There can be many reasons for vision impairment. Experts name a variety of eye diseases. Retinal degeneration (dystrophy) is a very common cause of vision impairment. The retina lacks sensory nerve endings. Because of this, diseases can be painless.

Definition

Retinal degeneration most often affects older people. Retinal disease in a child is very rare. It manifests itself in the form of pigmented and dotted white degeneration, in the form of a macula (Best's disease). These types of diseases are congenital and hereditary.

As we age, changes occur in the retina of the eye. Various waste products can be deposited between the membrane of the eye and the choroid. They begin to accumulate, and as a result, yellow or white “garbage” is formed - drusen.

During degeneration, the most important cells begin to die. This disease is called “yellow spot”.

Treatment with folk remedies

Retinal degeneration can be similar to various other abnormalities in the body. Drug treatment cannot be ignored. Traditional medicine is an auxiliary element that consolidates treatment.

You definitely need to diversify your diet. Eat more seaweed, cinnamon and honey.

1. Mix water and goat milk in equal proportions. This solution should be dripped into the eyes, two to three drops per day. Cover your eyes with a tight bandage and rest for a few minutes. You cannot move your eyes or open them.
2. Prepare the next drink. Pine needles - five tablespoons, dried rose hips - two tablespoons, onion peels - two tablespoons. Mix the whole mixture well and grind. Pour a liter of water and boil over heat for no more than 15 minutes. The broth is filtered and infused for another day. Use for a month half an hour before meals.
3. Take five tablespoons of nettle, one tablespoon of lily of the valley. Pour one glass of water and leave for ten hours in a dark place. Then add a teaspoon of soda and make a compress for the eyes from the resulting broth.

Prevention

All forms are caused either by diseases of the organs of vision or the body as a whole. Most often, people who have moderate or high myopia suffer. It is impossible to prevent the disease, but it can be detected and controlled in time.

Prevention means that you need to be examined by an ophthalmologist twice a year.

It is advisable not to smoke, abuse alcohol or take various medications. Eat right, and the best thing is to add more vitamins to your diet.

• Vitamin A. These are carrots, sunflower seeds, potatoes, seafood, fish liver.
• Thiamine, vitamin Bi. This includes brewer's yeast, honey, green peas, nuts, and wheat.
• Vitamin C, ascorbic acid. These are leafy vegetables, bell peppers, spinach, black currants.
• Potassium (honey and vinegar).
• Vitamin B12. Beets, blueberries, parsley, apricots, prunes, dates.

Macular retinal degeneration

There are two forms of macular degeneration:

1. Astrophic.
2. Exudative.

These two forms differ from each other in that during exudative degeneration, cells begin to exfoliate due to fluid coming from the vessels. Cells detach from the underlying membranes, and hemorrhage may eventually occur. Swelling may form at the site.

In the astrophic form, the “yellow spot” is affected by pigment. There is no scarring, swelling or fluid. In this case, both eyes are always affected.

Signs

With macular degeneration of the retina, vision gradually deteriorates and decreases. The disease is painless, so it is very difficult to detect the disease at an early stage. But when one eye is affected, the main symptom is seeing thin lines wavy. There are times when vision decreases sharply, but does not lead to complete blindness.

If there is any distortion of straight lines, you should immediately consult a doctor. Other symptoms include blurred vision and trouble reading books, newspapers, etc.

Reasons

The main reason is old age. After 50 years, the risk of developing this disease increases several times; by the age of 75, a third of older people suffer from retinal degeneration.

The second reason is the hereditary line. An interesting fact is that dark-skinned people suffer from the disease less often than Europeans.

The third reason is the lack (deficiency) of vitamins and microelements. For example, vitamins C, E, lutein carotenoids, zinc and antioxidants.

Diagnosis and treatment

It is impossible to independently identify the disease at an early stage. The disease can only be detected by regularly visiting an ophthalmologist. The doctor will conduct an examination and identify any changes that are starting to occur. This is the only way to prevent the development of macular degeneration of the retina.

Modern medicine does not have many ways to treat this disease, but if the deviations were replaced at an early stage, then laser correction can be done. If the cataract matures, doctors replace the lens.

Age-related macular degeneration

This disease is most common in older people. The Caucasian population is especially affected.

• The causes of AMD are as follows:
• genetic predisposition;
• smoking;
• age;
• obesity;
• cardiovascular diseases;
• anamnesis;
• hypertension;
• low intake of fatty acids and green leafy vegetables.

There are two forms of the disease. The most common is dry. Non-exudative and astrophic. Any AMD disease begins with it. The dry form affects about 85 percent of people.

In the dry form, changes occur in the pigment epithelium, where the lesions appear as dark dots. The epithelium performs a very important function. It maintains the normal condition and functioning of cones and rods. The accumulation of various waste products from rods and cones leads to the formation of yellow spots. In case of advanced disease, chorioretinal atrophy occurs.

Read also: – a disease that affects the central part of the retina – the macula.

The second form is wet. These are neovascular and exudative. About 25 percent of people develop this disease. With this form, a disease called choroidal neovascularization begins to develop. This is when new abnormal blood vessels develop under the retina. Hemorrhage or swelling of the optic nerve can lead to retinal pigment epithelial detachment. If the disease is not treated for a long time, a disc-shaped scar will form under the macula.

Diagnostics

Specialists use one of the diagnostic methods:

1. Ophthalmoscopy. Allows you to identify both forms of the disease. An Amsler grid is used.
2. Color fundus photography and fluorescein angiography. If doctors suspect a wet form of the disease, then these two diagnostics are performed. Angiography reveals choroidal neovascularization and geographic atrophy.
3. Optical coherence tomography. Helps evaluate the effectiveness of therapy and identify intraretinal or subretinal fluid at an early stage.

Treatment

1. For dry AMD or the unilateral wet form, special nutritional supplements are needed.
2. Anti-VEGF medications.
3. For the wet form, laser treatment is used.
4. Various supportive measures.

Peripheral degeneration

Peripheral retinal degeneration is a common disease in modern medicine. From 1991 to 2010, the number of cases increased by 19%. The probability of development with normal vision is 4%. The disease can manifest at any age.

If we touch on the topic of peripheral degeneration, then this is a more dangerous phenomenon. After all, it is asymptomatic.

Diagnosing peripheral disease can be difficult because... changes in the fundus are not always pronounced. It is difficult to examine the area in front of the equator of the eye. This type very often leads to retinal detachment.

Reasons

Peripheral degeneration develops in people suffering from myopic or hyperopic refraction. People who suffer from myopia are especially at risk. There are also other causes of the disease:

1. Traumatic injuries. For example, severe traumatic brain injury or damage to the bone walls of the orbit.
2. Impaired blood supply. Changes in blood flow can lead to trophic disorders and thinning of the inner lining of the eyeball.
3. Various inflammatory diseases.
4. Iatrogenic influence. Changes occur in the inner lining of the eye. This happens after vitreoretinal surgery or when the effect of laser coagulation has been exceeded.

Who is at risk?

People who suffer from myopia are most susceptible to the disease. In myopic people, the retina becomes thin and stretched. This leads to dystrophy.

This may include older people, especially those over 65 years of age. At this age, the main reason for a sharp decrease in vision is peripheral dystrophy.

The following persons also fall into this group:

• Suffering from diabetes.
• Atherosclerosis.
• Arterial hypertension.

