision loss may be mild to severe, but in many cases, your peripheral (side) vision remains. The more widespread, thicker, and severe the swelling becomes, the more likely one will notice visual symptoms of blur, distortion, and difficulty reading. Macular edema is often a complication of diabetic retinopathy, and is the most common form of vision loss for people with diabetes. If untreated, chronic macular edema can lead to irreversible damage of the macula and permanent vision loss.
Treatment and PrognosisThe most effective treatment strategies for macular edema address the underlying cause (diabetes, blood vessel occlusion, neovascularization, inflammation, etc), as well as an excess of fluid leaking from abnormal blood vessels in and around the macula. Eye drops, laser, and surgery can be effective in many diseases, but the mainstay of treatment is intravitreal injections (IVI). If you would like to learn more about macular edema visit ASRS - macular edema.
Macular Edema Video: American Academy of Ophthalmology
Macular Holes and Macular Puckers
The macula is a small collection of nerve cells found in the middle of the retina (the back of the eye). Responsible for our central vision, this is the sharp point where the eye focuses the images that we see. When a break develops in these nerve fibers, this is called a macular hole. As we age, the macula can also begin to grow a thin layer of scar tissue over the light-sensitive surface. This is a macular pucker.
Macular HolesMacular holes are painless but they can seriously affect your vision as you grow older. Most people develop these after age 60; women are more susceptible to the disease. Symptoms can include:
- Loss of Central Vision
- Distortion/Blurriness of Central Vision
- Straight Lines That Look Wavy
- Foveal Detachment
- Partial-Thickness Holes
- Full-Thickness Holes
Causes of Macular Holes
- Diabetic Eye Disease
- Macular Pucker
- Detached Retina
- Eye Trauma or Injury
- Extreme Myopia (nearsightedness)
- Shrinkage or detachment of the vitreous (jelly-like substance) in the eye.
Treatment of Macular HolesMacular holes in Phoenix are most often treated surgically with a procedure known as a vitrectomy. During a vitrectomy surgery, the vitreous gel in the middle of the eye is removed and replaced with an air/gas bubble. The bubble pulls the edges of the hole together and keeps it together as the hole heals. The bubble dissipates on its own and the eye replaces it with its own saline fluid. Read more about macular holes at ASRS: macular holes
Macular PuckerA macular pucker can have some of the same symptoms as a macular hole, although this is not the same as a macular hole and severe vision loss is uncommon with this condition. Symptoms can include:
- Blurry Central Vision
- Mildly Distorted Central Vision
- Straight Lines Look Wavy
- Difficulty Reading Small Print
- Gray Spot In Central Vision
- Blind Spot In Central Vision
Causes of Macular PuckerMacular pucker is often caused by the shrinkage or detachment of the vitreous (jelly-like substance) in the eye. When the vitreous pulls away from the retinal surface (a very normal occurrence) the retina will begin to heal the damaged area and form scar tissue. When this occurs on other areas of the retina, there is usually no effect on central vision; however, if it forms on the macula and begins to wrinkle, central vision will be affected. Eye trauma and prior eye surgery can also have an impact on the vitreous and lead to a macular pucker.
Treatments for Macular PuckerMost macular pucker patients do not require any type of treatment if the symptoms are mild. However, if your vision distortion is affecting your daily activities, a vitrectomy surgery may be performed to remove the vitreous gel to prevent it from pulling on the retina, replacing it with a saline solution. The scar tissue is also removed. This surgery is effective in restoring clear central vision after a few months. If you are experiencing vision problems in Phoenix, contact Associated Retina Consultants today to schedule a retinal exam. Our doctors can pinpoint the source of your problems, fully explain your treatment options and then provide the necessary treatment to preserve your vision. Read More About Macular Puckers at ASRS
Ocular MelanomaThe most common cancer of the eye is melanoma, also known as ocular melanoma. Melanoma is a type of cancer that develops in the cells responsible for producing the pigment that gives your skin, hair and eyes color. Just as you can develop a melanoma on your skin, you can also develop it in your eye. Although it is the most common type of eye cancer in adults, ocular melanoma is rare. Ocular melanoma also known as uveal melanoma because it usually develops in the part of the eyeball called the uvea — a layer in the eye wall between the sclera and retina. Melanoma nearly always develops in the part of the uvea called the choroid, a pigmented layer lining the eyeball, because choroid cells have the same kind of pigment as cells in skin. While most ocular melanoma begins in the choroid, a smaller number develop in the iris (also a part of the uvea), which is the colored area around the pupil. Melanomas in the iris usually grow slowly and generally don’t spread to other areas of the body.
