Retinal Anatomy

DOLOT, MIGUEL C.
DECANO, JOANNEAPRIL
Anatomy
Retina and Areas

 Optic nerve
 Macula
 Central/peripheral retina
 Retinal Vasculature
 Choroidal Vessels
Normal Retina

 The retina is approximately 0.5 mm thick and lines the back of

eye.
Normal Retina
Normal Retina
Optic Nerve and Vessels

 Circular to oval white area

 Measures about 2 x 1.5 mm
across.
 Major blood vessels of the retina
radiate from the center of the
nerve
Optic Nerve

 Transmits visual
impulses from the
retina to the brain.
 Visible
part of the
optic nerve is the
optic disc, or optic
nerve head.
Optic Nerve

 ON goes through the lamina

cribrosa, a fibrous, sieve-like
structure
 Lamina cribrosa forms the base of
the physiologic cup, the
depression in the disc.
Cup/Disc
C/D ratio
Rim of ON is
compared in
size with the
cup to get
C/D ratio.
Scale from
0.1 to 0.9
Normal 0.3 or
less
Optic Nerve

 Peri = around  papilledema

 Papillary = ON
 Peripapillary =
area of the
retina around
ON.
Optic Nerve disease

 Optic disc drusen  Glaucoma

Optic Nerve Disease

 Optic disc pit  Optic nerve

hypoplasia
Optic Nerve Disease

 Optic atrophy  Leber’s optic

neuropathy
Macular Area
 “Straight ahead” vision
 Best visual acuity
 Cones form a
concentrated area
known as the fovea,
 Fovea is center of the
macula
Fovea

 Located 2 1/2 disc

diameters to the
left of the disc,
 slightlyoval-
shaped
 blood vessel-free
reddish spot
Macula

 The center of the fovea is known as the foveal pit

 Macula
 The whole foveal area
 foveal pit,
 foveal slope,
 parafovea and
 perifovea is considered the MACULA
area
 A yellow pigmentation to the
macular area is known as the macula
lutea.
Macula lutea

 Yellow pigmentation
 Acts as a short wavelength filter,
 (Lens also a filter)
 Protective mechanism for avoiding
bright light and especially UV
irradiation damage
Macular Disease

 AMD  Stargardts
Macular Disease

 Best’s juvenile, adult

Macular Disease

 Coat’s  CME
Macular Disease

 Drusen  Macular hole

Central and Peripheral Retina

 Central retina =
circular field 6 mm
around fovea
 Peripheral retina
stretches to the
ora serrata, 21
mm from the
center of the
optic disc.
Ora Serrata
 Anterior
termination of
the retina
 Junction of the
retina and the
ciliary body.
 Retina attaches
to the choroid at
ora serrata.
Peripheral Retinal Disease

 Retinitis Pigmentosa  Sickle Cell

Retinopathy
Peripheral Retinal Disease

 Lattice Degeneration  Retinal tear

2 sources of retinal blood supply

 CHOROIDAL BLOOD
VESSELS

 65-85% of blood flow

 Nourishes outer retina
(photoreceptors = rods and
cones)
2 sources of retinal blood supply

 CENTRAL RETINAL
ARTERY

 20-30% blood flow

 Nourishes inner retinal layers
 Has 4 main branches
Retinal vessels

 Arteries cross over  Arteriole

veins narrowing in
hypertension
Arteriole Disease

 CRAO  BRAO
Vein Disease

 CRVO  BRVO
Choroid

 Layer in-between the retina

and the sclera
 Mainly composed of blood
vessels
 Function is to supply
nourishment to the outer
portion of the retina
Choroidal Disease

 Choroidal neovasc
Chorioderemia
Anatomy by Area

 Optic nerve
 Macula
 Central/peripheral retina
 Retinal Vasculature
 Choroidal Vessels
Anatomy by Layers
Bruch’s Membrane
 Separates the
retina and
choroid
 Permeable
membrane
 Water-soluble
nutrients
diffuse from
the choroid
to the RPE
and retina
Bruch’s membrane