Classification

Experts classify pathology into several types. These are ethmoid, frost-like and racemose. Some variations may resemble a “snail trail” or a “cobblestone street.”

Forms of the disease:

1. Peripheral vitreochorioretinal (PVCRD). It is characterized by damage to the vitreous body, retina and choroid.
2. Peripheral chorioretinal (PCRD). Pathologies of the retina and choroid.

Vitreochorioretinal dystrophy is divided by location:

1. Equatorial. The most common phenomenon of retinal damage.
2. Paraoral. Dystrophic changes occur at the dentate line.
3. Mixed. The shape is associated with the greatest risk of rupture due to the presence of diffuse changes throughout the retinal surface.

Diagnostics

During a routine fundus examination, the peripheral area is inaccessible. In most cases, diagnosis of this area is possible only with the maximum possible medicinal dilation of the pupil; a three-mirror Goldmann lens is used for examination.

In order to identify the disease and prescribe treatment, the patient may undergo the following studies:

1. Ophthalmoscopy. In this case, studies are carried out on the optic nerve head, retina and choroid. Here, rays of light are used that are reflected from the structures of the fundus. There are two types of ophthalmoscopy: direct and reverse.
2. Perimetry. This method will help identify concentric narrowing of the visual fields. If the doctor detects the onset of the disease, the patient will be prescribed quantitative perimetry.
3. Visometry. It is considered the simplest way to determine visual acuity. It is carried out everywhere: in various educational institutions, in the army, during examinations for ophthalmological diseases, etc.
4. Refractometry. One of the modern methods where medical equipment is used is a refractometer. At the moment, there is improved equipment - a computer automatic refractometer. With the help of such a study, the development of refractive errors is detected, as well as to diagnose myopia, farsightedness or astigmatism.
5. . Allows you to detect pathologies at the earliest stages. Ultrasound is used to diagnose changes in the vitreous body and assess the size of the longitudinal axis of the eye.

Treatment

Before prescribing treatment, the specialist assesses the nature of the pathology. To eliminate the disease use:

1. Conservative therapy. Treatment uses medications from the groups of antiplatelet agents, angioprotectors, and antihypoxants. Bioactive additives, vitamins C and B are also used here.
2. Surgical intervention. The treatment uses laser coagulation of blood vessels in areas of increased thinning. The operation is performed on an outpatient basis. After surgery, conservative therapy is prescribed, including taking various medications.

Retinal pigmentary degeneration

Pigmentary degeneration (abiotrophy) is a hereditary disease of the inner lining of the eye. The retinal rods begin to deteriorate. This disease is very rare. If a person falls ill and does not take any action, then blindness occurs.

The disease was described in 1857 by D. Donders and called “retinitis pigmentosa.” And five years later, a hereditary disease was discovered.

Reasons

The most sensitive area of ​​the eyes is made up of cells. These are rods and cones. They are so called because their appearance resembles this shape. The cones are located in the central part. They are responsible for acute and color vision. The rods took up all the space, filling the retina. They are responsible for, as well as for visual acuity in poor lighting.

When individual genes that are responsible for the nutrition and functioning of the eye are damaged, the outer layer of the retina is destroyed. It all starts in the periphery and over a few years spreads throughout the retina.

At an early stage, both eyes are affected. The first signs are visible in childhood, the main thing is to consult a doctor in time. If the disease is not treated, then by the age of twenty, patients lose their ability to work.

There are other developments of the disease: only one eye, a separate sector of the retina, is affected, or a later disease occurs. Such people are at risk of developing glaucoma, cataracts, and swelling of the central retina.

Symptoms

Hemeralopia or otherwise “night blindness”. Occurs due to damage to the retinal rods. People who suffer from this disease have difficulty navigating in places with poor lighting. If a person notices that he can’t navigate well in the dark, then this is the first sign of the disease.

The progression of the disease begins with damage to the retinal rods. It starts from the periphery and gradually approaches the central part. In the later stages, the patient's sharp and color vision decreases. This happens because the central cones are affected. If the disease progresses, complete blindness may occur.

Diagnostics

The disease can be detected only in the earliest stages and only at a young age. The disease can be detected if the child begins to have trouble finding his way at night or in the twilight.

The doctor examines your vision for visual acuity and light reaction. An examination of the fundus of the eye takes place, since this is where the retinal changes occur. The diagnosis is also clarified using electrophysiological studies. This method will help to better assess the functioning of the retina. Doctors evaluate dark adaptation and orientation in a dark room.

If a diagnosis has been established or suspicions have been identified, then it is necessary to examine the patient’s relatives.

Treatment

To stop the progression of the disease, the patient is prescribed various vitamins and medications. They help improve blood supply and provide nutrition to the retina.

The following drugs are used by injection:

• Mildronate.
• Emoxilin.

The following medications are prescribed in the form of drops:

• Taufon.
• Emoxilin.

To stop the development of pathology, doctors use physiotherapeutic methods. The most effective device used at home is Sidorenko glasses.

Science is developing, and news is emerging about new treatment methods. For example, this includes gene therapy. It helps restore damaged genes. In addition, there are electronic implants that help blind people move freely and navigate in space.

In some patients, the progression of the disease can be slowed. For this purpose, vitamin A is used weekly. People who have completely lost their vision restore their visual sense with the help of a computer chip.

Before starting treatment, you need to consider the cost, as well as the reputation of the medical center. The most important thing is to pay attention to the work of specialists and their training. Familiarize yourself with local equipment and medical personnel. All these steps will help you achieve a good result.

Conclusion

It is impossible to get rid of the disease once and for all. It is only possible to identify it in time and slow down its development and progression. The prognosis for a full recovery is not the most pleasant, so the disease must be blocked in the early stages. And to preserve your vision, you need to be examined by a doctor every year and take preventive measures.

The retina is responsible for sensing light and converting it into electrical impulses that are sent to the brain. This is a very sensitive part of the visual apparatus.

As a result of negative influences, certain parts of it become thinner and even tear. Ophthalmological pathologies in which the retinal membrane changes and “wears out” is called peripheral retinal dystrophy.

There are types of dystrophy, the development of which is due to hereditary predisposition. Some are formed under the influence of external factors. It is important to note that the risk group includes people with diabetes mellitus, and also those suffering from myopia (less commonly, farsightedness).

The following can trigger the development of the disease:

• Severe poisoning
• Inflammatory process in the eyes
• Injuries (craniocerebral, visual organs)
• Complications after surgery
• High blood pressure (hypertension)
• Vascular pathologies
• Acute viral infections
• Chronic vitamin deficiency
• Alcohol and smoking abuse.
• Sunburn

The chance of vision impairment due to retinal dystrophy is the same for men and women, and increases with age. Why is this so? To answer this question, you need to understand where the disease begins.

Pathogenesis

The vessels responsible for feeding the retina are extremely thin and fragile. As the blood ages, and with it oxygen and nutrients, it becomes increasingly difficult to reach its target. The peripheral parts of the retina, in the absence of normal trophism, are the first to suffer. Tissues become thinner, photoreceptors are destroyed.

And if at the beginning of the development of pathology, the symptoms are subtle and practically do not bother the person, then in the later stages there is a risk of complete and irreversible loss of vision. This occurs when the deformed areas are torn. Blindness also occurs as a result of retinal detachment.

Classification

Having studied how common the lesions are, a specialist can make a diagnosis:

• Peripheral chorioretinal dystrophy, if only the retinal tissue and choroid are changed.
• Peripheral vitreochorioretinal dystrophy of the retina, if the pathology also affects the vitreous body.