Primary Intraocular LymphomaPrimary intraocular lymphoma (lymphoma of the eye) is a kind of cancer that involves the body’s white blood cells, or lymphocytes, located throughout the body. Lymphomas can also start in organs such as the lungs, stomach, and rarely, the eyes. The two main types of lymphoma are Hodgkin’s disease and non-Hodgkin’s lymphoma. Primary intraocular lymphoma is always a non-Hodgkin’s B cell lymphoma. Most people with primary intraocular lymphoma are elderly or have disorders that weaken the immune system such as AIDS. Primary intraocular lymphoma often occurs with lymphoma of the brain, called primary central nervous system lymphoma (PCNSL).
Read more about Primary Intraocular Lymphoma at American Academy of Ophthalmology.
RetinoblastomaA different kind of eye cancer, called retinoblastoma, affects young children. Caused by a genetic mutation, it begins in the retina, the light-sensitive tissue lining the back of the eye. Retinal nerve cells begin to grow and multiply, then usually spread into the eye and possibly other parts of the body. Other types of cancers can affect the eye. Orbital cancers affect the tissues surrounding the eyeball (called the orbit), including muscles that move the eyeball around and nerves attached to the eyeball. Adnexal structures are other parts of the eye called accessory structures, and include the eyelids and tear glands. Cancers that develop in these tissues are called adnexal cancers.
Read more about Retinoblastoma at American Academy of Ophthalmology.
- Low birth weight (just under 3 pounds or less).
- How early a baby is born. A premature baby born at 28 weeks has a greater risk of having ROP than a premature baby born at 32 weeks.
- Giving the infant extra oxygen after birth.
- Caucasian (white) babies are more likely to get ROP than babies who are African-American.
- Premature infants are also more likely to get ROP if they have other health problems. These problems include anemia (low levels of iron in the blood), not enough vitamin E, or breathing problems.
Retinal Artery OcclusionRetinal artery occlusion refers to blockage of the retinal artery carrying oxygen to the nerve cells in the retina at the back of the eye. The lack of oxygen delivery to the retina may result in severe loss of vision.
SymptomsRetinal artery occlusion is usually associated with sudden painless loss of vision in one eye. The area of the retina affected by the blocked vessels determines the area and extent of visual loss.
- The main artery supplying blood to the eye is the ophthalmic artery; when it is blocked, it produces the most damage. A blockage in the main artery in the retina is called central retinal artery occlusion (CRAO), which often results in severe loss of vision. However, about 25% of people who develop CRAO have an extra artery called a cilioretinal artery in their eyes. When CRAO occurs, having a cilioretinal artery can greatly lessen the chances of damage to your central vision, as long as the cilioretinal artery is not affected.
- A blockage in a smaller artery is called branch retinal artery occlusion (BRAO); this may cause a loss of a section of your visual field, such as your vision to one side. If the affected area is not in the center of the eye or is relatively small, a BRAO may go unnoticed with no symptoms.
UveitisUveitis occurs when the middle layer of the eyeball gets inflamed (red and swollen). This layer, called the uvea, has many blood vessels that nourish the eye. Uveitis can damage vital eye tissue, leading to permanent vision loss. You are more likely to get uveitis if you have or have had: Infections such as:
- Shingles Virus
- Herpes Simplex Virus
- Lyme Disease
- Parasites such as Toxoplasmosis
- Inflammatory Bowel Disease (IBS)
- Rheumatoid Arthritis
- Sensitivity to Bright Light
- Blurry Vision
- Red eye with or without pain.
- Seeing “floaters” (specks or moving clouds in your vision) all of a sudden.