 If Bruch’s membrane
compromised,
nutrients such as
vitamin A, might not
be able to reach rods
and cones.
 Drusen deposits of
extracellular material
 Provide space for
SRNV by lifting up the
RPE
Subretinal neovascularization

 SRNV  SRNV
 abnormal vessels
develop and
penetrate Bruch’s
membrane after it is
first damaged by
something else.
Subretinal neovascularization

 SRNV  SRNV
 AMD correlates with
a thickening of the
membrane with
extra-cellular
material
 Retinal Pigment Epithelium
 Next layer near
the choroid,
furthest away
from the vitreous
 Cells have varying
amounts of
melanin pigment
 Gives a granular
appearance to
the fundus.
 Retinal Pigment Epithelium

 RPE
 layerof dark tissue
 absorbs excess light so that the
photoreceptors can give a clearer
signal (reduces scattering)
Retinal Pigment Epithelium
 Plays a role in "trimming"
photoreceptors -- cones are
"trimmed" at dusk, and rods are
"trimmed" at dawn
 Move nutrients to (and waste
from) the photoreceptors to the
choroid.
 Bruch's membrane separates the
choroid from the RPE.
Diseases of RPE

 Central serous  Central serous

Sensory Retina: Rods and Cones

RPE
Rods and Cones

 The rods and cones are right

above the RPE
 Photoreceptors: specialized
nerve endings convert light into
electro-chemical signals.
 The cones are located in the
central visual area (macula) and
are responsible for color vision
Rods and Cones

 Rods designed to operate under d

light
 Not directionally selective like the
cones.
 Cones ignore blurred off-axis light
 Only use sharp high-contrast image
produced by axial light
 Retinitis Pigmentosa

 Degeneration of
rods
 Loss of peripheral
vision
External Limiting Membrane
 Outer Nuclear Layer
 The
outer nuclear layer contains cell
bodies of the rods and cones
 Outer Plexiform Layer
 The outer
plexiform
layer (OPL)
 Connections
between rod
and cones,
 and bipolar
cell dendrites
Inner Nuclear Layer

 Contains:
 Nuclei of bipolar cells
 MÜller cells (synthesize and store
glycogen)
 Amacrine cell bodies (act as
condensers, as in an electric circui
 Inner Plexiform Layer

 Relay station for the

bipolar cells, to connect
to ganglion cells.
 Amacrine cells also
interact in networks to
influence and integrate
ganglion cell signals
 Ganglion Cell Layer
 Ganglion cell
axons are fibers
that carry
electrical signal
to the optic
nerve
 Nerve Fiber Layer
 Located above the ganglion cell
layer
 Fibers radial to the optic nerve
 Distribution plays role in VF defect
patterns
 Major blood vessels embedded in
this layer
Nerve Fiber Pattern
Blood vessels in NFL

 Flame hemorrhage  located in NFL

 Internal Limiting Membrane

 Layer right next

to the vitreous.
 Forms a
diffusion barrier
between neural
retina and
vitreous humor.
Internal Limiting Membrane

 Wrinkling of the ILM can cause

distorted central VA
 ILM
 Standard surgery for  Membrane Peel
macular pucker or
macular hole repair
 Peeling away the ILM
with microsurgical
forceps.
 Time-sensitive delicate
and difficult operation
 ILM
 Fluidic Internal Limiting
 New technique Membrane Separation
 Removes the
abnormal macular
tissue and wrinkled
ILM
 Fluid pressure lifts
ILM and separates
tissue
 Also smoothes
underlying distorted
retinal layer
Recap of 10 layers
 Bruch’s membrane is between the
RPE and choroid
 RPE responsible for absorbing
excess light so that the
photoreceptors can give a clearer
signal
 Rods and cones convert light into
electrical signals
 Recap of 10 layers
 Nuclear layers and plexiform layers
internal circuits in the retina: transmit
info to other neurons
 Gangion cell layer final retinal station
 Nerve fiber layer ganglion axons form
the optic nerve
 Internal limiting membrane diffusion
barrier between neural retina and
vitreous humor.
Neovascularization

 neovasc  New blood

vessels
Blood in front of retina