For convenience, diagnoses are written down abbreviated as abbreviations – phrd and pvkhrd, respectively.
How quickly the disease progresses, as well as the prognosis for treatment, depends on its type. The names are mainly based on how the shell damage appears when examined.

Each type of disease has its own characteristics and needs to be carefully studied. Here are the main ones:

Lattice retinal dystrophy

Damaged vessels intersect and form something like a mesh (or lattice). At the same time, their tint is white, because... blood no longer flows through them. This pathology is common among peripheral dystrophies and the most dangerous.

Degenerative processes occur between damaged vessels in tissues, which leads to ruptures. There is also a high risk of cysts forming in these places. Another unfavorable prognosis is retinal detachment. The only thing that can somehow console me is that the disease comes very slowly.

Interestingly, this type of pathology is dangerous mainly for the male part of the population. Representatives of the fairer sex suffer from PD much less frequently. From this we can conclude about the importance of the genetic factor.

Dystrophy of the “snail traces” type

Patients with myopia most often suffer from this pathology. The fact is that with myopia (especially pronounced) the configuration of the retina changes, it takes on an elongated shape.

Because the tissue of the shell is stretched too much, damage occurs in some places. As a rule, they are located in one line and are characterized by small holes and whitish, glittering marks. During the examination, it all looks as if a snail crawled across the retina and left a trail behind it. Hence the name.

Despite the harmless name, the disease is dangerous due to large ruptures of the retina, after which it is almost impossible to restore vision.

Frost-like retinal dystrophy

The disease progresses quite slowly. Basically does not cause ruptures and detachments. It is transmitted through hereditary lines, and gender does not matter. A plaque forms on the retina, in the form of flakes, reminiscent of either snow or frost. The color of the discharge is yellow and white. Unfortunately, both eyes are affected.

Cobblestone dystrophy

typical for older people and patients suffering from myopia. The most “harmless” pathology. It does not cause catastrophic consequences and develops slowly. The depleted areas are located far from the center of the retina, and have almost no effect on visual acuity. At the same time, the damaged segment looks as if someone decided to pave it and laid it with cobblestones.

Small cystic retinal dystrophy

From the name it is clear that in this disease, small cysts form on the periphery of the fundus of the eye. They often combine into larger ones. The disease develops slowly and can be successfully treated. The main thing for patients is to avoid falls and injuries so that the cysts do not break off and leave behind damage in the form of holes.

Pediatric Leber's taperetinal amaurosis

The disease is congenital, caused by a gene mutation. Appears at an early age. Photoreceptors (cones and rods) die. The field of vision narrows and complete blindness gradually sets in. Since the disease is genetic, it is extremely difficult to treat.

X - chromosomal juvenile retinoschisis

The pathology is transmitted along the hereditary line. Under its influence, the retina stratifies, and large cysts form between the layers. Degenerative damage also extends to the central part of the retina. Retinoschisis can also be acquired. There is a danger of getting sick in older people and people with myopia.

At-risk groups

Almost anyone can develop retinal dystrophy (acquired form) under the influence of destructive factors. However, there are people who need to be especially attentive to their eye health and should be periodically checked for the presence of degenerative processes. These people include:

• Patients with diabetes mellitus. The vessels in these patients are fragile not only in the eyes, but throughout the body. Weak vessels in the retina often break and hemorrhage occurs. In addition, as a result of poor blood flow, the nutrition of the retina is disrupted, which leads to its thinness ruptures. Blindness is unfortunately a common complication among diabetics.
• Pregnant women. Hormonal surges and a lack of vitamins (all resources go towards the development of the baby) lead to the fact that the right amount of nutrients does not reach the eyes. The result is retinal dystrophy. If a pathology is detected, natural childbirth is contraindicated for a woman. Of course, most women carry a child without any visual complications, but it’s still worth visiting an ophthalmologist once again.
• Patients with myopia. This is due to the elongated shape of the eye as a result of the disease.
• Hypertensive patients and other people suffering from vascular pathology.
• Persons over 60 years of age because their metabolism deteriorates.

Just because a person is at risk does not mean that the disease will definitely develop. It all depends on lifestyle and how it controls the course of the underlying disease. Thus, it is very important for diabetics to keep their blood sugar levels under control.

Symptoms of peripheral retinal dystrophy

Due to the fact that the pathology affects not the central part of the retina, but its periphery, the patient is unaware of the presence of a problem for a long time. It happens that the disease is discovered by chance, during an examination by an ophthalmologist.

Sometimes a bright flash of light, lightning or a spot appears before a person’s eyes. All this indicates a retinal rupture or hemorrhage into it. This phenomenon cannot be ignored. You need to urgently seek help.

Later, the field of view narrows. Those. the patient sees normally in the center, but to see, for example, what is happening a little to the left, he will have to turn his head. The image quality also decreases in low light (in the evening and morning, during twilight).

Often, as the disease progresses, the patient sees a dark outline around objects. If all this is not treated, as a result of complications, vision decreases and the person gradually goes blind.

Complications

As mentioned above, the worst thing with retinal retinal retina is its detachment and the formation of tears. There is no pain during this. In case of detachment, a person begins to see everything through a veil (curtain, blind).

When there are ruptures, the damaged area stops responding to incoming information. When there are 1-2 ruptures, it may seem that nothing terrible happened. But when there are many of them, vision gradually decreases and blindness occurs.

Diagnostic tests

If the ophthalmologist suspects that a patient has peripheral retinal dystrophy, he will definitely prescribe drops to dilate the pupils. After which, he will examine the fundus of the eye using a Goldmann lens. The procedure is called ophthalmoscopy.

Due to the fact that the damaged areas of the cornea are located far from its center, it is sometimes extremely difficult to examine them. Sometimes it becomes necessary to use scleroscopy. The doctor tries to bring the peripheral areas closer to the center by pressing the sclera. Another common research method for this problem is ultrasound.

Perimetry is used to detect problems with peripheral vision. By the way the field of perception is narrowed, the location of dystrophy can be diagnosed.

Principles of treatment

At the moment, a complete treatment for retinal dystrophy, which can lead to a cure, has not yet been found. But there are methods that slow down the course of the disease and allow you to maintain visual acuity for a long time.

Conservative treatment methods consist of taking medications aimed at:

• Blood thinning. This helps improve the nutrition of the eye and avoid the formation of blood clots. The simplest and most common drug is aspirin. Its use is also useful for older patients, for the prevention of blockages of veins and heart problems.
• Strengthening blood vessels and relieving spasms. Prescribed to avoid hemorrhages and ruptures. Similar drugs are also used for the prevention of strokes and during the rehabilitation period. The most common medications are vimpatsetin and actoverine.
• Supplying the retina with nutrition. There are special vitamins for this. Also, for this purpose, Taufon drops are prescribed,
• Resorption of the consequences of hemorrhages. For example, heparin, aminocaproic acid, etc.

Surgical methods

The main method is laser coagulation. The choroid is, as it were, welded to the retina. The operation helps to avoid detachment and ruptures. It will not restore vision, but will keep it at the same level for many years.

