Group 1

Bungay, Ashaley
Mohammed, Yousef
Natal, Ralph
Tagal, Ezra
What is retina?
• The retina is a thin layer of tissue that lines the back of the eye
on the inside. It is located near the optic nerve. The purpose of
the retina is to receive light that the lens has focused, convert the
light into neural signals, and send these signals on to the brain
for visual recognition.
• The retina processes light through a layer of photoreceptor cells.
These are essentially light-sensitive cells, responsible for
detecting qualities such as color and light-intensity. The retina
processes the information gathered by the photoreceptor cells
and sends this information to the brain via the optic nerve.
Basically, the retina processes a picture from the focused light,
and the brain is left to decide what the picture is.
• Due to the retina's vital role in vision, damage to it can cause
permanent blindness. Conditions such as retinal detachment,
where the retina is abnormally detached from its usual position,
can prevent the retina from receiving or processing light. This
prevents the brain from receiving this information, thus leading to
blindness.
Function
The retina translates an optical image into neural impulses by the patterned
excitation of the colour-sensitive pigments of its rods and cones, the retina's
photoreceptor cells. The excitation is processed by the neural system and
various parts of the brain working in parallel to form a representation of the
external environment in the brain.
The cones respond to bright light and mediate high-resolution colour vision
during daylight illumination (also called photopic vision). The rods are saturated
at daylight levels and don't contribute to pattern vision. However, rods do
respond to dim light and mediate lower-resolution, monochromatic vision under
very low levels of illumination (called scotopic vision). The illumination in most
office settings falls between these two levels and is called mesopic vision. At
mesopic light levels, both the rods and cones are actively contributing pattern
information.
Functions of the sensory retina
• visual acuity - sharpness of vision,
measured by the ability to discern
letters or numbers at a given
distance according to a fixed
standard.
• dark adaptation - the adjustment of
the eye to low light intensities,
involving reflex dilation of the pupil
and activation of the rod cells in
preference to the cone cells.
• day illumination
• color vision - is the ability of an
organism or machine to distinguish
objects based on the wavelengths
(or frequencies) of the light they
reflect, emit, or transmit. Colors can
be measured and quantified in
various ways; indeed, a person's
perception of colors is a subjective
process whereby the brain
responds to the stimuli that are
produced when incoming light
reacts with the several types of
cone cells in the eye.
• central & peripheral visual fields - is
a part of vision that occurs only on
the side gaze. There is a broad set
of non-central points in the visual
field that is included in the notion of
peripheral vision.
• electroretinography (ERG) -
measures the electrical responses
of various cell types in the retina,
including the photoreceptors (rods
and cones), inner retinal cells
(bipolar and amacrine cells), and
the ganglion cells.
Retinal layers
The vertebrate retina has ten distinct layers. From closest to farthest from the
vitreous body:

• Inner limiting membrane – basement membrane elaborated by Müller cells.

• Nerve fibre layer – axons of the ganglion cell nuclei (note that a thin layer of
Müller cell footplates exists between this layer and the inner limiting
membrane).
• Ganglion cell layer – contains nuclei of ganglion cells, the axons of which
become the optic nerve fibres for messages and some displaced amacrine
cells.
• Inner plexiform layer – contains the synapse between the bipolar cell axons
and the dendrites of the ganglion and amacrine cells.
• Inner nuclear layer – contains the nuclei and surrounding cell bodies
(perikarya) of the amacrine cells, bipolar cells, and horizontal cells.
• Outer plexiform layer – projections of rods and cones ending in the rod
spherule and cone pedicle, respectively. These make synapses with
dendrites of bipolar cells. In the macular region, this is known as the Fiber
layer of Henle.
• Outer nuclear layer – cell bodies of rods and cones.
• External limiting membrane – layer that separates the inner segment portions
of the photoreceptors from their cell nucleus.
• Layer of rods and cones – layer of rod cells and cone cells.
• Retinal pigment epithelium – single layer of cuboidal cells (with extrusions
not shown in diagram). This is closest to the choroid.
Retinal layers
There are many inherited and acquired diseases or disorders that
may affect the retina. Some of them include:
Retinitis 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.
diagnosis
- electroretinogram
- visual field testing
- genetic testing
signs and symptoms
Night blindness
Tunnel vision
Photopsia (blinking/shimmering lights)
Photophobia (aversion to bright lights)
Blurring of vision
Poor color separation
Loss of central vision
Eventual blindness
• treatment
– There’s no cure for retinitis pigmentosa, but doctors are working hard to find new treatments. A few
options can slow your vision loss and may even restore some sight:

 Acetazolamide : In the later stages, the tiny area at the center of your retina can swell. This is
called macular edema, and it, too, can reduce your vision. This medication can ease swelling and
improve your vision.
 Vitamin A palmitate: High doses of this compound may slow retinitis pigmentosa a little each year.
But you have to be careful, because too much can be toxic. Work closely with your doctor and
follow her recommendations.
 Sunglasses: These make your eyes less sensitive to light and protect your eyes from harmful
ultraviolet rays that may speed vision loss.
 Retinal implant: A surgeon puts an electronic device in and around your eye. When paired with
special glasses, it allows some people with late-stage retinitis pigmentosa to read large letters and
get around without a cane or guide dog.
Age-related macular degeneration is an acquired degeneration of the retina that
causes significant central visual impairment through a combination of non-neovascular (drusen
and retinal pigment epithelium abnormalities), and neovascular derangement (choroidal
neovascular membrane formation). Advanced disease may involve focal areas of retinal
pigment epithelium (RPE) loss, subretinal or sub-RPE hemorrhage or serous fluid, as well as
subretinal fibrosis.
Risk Factors
- Age
- Cigarette Smoking
- Genetic susceptibility
 Physical examination
- Periodic dilated fundus exams are warranted to identify patients who progress to
neovascular ARMD without having symptoms.
- Amsler grid
- The Preferential Hyperacuity Perimeter is useful, when available, to identify new-onset
neovascular ARMD changes.
 Signs
- Drusen
- Geographic atrophy
- Subretinal fibrosis
- RPE changes
- Subretinal fluid or hemorrhage
 Symptoms
- Decreased visual acuity, insidious or sudden-onset
- Blurred vision
- Distorted near vision
 - Visual distortion, metamorphopsia, micropsia
- Vague visual complaints
 Diagnostic procedures
- Fluorescein Angiography
- Optical Coherence Tomography
 Medical therapy
Nonneovascular ARMD Treatments
- Antioxidant and mineral supplementation
Neovascular ARMD Treatments
- Macular Photocoagulation Studies
- Photodynamic therapy
- Anti-VEGF treatments
- Radiation therapy
 Complications
- Subretinal hemorrhage - Diplopia
- Vitreous hemorrhage - Legal blindness
Treatment
• Treatment depends upon the nature of the disease or disorder.

Common treatment modalities

The following are commonly modalities of management for retinal disease:

• Intravitreal medication, such as anti-VEGF (Anti–vascular endothelial
growth factor therapy) or corticosteroid agents
• Vitreoretinal surgery
• Use of nutritional supplements
• Modification of systemic risk factors for retinal disease
diabetic retinopathy
• DR is a complication of diabetes and a leading cause of
blindness
• DR usually affects both eyes.
• Diabetic retinopathy damages the blood vessels within
the retinal tissue, causing them to leak fluid and distort
vision.
• 2 types of DR
– Non-proliferative diabetic retinopathy (NPDR): This
is the milder form of diabetic retinopathy and is
usually symptomless.
– Proliferative diabetic retinopathy (PDR): PDR is the
most advanced stage of diabetic retinopathy and
refers to the formation of new, abnormal blood
vessels in the retina.
• symptoms
– blurred vision
– the impairment of color vision
– floaters, or transparent and colorless spots and dark strings that float in the patient's
field of vision
– patches or streaks that block the person's vision
– poor night vision
– sudden and total loss of vision
• causes and risk factor
– does not correctly control blood sugar levels
– experiences high blood pressure
– has high cholesterol
– is pregnant
– smokes regularly
– has had diabetes for a long time
• prevention
- eating a healthy and balanced diet
- regularly exercising
-maintaining a healthy body weight
- smoking cessation
- strictly controlling alcohol intake
-taking any antihypertensive measures according to their doctor's instructions
- attending regular screenings