General questions:

I have severe visual loss because of retinal disease. Is it possible for a patient to receive a retina or eye transplant?

No.Transplantation of retinal cells is an active area of research, but it has not yet been successful in improving vision in a significant way. Transplantation of the entire eye is a complex idea that is currently not realistic. Many people have undergone successful transplantation of the cornea, but this would be of no benefit to someone with retinal disease. Currently, there is also research aimed at developing an electronic chip that is implanted in the eye to serve as an artificial retina. As with transplantation, it may be years before this technology proves successful.

Can taking vitamins improve my vision?

A research study called the Age-Related Eye Disease Study (AREDS) has shown that vitamin supplements are important in slowing the progression of macular degeneration in patients with moderate dry macular degeneration or in patients with more advanced disease in one eye only. The most benefit was derived from a combination of antioxidants and zinc, in the following daily doses:

Beta Carotene 15 mg
Vitamin C 500 mg
Vitamin E 400 IU
Zinc 80 mg (as zinc oxide)
Copper 2 mg (as cupric oxide)

Consult with your physician, however, before taking such supplements.

There is evidence that taking beta carotene supplements actually increases the risk of lung cancer in smokers, so current or recent smokers (within the past 5 years, or with a history of heavy smoking) should probably avoid beta carotene. There is also evidence that taking vitamin E supplements may have a negative impact on the effect of cholesterol-lowering drugs called statins.

One limitation of the AREDS study is that carotenoids, such as lutein, were not studied. Lutein is a dietary carotenoid found in highest amounts in dark green leafy vegetables, such as spinach, kale, and collard greens. It seems that lutein may benefit patients with macular degeneration based on various pieces of evidence, but no trial has been performed to assess the safety or efficacy of lutein supplementation.

There is also evidence that patients with retinitis pigmentosa (RP) benefit from vitamin A supplementation. 15,000 IU of Vitamin A palmitate daily has been shown to slow the loss of retinal function in typical RP. However, high dose vitamin A supplementation may be associated with liver damage and birth defects, so your physician should be involved in such a treatment, and regular blood testing during treatment is recommended.

Even with vitamin supplementation, a good healthy diet, low in fat and rich in fruits and vegetables, is likely to play an important part in macular degeneration prevention. Regular exercise and avoiding smoking are other ways to improve overall health and prevent various eye diseases.

Is it okay for me to watch TV or could that harm my vision?

Many people are concerned that using their eyes may make diseases of the eye worse. This is generally not true. You cannot harm the eyes by using them. Even eye fatigue caused by extensive computer use does not damage the eyes. In some patients with certain conditions, a doctor will recommend temporarily restricting some visual activities, and your doctor will tell you if this is required.

Should I be wearing sunglasses—and if so, how often?

Yes. There is evidence that sunlight exposure plays a role in certain eye diseases, such as cataract, macular degeneration, and eyelid cancer. It is a good idea to wear sunglasses with protection against ultraviolet (UV) light. Even on cloudy and rainy days, UV light still reaches the eyes, so wearing sunglasses whenever you’re outdoors could have some benefit. Patients with, or at risk for, macular degeneration may also benefit from lenses that block blue wavelengths, such as sunglasses that have yellow or amber lenses.


Questions about…

Posterior vitreous separation

I had a vitreous separation a couple of months ago, and I still see floaters. Why aren't they going away?

After vitreous separation, the floaters and flashes that occur tend to clear up or become less noticeable within a few months. However, some patients will have persistent symptoms. If so, these floaters are usually only noticeable in certain lighting conditions or against light backgrounds. People generally get used to the floaters they have, and there is rarely any impact on visual function. However, if you have a new increase in flashes or floaters, that could indicate a retinal tear or some other issue, and should be reported to your doctor. Vitrectomy surgery can remove floaters, but because of the surgical risks, it is rarely performed for this purpose.

Retinal detachment

Once my retinal detachment has been repaired, could my retina detach again?

There is a slight chance that the retina can become detached again despite successful reattachment. The risk is greatest during the weeks to months immediately following the surgery.

Diabetic retinopathy

I had laser treatment because of my diabetic retinopathy, but my vision is still blurry. Is that normal?