Sometimes, through surgery, special medications are injected into the eye to help improve the nutrition of the retina. According to clinical data, such manipulation can improve vision for a while. It also slows down the development of dystrophy. The procedure is performed under local anesthesia and does not require a long stay in the clinic after it is performed.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

The retina is a specific structural and functional unit of the eyeball, necessary for capturing the image of the surrounding space and transmitting it to the brain. From an anatomical point of view, the retina is a thin layer of nerve cells thanks to which a person sees, since it is on them that the image is projected and transmitted along the optic nerve to the brain, where the “picture” is processed. The retina of the eye is formed by light-sensitive cells, which are called photoreceptors, since they are able to capture all the details of the surrounding “picture” that appears in the field of vision.

Depending on which area of ​​the retina is affected, they are divided into three large groups:
1. Generalized retinal dystrophies;
2. Central retinal dystrophies;
3. Peripheral retinal dystrophies.

With central dystrophy, only the central part of the entire retina of the eye is affected. Since this central part of the retina is called macula, then the term is often used to denote dystrophy of the corresponding localization macular. Therefore, a synonym for the term “central retinal dystrophy” is the concept of “macular retinal dystrophy”.

In peripheral dystrophy, the edges of the retina are affected, while the central areas remain undamaged. With generalized retinal dystrophy, all parts of the retina are affected - both central and peripheral. A special case is age-related (senile) retinal dystrophy, which develops against the background of senile changes in the structure of microvessels. According to the location of the lesion, senile retinal dystrophy is central (macular).

Depending on the characteristics of tissue damage and the characteristics of the course of the disease, central, peripheral and generalized retinal dystrophies are divided into numerous varieties, which will be discussed separately.

Central retinal dystrophy - classification and brief description of varieties

Depending on the characteristics of the pathological process and the nature of the resulting damage, the following types of central retinal dystrophy are distinguished:

• Stargardt's macular dystrophy;
• Yellow-spotted fundus (Franceschetti's disease);
• Best's vitelline (vitelliform) macular degeneration;
• Congenital cone retinal dystrophy;
• Colloid retinal dystrophy Doina;
• Age-related retinal degeneration (dry or wet macular degeneration);
• Central serous choriopathy.

Among the listed types of central retinal dystrophy, the most common are age-related macular degeneration and central serous choriopathy, which are acquired diseases. All other types of central retinal dystrophies are hereditary. Let us consider brief characteristics of the most common forms of central retinal dystrophy.

Central chorioretinal retinal dystrophy

Central chorioretinal dystrophy of the retina (central serous choriopathy) develops in men over 20 years of age. The reason for the formation of dystrophy is the accumulation of effusion from the vessels of the eye directly under the retina. This effusion interferes with normal nutrition and metabolism in the retina, resulting in its gradual degeneration. In addition, the effusion gradually detaches the retina of the eye, which is a very serious complication of the disease that can lead to complete loss of vision.

Due to the presence of effusion under the retina, a characteristic symptom of this dystrophy is a decrease in visual acuity and the appearance of wave-like curvatures of the image, as if a person is looking through a layer of water.

Macular (age-related) retinal degeneration

Macular (age-related) retinal degeneration can occur in two main clinical forms:
1. Dry (non-exudative) form;
2. Wet (exudative) form.

Both forms of macular degeneration of the retina develop in people over 50–60 years of age against the background of senile changes in the structure of the walls of microvessels. Against the background of age-related dystrophy, damage occurs to the vessels of the central part of the retina, the so-called macula, which provides high resolution, that is, allows a person to see and distinguish the smallest details of objects and the environment at close range. However, even with severe age-related dystrophy, complete blindness occurs extremely rarely, since the peripheral parts of the retina remain intact and allow a person to partially see. Preserved peripheral parts of the retina allow a person to navigate normally in his usual environment. In the most severe course of age-related retinal dystrophy, a person loses the ability to read and write.

Dry (non-exudative) age-related macular degeneration The retina of the eye is characterized by the accumulation of waste products of cells between the blood vessels and the retina itself. These waste products are not removed in a timely manner due to disruption of the structure and function of the microvessels of the eye. Waste products are chemicals that are deposited in the tissues under the retina and appear as small yellow bumps. These yellow tubercles are called Druze.

Dry retinal dystrophy accounts for up to 90% of cases of all macular degeneration and is a relatively benign form, since its course is slow, and therefore the decrease in visual acuity is also gradual. Non-exudative macular degeneration usually occurs in three successive stages:
1. The early stage of dry age-related macular degeneration of the retina is characterized by the presence of small drusen. At this stage, the person still sees well and is not bothered by any visual impairment;
2. The intermediate stage is characterized by the presence of either one large drusen or several small ones localized in the central part of the retina. These drusen reduce a person's field of vision, as a result of which he sometimes sees a spot in front of his eyes. The only symptom at this stage of age-related macular degeneration is the need for bright light for reading or writing;
3. The pronounced stage is characterized by the appearance of a spot in the field of vision, which is dark in color and large in size. This spot does not allow a person to see most of the surrounding image.

Wet macular degeneration of the retina occurs in 10% of cases and has an unfavorable prognosis, since against its background, firstly, there is a very high risk of developing retinal detachment, and secondly, vision loss occurs very quickly. With this form of dystrophy, new blood vessels, which are normally absent, begin to actively grow under the retina of the eye. These vessels have a structure that is not typical for the eye, and therefore their membrane is easily damaged, and fluid and blood begin to leak through it, accumulating under the retina. This effusion is called exudate. As a result, exudate accumulates under the retina, which puts pressure on it and gradually peels off. That is why wet macular degeneration is dangerous due to retinal detachment.

With wet macular degeneration of the retina, a sharp and unexpected decrease in visual acuity occurs. If treatment is not started immediately, complete blindness may occur due to retinal detachment.

Peripheral retinal dystrophy - classification and general characteristics of types

The peripheral part of the retina is usually not visible to the doctor during a standard fundus examination due to its location. To understand why the doctor does not see the peripheral parts of the retina, you need to imagine a ball through the center of which the equator is drawn. One half of the ball up to the equator is covered with a mesh. Further, if you look at this ball directly in the region of the pole, then parts of the grid located close to the equator will be poorly visible. The same thing happens in the eyeball, which also has the shape of a ball. That is, the doctor can clearly distinguish the central parts of the eyeball, but the peripheral ones, close to the conventional equator, are practically invisible to him. This is why peripheral retinal dystrophies are often diagnosed late.

Peripheral retinal dystrophies are often caused by changes in the length of the eye against the background of progressive myopia and deterioration of blood circulation in this area. As peripheral dystrophies progress, the retina becomes thinner, resulting in the formation of so-called tractions (areas of excessive tension). These tractions, when present for a long time, create the preconditions for a tear in the retina, through which the liquid part of the vitreous seeps under it, lifts it and gradually peels off.

Depending on the degree of danger of retinal detachment, as well as on the type of morphological changes, peripheral dystrophies are divided into the following types:

• Lattice retinal dystrophy;
• Retinal degeneration of the “snail traces” type;
• Frost-like degeneration of the retina;
• Cobblestone retinal degeneration;
• Small cystic degeneration of Blessin-Ivanov;
• Retinal pigmentary dystrophy;
• Pediatric Leber's taperetinal amaurosis;
• X-chromosomal juvenile retinoschisis.

Let's consider the general characteristics of each type of peripheral retinal dystrophy.

Lattice retinal dystrophy

Lattice retinal dystrophy occurs in 63% of cases of all types of peripheral dystrophy. This type of peripheral dystrophy provokes the highest risk of developing retinal detachment, and is therefore considered dangerous and has a poor prognosis.

Most often (in 2/3 of cases) lattice retinal dystrophy is detected in men over 20 years of age, which indicates its hereditary nature. Lattice dystrophy affects one or both eyes with approximately equal frequency and then progresses slowly and gradually throughout a person's life.

With lattice dystrophy, white, narrow, wavy stripes are visible on the fundus, forming lattices or rope ladders. These stripes are formed by collapsed and hyaline-filled blood vessels. Between the collapsed vessels, areas of thinning of the retina are formed, which have the characteristic appearance of pinkish or red lesions. In these areas of the thinned retina, cysts or tears can form, leading to detachment. The vitreous body in the area adjacent to the area of ​​the retina with dystrophic changes is liquefied. And at the edges of the area of ​​dystrophy, the vitreous body, on the contrary, is very tightly fused to the retina. Because of this, areas of excessive tension on the retina (traction) arise, where small tears are formed that look like valves. It is through these valves that the liquid part of the vitreous penetrates under the retina and provokes its detachment.

Peripheral retinal dystrophy of the “snail traces” type

Peripheral retinal dystrophy of the “snail trace” type develops in people suffering from progressive myopia. Dystrophy is characterized by the appearance of shiny streak-like inclusions and holey defects on the surface of the retina. Typically, all defects are located on the same line and, when examined, resemble a snail's footprint left on the asphalt. It is precisely because of the external resemblance to the track of a snail that this type of peripheral retinal dystrophy received its poetic and figurative name. With this type of dystrophy, breaks often form, leading to retinal detachment.

Frost-like retinal dystrophy

Frost-like retinal dystrophy is a hereditary disease that occurs in men and women. Usually both eyes are affected at the same time. Yellowish or whitish inclusions resembling snow flakes appear in the retinal area of ​​the eye. These inclusions are usually located in close proximity to thickened retinal vessels.

Retinal dystrophy "cobblestone"

Cobblestone retinal dystrophy usually affects the distant parts located directly in the equator of the eyeball. This type of dystrophy is characterized by the appearance on the retina of individual, white, elongated lesions with an uneven surface. Typically these lesions are located in a circle. Most often, cobblestone dystrophy develops in older people or in those suffering from myopia.

Small cystic retinal dystrophy Blessin–Ivanov

Blessin-Ivanov small cystic retinal dystrophy is characterized by the formation of small cysts located on the periphery of the fundus. In the area of ​​the cysts, holes may subsequently form, as well as areas of retinal detachment. This type of dystrophy has a slow course and a favorable prognosis.

Retinal pigmentary dystrophy

Retinal pigmentary dystrophy affects both eyes at once and manifests itself in childhood. Small foci of bony bodies appear on the retina, and the waxy pallor of the optic disc gradually increases. The disease progresses slowly, as a result of which a person’s field of vision gradually narrows, becoming tubular. In addition, vision deteriorates in the dark or twilight.

Pediatric Leber's taperetinal amaurosis

Pediatric Leber taperetinal amaurosis develops in a newborn child or at the age of 2–3 years. The child's vision deteriorates sharply, which is considered the beginning of the disease, after which it slowly progresses.

X-chromosomal juvenile retinoschisis

X-chromosomal juvenile retinoschisis is characterized by the development of retinal separation simultaneously in both eyes. Huge cysts form in the area of ​​the dissections, gradually filling with glial protein. Due to the deposition of glial protein, star-shaped folds or radial lines appear on the retina, resembling the spokes of a bicycle wheel.

Congenital retinal dystrophy

All congenital dystrophies are hereditary, that is, they are transmitted from parents to children. The following types of congenital dystrophies are currently known:
1. Generalized:

• Pigmentary dystrophy;
• Leber's amaurosis;
• Nyctalopia (lack of night vision);
• Cone dysfunction syndrome, in which color perception is impaired or complete color blindness is present (a person sees everything as gray or black and white).

2. Central:

• Stargardt's disease;
• Best's disease;
• Age-related macular degeneration.

3. Peripheral:

• X-chromosomal juvenile retinoschisis;
• Wagner's disease;
• Goldman-Favre disease.

The most common peripheral, central and generalized congenital retinal dystrophies are described in the relevant sections. The remaining variants of congenital dystrophies are extremely rare and are of no interest or practical significance for a wide range of readers and non-ophthalmologists, so it seems inappropriate to provide a detailed description of them.

Retinal dystrophy during pregnancy

During pregnancy, a woman’s body undergoes a significant change in blood circulation and an increase in metabolic rate in all organs and tissues, including the eyes. But in the second trimester of pregnancy there is a decrease in blood pressure, which reduces blood flow to the small vessels of the eyes. This, in turn, can provoke a deficiency of nutrients necessary for the normal functioning of the retina and other structures of the eye. And inadequate blood supply and deficiency of nutrient delivery is the cause of the development of retinal dystrophy. Thus, pregnant women have an increased risk of retinal dystrophy.

If a woman had any eye diseases before pregnancy, for example, myopia, hemeralopia and others, this significantly increases the risk of developing retinal dystrophy during pregnancy. Since various eye diseases are widespread in the population, the development of retinal dystrophy in pregnant women is not uncommon. It is precisely because of the risk of dystrophy with subsequent retinal detachment that gynecologists refer pregnant women for consultation with an ophthalmologist. And for the same reason, women suffering from myopia need permission from an ophthalmologist to give birth naturally. If the ophthalmologist considers the risk of fulminant dystrophy and retinal detachment during childbirth to be too high, he will recommend a cesarean section.

Retinal dystrophy - causes

Retinal dystrophy develops in 30–40% of cases in people suffering from myopia (myopia), in 6–8% against the background of hypermetropia (farsightedness), and in 2–3% with normal vision. The entire set of causative factors of retinal dystrophy can be divided into two large groups - local and general.

Local causative factors of retinal dystrophy include the following:

• Hereditary predisposition;
• Myopia of any severity;
• Inflammatory eye diseases;
• Previous eye surgeries.

Common causative factors for retinal dystrophy include the following:

• Hypertension;
• Diabetes mellitus;
• Past viral infections;
• Intoxication of any nature (poisoning with poisons, alcohol, tobacco, bacterial toxins, etc.);
• Increased blood cholesterol levels;
• Deficiency of vitamins and minerals entering the body with food;
• Chronic diseases (heart, thyroid, etc.);
• Age-related changes in the structure of blood vessels;
• Frequent exposure to direct sunlight on the eyes;
• White skin and blue eyes.

In principle, retinal dystrophy can be caused by any factors that disrupt normal metabolism and blood flow in the eyeball. In young people, the cause of dystrophy is most often severe myopia, and in older people it is age-related changes in the structure of blood vessels and existing chronic diseases.

Retinal dystrophy - symptoms and signs

At the initial stages, retinal dystrophy, as a rule, does not manifest itself with any clinical symptoms. Various signs of retinal dystrophies usually develop in the moderate or severe stages of the disease. With different types of retinal dystrophies, a person experiences approximately the same symptoms, such as:

• Decreased visual acuity in one or both eyes (the need for bright light for reading or writing is also a sign of decreased visual acuity);
• Narrowing of the field of view;
• The appearance of scotoma (a spot or sensation of a curtain, fog or obstruction in front of the eyes);
• A distorted, wave-like image before the eyes, as if a person is looking through a layer of water;
• Poor vision in darkness or twilight (nyctalopia);
• Impaired color discrimination (colors are perceived as different, not corresponding to reality, for example, blue is seen as green, etc.);
• Periodic appearance of “floaters” or flashes before the eyes;
• Metamorphopsia (incorrect perception of everything related to the shape, color and location in space of a real object);
• Inability to correctly distinguish a moving object from a stationary one.