It is best if focal laser treatment of diabetic macular edema is performed before a patient’s central vision has been affected. Once the center of the macula is swollen, laser treatment often results in some improvement, but the vision may be permanently impaired to some degree. This is one reason why regular retinal exams are so important.

Another condition that often damages vision is poor blood flow (ischemia) in the macula. There is currently no treatment for macular ischemia. The only way to slow the progression of retinopathy and avoid this complication is through medical control of the blood sugar and blood pressure.

Patients with proliferative diabetic retinopathy often develop hemorrhage into the vitreous gel. The recommended treatment for this condition is called panretinal laser photocoagulation. This laser treatment helps prevent any further neovascularization, hemorrhage, and retinal detachment. However, it will not improve the vitreous hemorrhage that has already occurred. Blood within the vitreous must be cleared by the body, and may take several months to go away. If vitreous hemorrhage affecting the vision does not clear in a reasonable amount of time, vitrectomy surgery might be recommended by your eye specialist.

Macular degeneration

I lost central vision in one eye because of age-related macular degeneration. Does this mean my other eye will be affected?

Typical age-related macular degeneration is a bilateral disease, which means that it affects both eyes. For example, one eye may have severe visual loss caused by the wet form of the disease, but if the other eye does not have the wet form, it probably has dry macular degeneration (even if the vision in this eye is good). If someone has developed the wet form of the disease in one eye, there is a significant chance that the other eye will also progress to the wet form. Use of an Amsler grid and regular retinal exams help in the early detection of any progression. Then early treatment can occur, which is when vision is most likely to be preserved.

My doctor told me I have dry macular degeneration, but my eyes are always tearing. Could this mean I have the wet form?

The terms “dry” and “wet” macular degeneration have nothing to do with dry eyes, tearing, or other problems with the tear film or surface of the eye. We use these terms to indicate whether or not abnormal blood vessels are growing beneath the retina, which leads to bleeding and leakage of fluid (the “wet” form).

I was told I have macular degeneration, but I feel like I'm too young for that. Could I have been misdiagnosed?

There are some other eye conditions that share features with age-related macular degeneration, but occur in younger patients. Hereditary retinal degenerations, severe nearsightedness (myopic degeneration), and certain infectious or inflammatory eye diseases are sometimes referred to as “macular degeneration,” but they are distinct disorders. Talk with your doctor about whether you may have one of these types of eye diseases.

Macular hole

After macular hole surgery, I’m supposed to stay in a face-down position for 2 weeks. How is that possible?

Many patients find it helpful to obtain special equipment, such as massage furniture, which allows for more comfortable positioning. There are many places where this equipment can be obtained, and the cost may be fully or partially covered by your health insurance company.

A dedicated space where the patient can remain in a face down position and have easy access to telephone, tissues, drops, drinking straws, etc. is a good idea. You can read or even watch TV in a face-down position by placing the book or TV on the floor facing up. You might also be able to place a mirror in a position that reflects the TV screen. Some patients find that listening to the radio or books on tape can be soothing.

Nevertheless, some patients will have difficulty maintaining this position. In some cases, your doctor may ease these requirements.

For patients who cannot manage this face-down position, silicone oil may be used instead of intraocular gas during the surgical procedure. Silicone oil is a clear viscous fluid that is used to fill the vitreous cavity. One drawback to this option is that it must be removed later through another surgical procedure.

Will I go blind from a macular hole?

It is very uncommon for macular holes to lead to total blindness. Most patients have central distortion and vision loss, but maintain peripheral vision. Occasionally, macular holes are associated with retinal detachment in a patient, which can cause more extensive visual loss.

I have a macular hole in one eye. Will I get one in the other eye?

Many patients with a macular hole in one eye will develop a macular hole in their other eye at some point. The risk is about 1% per year. The likelihood is greatly reduced for a patient, however, if the vitreous gel has already separated in the other eye.

Macular pucker

I had a vitrectomy for macular pucker, but my vision is still distorted. Does this mean the pucker is still there?

When macular pucker surgery is the appropriate treatment for a patient, this procedure improves vision and reduces visual distortion in most patients. However, some residual blurring or distortion is common. This does not necessarily mean that the membrane is still present or has regrown (this occurs in only a small percentage of patients). Persistent visual changes are probably more likely if the macular pucker is chronic or if surgery is delayed for a long time.


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