If a person experiences any of the above symptoms, they should immediately consult a doctor for examination and treatment. You should not delay a visit to an ophthalmologist, since without treatment, dystrophy can quickly progress and provoke retinal detachment with complete loss of vision.

In addition to the listed clinical symptoms, retinal dystrophy is characterized by the following signs identified during objective examinations and various tests:
1. Distortion of lines on Amsler test. This test involves having a person look at a point located in the center of a grid drawn on a piece of paper with each eye in turn. First, the paper is placed at arm's length from the eye, and then slowly brought closer. If the lines are distorted, this is a sign of macular degeneration of the retina (see Figure 1);


Figure 1 – Amsler test. At the top right is a picture seen by a person with normal vision. At the top and bottom left is the image that a person sees with retinal dystrophy.
2. Characteristic changes in the fundus (for example, drusen, cysts, etc.).
3. Reduced electroretinography readings.

Retinal dystrophy - photo

This photograph shows retinal dystrophy of the “snail track” type.

This photograph shows retinal dystrophy of the “cobblestone” type.

This photograph shows dry age-related macular degeneration of the retina.

Retinal dystrophy - treatment

General principles of treatment of various types of retinal dystrophy

Since dystrophic changes in the retina cannot be eliminated, any treatment is aimed at stopping further progression of the disease and, in fact, is symptomatic. For the treatment of retinal dystrophies, drug, laser and surgical treatment methods are used to stop the progression of the disease and reduce the severity of clinical symptoms, thereby partially improving vision.

Drug therapy for retinal dystrophy involves the use of the following groups of drugs:
1. Antiplatelet agents– drugs that reduce thrombus formation in blood vessels (for example, Ticlopidine, Clopidogrel, acetylsalicylic acid). These drugs are taken orally in tablet form or administered intravenously;
2. Vasodilators And angioprotectors – drugs that dilate and strengthen blood vessels (for example, No-shpa, Papaverine, Ascorutin, Complamin, etc.). The drugs are taken orally or administered intravenously;
3. Lipid-lowering drugs – drugs that lower blood cholesterol levels, for example, Methionine, Simvastatin, Atorvastatin, etc. The drugs are used only in people suffering from atherosclerosis;
4. Vitamin complexes , which contain elements important for the normal functioning of the eyes, for example, Okyuvit-lutein, Blueberry-forte, etc.;
5. B vitamins ;
6. Drugs that improve microcirculation , for example, Pentoxifylline. Typically, drugs are injected directly into the structures of the eye;
7. Polypeptides, obtained from the retina of cattle (the drug Retinolamine). The drug is injected into the structures of the eye;
8. Eye drops containing vitamins and biological substances that promote repair and improve metabolism, for example, Taufon, Emoxipin, Ophthalm-Katachrome, etc.;
9. Lucentis– a remedy that prevents the growth of pathological blood vessels. Used for the treatment of age-related macular degeneration of the retina.

The medications listed above are taken in courses, several times (at least twice) throughout the year.

In addition, for wet macular degeneration, Dexamethasone is injected into the eye, and Furosemide is administered intravenously. When hemorrhages develop in the eye, heparin, Etamsylate, aminocaproic acid or Prourokinase are administered intravenously in order to quickly resolve and stop it. To relieve swelling in any form of retinal dystrophy, Triamcinolone is injected directly into the eye.

The following physiotherapy methods are also used in courses for the treatment of retinal dystrophies:

• Electrophoresis with heparin, No-shpa and nicotinic acid;
• Photostimulation of the retina;
• Stimulation of the retina with low-energy laser radiation;
• Electrical stimulation of the retina;
• Intravenous laser blood irradiation (ILBI).

If there are indications, then surgical operations are performed to treat retinal dystrophy:

• Laser coagulation of the retina;
• Vitrectomy;
• Vaso-reconstructive operations (crossing the superficial temporal artery);
• Revascularization operations.

Approaches to the treatment of macular degeneration of the retina

First of all, complex drug treatment is necessary, which consists of a course of taking vasodilators (for example, No-shpa, Papaverine, etc.), angioprotectors (Ascorutin, Actovegin, Vazonit, etc.), antiplatelet agents (Aspirin, Thrombostop, etc.) and vitamins A, E and group B. Typically, courses of treatment with these groups of drugs are carried out several times during the year (at least twice). Regular courses of drug treatment can significantly reduce or completely stop the progression of macular degeneration, thereby preserving a person’s vision.

If macular degeneration is in a more severe stage, then along with drug treatment, physiotherapy methods are used, such as:

• Magnetic stimulation of the retina;
• Retinal photostimulation;
• Laser stimulation of the retina;
• Electrical stimulation of the retina;
• Intravenous laser blood irradiation (ILBI);
• Surgeries to restore normal blood flow in the retina.

The listed physiotherapeutic procedures, along with drug treatment, are carried out in courses several times a year. The specific method of physiotherapy is selected by an ophthalmologist depending on the specific situation, type and course of the disease.

If a person has wet dystrophy, then first of all laser coagulation of sprouting, abnormal vessels is performed. During this procedure, a laser beam is directed to the affected areas of the retina, and under the influence of its powerful energy, blood vessels are sealed. As a result, fluid and blood stops sweating under the retina and peeling it off, which stops the progression of the disease. Laser coagulation of blood vessels is a short-term and completely painless procedure that can be performed in a clinic.

After laser coagulation, it is necessary to take drugs from the group of angiogenesis inhibitors, for example, Lucentis, which will inhibit the active growth of new, abnormal vessels, thereby stopping the progression of wet retinal macular degeneration. Lucentis should be taken continuously, and other medications should be taken in courses several times a year, as with dry macular degeneration.

Principles of treatment of peripheral retinal dystrophy

The principles of treatment of peripheral retinal dystrophy consist in carrying out the necessary surgical interventions (primarily laser coagulation of blood vessels and delimiting the zone of dystrophy), as well as subsequent regular courses of medication and physiotherapy. If you have peripheral retinal dystrophy, you must completely stop smoking and wear sunglasses.

Retinal dystrophy - laser treatment

Laser therapy is widely used in the treatment of various types of dystrophies, since a directed laser beam with enormous energy allows it to effectively affect the affected areas without affecting the normal parts of the retina. Laser treatment is not a homogeneous concept that includes only one operation or intervention. On the contrary, laser treatment of dystrophy is a combination of various therapeutic techniques that are carried out using a laser.

Examples of therapeutic treatment of dystrophy with a laser are retinal stimulation, during which the affected areas are irradiated in order to activate metabolic processes in them. Laser stimulation of the retina in most cases gives an excellent effect and allows you to stop the progression of the disease for a long time. An example of surgical laser treatment for dystrophy is coagulation of blood vessels or delimitation of the affected area of ​​the retina. In this case, the laser beam is directed to the affected areas of the retina and, under the influence of the released thermal energy, literally glues and seals the tissue and, thereby, delimits the treated area. As a result, the area of ​​the retina affected by dystrophy is isolated from other parts, which also makes it possible to stop the progression of the disease.

Retinal dystrophy - surgical treatment (operation)

Surgeries are performed only in severe cases of dystrophy, when laser therapy and drug treatment are ineffective. All operations performed for retinal dystrophies are conventionally divided into two categories - revascularization and vasoreconstruction. Revascularization operations are a type of surgery during which the doctor destroys abnormal vessels and opens normal ones as much as possible. Vasoreconstruction is an operation during which the normal microvascular bed of the eye is restored using grafts. All operations are performed in a hospital setting by experienced doctors.

Vitamins for retinal dystrophy

In case of retinal dystrophy, it is necessary to take vitamins A, E and group B, since they ensure the normal functioning of the organ of vision. These vitamins improve the nutrition of eye tissue and, with long-term use, help stop the progression of dystrophic changes in the retina.

Vitamins for retinal dystrophy must be taken in two forms - in special tablets or multivitamin complexes, as well as in the form of food products rich in them. Fresh vegetables and fruits, cereals, nuts, etc. are richest in vitamins A, E and group B. Therefore, these products must be consumed by people suffering from retinal dystrophy, since they are sources of vitamins that improve the nutrition and functioning of the eyes.

Prevention of retinal dystrophy

Prevention of retinal dystrophy consists of following simple rules:

• Do not overstrain your eyes, always give them rest;
• Do not work without eye protection from various harmful radiation;
• Do eye exercises;
• Eat well, including fresh vegetables and fruits in your diet, as they contain large amounts of vitamins and microelements necessary for the normal functioning of the eye;
• Take vitamins A, E and group B;
• Take zinc supplements.

The best prevention of retinal dystrophy is proper nutrition, since it is fresh vegetables and fruits that provide the human body with the necessary vitamins and minerals that ensure the normal functioning and health of the eyes. Therefore, include fresh vegetables and fruits in your diet every day, and this will be a reliable prevention of retinal dystrophy.

Retinal dystrophy - folk remedies

Alternative treatment for retinal dystrophy can only be used in combination with traditional medicine methods, since this disease is very serious. Traditional methods of treating retinal dystrophy include the preparation and use of various vitamin mixtures, which provide the visual organ with the vitamins and microelements it needs, thereby improving its nutrition and inhibiting the progression of the disease.
Before use, you should consult a specialist. 1107 08/02/2019 4 min.

Peripheral retinal dystrophy is one of the rare but quite dangerous diseases. If an illness occurs, the lack of timely medical care can lead to disastrous consequences, but proper treatment will help preserve vision. In addition, the problem can be difficult to diagnose and its analysis usually takes quite a long time.

Definition of disease

Peripheral retinal dystrophy usually refers to an eye disease (most often of a hereditary nature), the development of which is accompanied by processes of tissue destruction with subsequent deterioration of vision. In advanced stages, complete loss of vision is likely without the possibility of recovery (the same outcome is possible if ignored for a long time).

According to official statistics, up to forty percent of people with farsightedness and up to eight percent with myopia suffer from the disease.

For people with diseases of the visual organs, prevention and periodic examination are recommended for the possibility of acquiring retinal dystrophy.

The following forms of the disease are distinguished:

• Lattice. It is characterized by the appearance of white stripes, deterioration of blood circulation in the blood vessels of the eye and the formation of cysts. Often occurs against the background of retinal detachment.
• Retinoschisis. Characterized by retinal dissection, most often observed with the development of myopia. In most cases it is hereditary.
• Frost-like. It is characterized by the appearance of frost-like white inclusions on the front surface of the eye. Passed on by inheritance.
• With changes in the form of a snail trail. When the disease occurs, the appearance of perforated pathologies resembling a snail trail is observed. Often accompanied by tissue ruptures.
• With changes in the form of cobblestones. With the disease, pathologies in the form of oblong rings are observed, and pieces of pigment may be separated. Often diagnosed with myopia.
• Small cystic. Characterized by the appearance of a large number of red small cysts.

Causes

The disease can occur in people of any age and category. Among the most common causes of its occurrence are:

• Heredity (if relatives suffered from this type of problem);
• Traumatic brain injuries, eye damage;
• (less often – myopia);
• Injuries associated with excessive physical activity;
• Diabetes mellitus;
• Atherosclerosis;
• Cardiovascular diseases;
• Chronic diseases;
• Diabetes mellitus;
• Impaired blood supply to the organs of vision;
• Intoxication of the body.

The problem can also be caused by accumulated waste products in the body. Rarely, the disease develops during pregnancy.

Symptoms

In the first stages of the disease, most often there are no signs of its development. Most symptoms (with the exception of visible ones) are the same for each type of retinal dystrophy:

• (not always symmetrical);
• Veil, fog before the eyes;
• Incorrect perception of the shapes of objects in the surrounding reality;
• Fatigue, constant eye fatigue.

Sometimes symptoms can occur simultaneously, or they can occur separately or in sequence.

If abnormal fatigue of the visual organs occurs, it is recommended to consult an ophthalmologist for diagnosis for the development of retinal dystrophy.

Possible complications

If the disease is diagnosed early, its progression is stopped with treatment. The quality of the results of the intervention depends on the stage of development of dystrophy. In the absence of proper treatment, important tissues of the eye may be destroyed, complete or partial loss of vision (as happens during which we will look at next time) without the possibility of recovery. Retinal detachment is also possible.

Treatment

Currently, there are several methods. Their choice depends on the type and stage of the problem.

By medication

Treatment of the disease with medications gives positive results only in the early stages and in combination with other methods. Among the main drugs for procedures are:

• Vasoconstrictors;
• Angioprotectors;
• Means for strengthening blood vessels;
• Vitamin complexes.

Surgically

As a rule, surgical operations are indicated to improve blood supply and metabolism. However, the following procedures are most often carried out: Traditional methods will help prevent the irreversible consequences of peripheral dystrophy and improve the condition of the visual organs in general. However, they are recommended to be used only after consulting an ophthalmologist and as a complement to medical methods.

An infusion of Japanese sophora is used as such an additional remedy. Five grams of sophora are mixed with half a liter of vodka and infused for three months. Use one teaspoon three times a day, after mixing with a small amount of water.

Prevention

The main preventive method for peripheral retinal dystrophy is periodic examination by an ophthalmologist. For those who have vision problems and frequent diseases of the visual organs, constant monitoring by a doctor is especially important. In addition, a healthy lifestyle, supporting the immune system and taking vitamin complexes are useful.

Video

Conclusions

Peripheral is a rare but dangerous disease for health and vision. It is difficult to diagnose and cannot always be treated with complete recovery. However, its development can be easily prevented if you seek medical help as soon as the first symptoms appear, and its development can be stopped, thereby increasing the chances of maintaining vision.

It is at the periphery of the retina that dystrophic processes often develop.

Peripheral retinal dystrophies - an invisible danger

The peripheral zone of the retina is practically invisible during a routine standard fundus examination. But it is precisely on the periphery of the retina that dystrophic (degenerative) processes often develop, which are dangerous because they can lead to ruptures and retinal detachment.

Changes in the periphery of the fundus of the eye - peripheral retinal dystrophies - can occur in both nearsighted and farsighted people, as well as in people with normal vision.

Possible causes of peripheral retinal dystrophy

The causes of peripheral dystrophic changes in the retina are not fully understood. The occurrence of dystrophy is possible at any age, with equal probability in men and women.

There are many possible predisposing factors: hereditary, myopia of any degree, inflammatory eye diseases, traumatic brain injuries and injuries to the organ of vision. General diseases: hypertension, atherosclerosis, diabetes, intoxication, past infections.

The leading role in the occurrence of the disease is played by impaired blood supply to the peripheral parts of the retina. Deterioration of blood flow leads to metabolic disorders in the retina and to the appearance of local functionally altered areas in which the retina is thinned. Under the influence of physical activity, work associated with climbing to heights or diving under water, acceleration, carrying heavy loads, vibration, ruptures may occur in degenerative areas.

However, it has been proven that in people with myopia, peripheral degenerative changes in the retina are much more common, because With myopia, the length of the eye increases, resulting in stretching of its membranes and thinning of the retina at the periphery.

PRHD and PVHRD - what is the difference?

Peripheral retinal dystrophies are divided into peripheral chorioretinal dystrophies (PCRD), when only the retina and choroid are affected, and peripheral vitreochorioretinal dystrophies (PVCRD) - with the involvement of the vitreous body in the degenerative process. There are other classifications of peripheral dystrophies that are used by ophthalmologists, for example, according to the localization of dystrophies or the degree of danger of retinal detachment.

Some types of peripheral retinal dystrophy

Lattice dystrophy is most often detected in patients with retinal detachment. A family-hereditary predisposition to this type of dystrophy is assumed to be more common in men. As a rule, it is found in both eyes. It is most often localized in the upper outer quadrant of the fundus, equatorially or anterior to the equator of the eye.

When examining the fundus, lattice degeneration appears as a series of narrow white, fleecy stripes, forming figures resembling a lattice or a rope ladder. This is what obliterated retinal vessels look like.

Between these altered vessels, pinkish-red areas of retinal thinning, cysts and retinal breaks appear. Characteristic changes in pigmentation in the form of darker or lighter spots, pigmentation along the vessels. The vitreous body is, as it were, fixed to the edges of the dystrophy, i.e. “tractions” are formed - cords that pull the retina and easily lead to ruptures.

Dystrophy of the “snail track” type. The retina shows whitish, slightly shiny, streak-like inclusions with many small thinning and perforated defects. Degenerative lesions merge and form ribbon-like zones, which in appearance resemble a snail's mark. Most often located in the upper outer quadrant. As a result of such dystrophy, large, round shaped tears can form.

Frost-like dystrophy is a hereditary disease of the retinal periphery. Changes in the fundus are usually bilateral and symmetrical. On the periphery of the retina there are large yellowish-white inclusions in the form of “snow flakes”, which protrude above the surface of the retina and are usually located near thickened, partially obliterated vessels; there may be pigment spots.

Frost degeneration progresses over a long period of time and does not lead to rupture as often as ethmoid and trace cochlear degeneration.

Cobblestone degeneration is usually located far in the periphery. Individual white lesions are visible, slightly elongated in shape, around which small lumps of pigment are sometimes identified. Most often found in the lower parts of the fundus, although they can be detected along the entire perimeter.

Racemose (small cystic) retinal dystrophy is located at the extreme periphery of the fundus. Small cysts can merge to form larger ones. In case of falls or blunt injuries, cysts may rupture, which can lead to the formation of perforated ruptures. When examining the fundus, cysts appear as multiple round or oval bright red formations.

Retinoschisis - retinal separation - can be congenital or acquired. More often this is a hereditary pathology - a malformation of the retina. Congenital forms of retinoschisis include congenital retinal cysts, X-chromosomal juvenile retinoschisis, when patients, in addition to peripheral changes, often exhibit dystrophic processes in the central zone of the retina, leading to decreased vision. Acquired dystrophic retinoschisis most often occurs with myopia, as well as in old and senile age.

If there are also changes in the vitreous body, then tractions (cords, adhesions) are often formed between the changed vitreous body and the retina. These adhesions, joining one end to a thinned area of ​​the retina, greatly increase the risk of ruptures and subsequent retinal detachment.

Retinal tears

Based on their type, retinal tears are divided into perforated, valvular, and dialysis-type.
Perforated tears most often occur as a result of ethmoid and carpal dystrophy; the hole in the retina gapes.

A rupture is called a valve rupture when a section of the retina covers the site of the rupture. Valvular tears are usually the result of vitreoretinal traction, which “pulls” the retina with it. When a tear forms, the area of ​​vitreoretinal traction will be the apex of the valve.

Dialysis is a linear tear of the retina along the dentate line - the site of attachment of the retina to the choroid. In most cases, dialysis is associated with blunt trauma to the eye.

Ruptures in the fundus look like bright red, clearly defined foci of various shapes, through which the pattern of the choroid is visible. Retinal breaks are especially noticeable against the gray background of detachment.

Diagnosis of peripheral dystrophy and retinal breaks

Peripheral retinal dystrophies are dangerous because they are practically asymptomatic. Most often they are found by chance during examination. If there are risk factors, the detection of dystrophy may be the result of a thorough targeted examination. There may be complaints about the appearance of lightning, flashes, or the sudden appearance of more or less floating flies, which may already indicate a retinal rupture.

A full diagnosis of peripheral dystrophy and “silent” tears (without retinal detachment) is possible by examining the fundus under conditions of maximum drug-induced pupil dilation using a special three-mirror Goldmann lens, which allows you to see the outermost parts of the retina.

If necessary, compression of the sclera (sclerocompression) is used - the doctor, as it were, moves the retina from the periphery to the center, as a result of which some peripheral areas inaccessible for inspection become visible.

Today, there are also special digital devices with which you can obtain a color image of the periphery of the retina and, in the presence of zones of degeneration and ruptures, estimate their size relative to the area of ​​the entire fundus of the eye.

Treatment of peripheral dystrophy and retinal tears

If peripheral dystrophy and retinal breaks are detected, treatment is carried out, the purpose of which is to prevent retinal detachment.

Preventive laser coagulation of the retina is performed in the area of ​​dystrophic changes or delimiting laser coagulation around an existing gap. Using a special laser, the retina is impacted along the edge of the dystrophic focus or gap, resulting in “gluing” of the retina with the underlying membranes of the eye at the points of exposure to laser radiation.

Laser coagulation is performed on an outpatient basis and is well tolerated by patients. It is necessary to take into account that the process of formation of adhesions takes some time, therefore, after laser coagulation, it is recommended to follow a gentle regime that excludes heavy physical labor, climbing to heights, diving under water, activities associated with acceleration, vibration and sudden movements (running, parachute jumping , aerobics, etc.).

Prevention

When talking about prevention, we primarily mean the prevention of retinal ruptures and detachments. The main way to prevent these complications is timely diagnosis of peripheral retinal dystrophy in patients at risk, followed by regular monitoring and, if necessary, preventive laser coagulation.

Prevention of serious complications depends entirely on the discipline of patients and attention to their own health.

Patients with existing retinal pathology and patients at risk should be examined 1–2 times a year. During pregnancy, it is necessary to examine the fundus at least twice with a wide pupil - at the beginning and at the end of pregnancy. After childbirth, an examination by an ophthalmologist is also recommended.

Prevention of the degenerative processes themselves on the periphery of the retina is possible in representatives of the risk group - these are myopic patients, patients with a hereditary predisposition, children born as a result of severe pregnancy and childbirth, patients with arterial hypertension, diabetes mellitus, vasculitis and other diseases in which deterioration is observed peripheral circulation.