The retina is like a screen to capture the images of the outside world and the macula is the central part of the retina. If the macula is damaged, it may cause severe vision loss. There are various diseases that may cause damage to the macula. Our team specializes in treating patients with retinal and macular diseases such as age-related macular degeneration (AMD), macular hole, branch/central retinal vein occlusion (BRVO/CRVO), central serous chorioretinopathy (CSC) and so on. We provide our patients with comprehensive services including tests, diagnoses, medical and surgical treatments, and research of retinal and macular disorders.
In addition, we also excel at the diagnoses of retinal and choroidal tumors by using advanced imaging devices. Uveitis clinic is also affiliated to our ophthalmology department and the team is committed to the treatment of malignant lymphoma with the advantages of advanced diagnostic imaging provided by our team. Our teams cooperate together to provide our patients with more accurate diagnosis and better treatments. Our team also has a wealth of experiences in treating retinal and choroidal benign tumors such as hamartoma and hemangioma.
The most common retinal diseases including age-related macular degeneration, retinal vein occlusion and central serous chorioretinopathy are described below.
Age-related macular degeneration (AMD)
AMD is a disease of macular dysfunction caused by aging that leads to anorthopia, central scotoma and color-vision deficiency. This degenerative disease affects 1% of the older patient population, aged 50 years or older, and advanced stages of the disease are the leading cause of blindness among middle- and old-age population in developed countries. In Japan, population aging and westernization of the life have led to the increase of AMD patients. Abnormal blood vessels (CNV: choroidal neovascularization) arise from choroid, invade the retina and cause irreversible macular damages, which leads to vision loss caused by retinal edema and subretinal fluid from the leakage of the blood components and bleeding on the retina.
Retinal vein occlusion (RVO)
The retinal vein which returns to the bloodstream of whole body runs throughout the retina. When a retinal vein is blocked for various causes, it is called retinal vein occlusion. The obstruction of a root of the retinal vein suffers from the central retinal vein occlusion (CRVO) and the obstruction of branch of retinal vein suffers from the brunch retinal vein occlusion (BRVO). Such vein brunch occlusion leads to bleeding on the retina. The subjective symptoms of loss and distortion of the vision occur due to macular ischemia and macular edema.
Central serous chorioretinopathy (CSC)
Central serous chorioretinopathy (CSC) is an eye disease characterized by the leakage of fluid under the retina that has a propensity to accumulate under the central macula. It is considered that the cause of CSC is choroidal venous congestion. CSC typically affects adults ages 30-50. The condition is associated with stress, pregnancy, cortisol and corticosteroids. Although CSC usually doesn't affect visual acuity, it leads to blurred or distorted vision and some patients complain a difficulty to distinguish contrast of color.
Medical treatment depends on the diagnoses of the diseases and stages. Treatment usually includes retinal photocoagulation, anti-VEGF therapy and photodynamic therapy (PDT). Single or combination of different treatments is usually performed in this outpatient clinic. Hospitalization is not always required. Drug and laser treatments are effective to ease the symptom for most patients. However, the disease tends to relapse, so regular outpatient visits are necessary. We always exam patients carefully, select best treatments and do our best to maintain visual performance.
Laser therapy (photocoagulation), is to irradiate laser to the retina. As the radiated lesion would degenerate, the therapy is only used for the treatment of the CNVs apart from macula, BRVO, CSC with the leak point far from the macula, and benign tumor.
Photodynamic therapy (PDT)
PDT uses a low power laser in combination with a light reactive drug, Visudyne® (Verteporfin). The drug is intravenously injected into a patient's systemic circulation and it accumulates in the CNVs. The power of the laser is low enough to avoid the damage to normal tissue and the Visudyne® has the feature to pool in the abnormal vessels than the normal ones. After the therapy, patients should avoid going out during the daytime because it takes about 5 days for the drug to be cleared out from the system. Patients should avoid exposure to the ultraviolet for 5-7 days because the Visudyne® is light reactive drug that could cause sunburn on the skin.
The anti-VEGF medicine is delivered by intravitreal injections with the syringe under topical anesthesia by eye drops. VEGF (vascular endothelial growth factor therapy) is a chemical mediator that has effects on the proliferation and activation of the CNVs and it can also increase the permeability of blood vessels. Anti-VEGF drugs suppress the function of overexpressed VEGF and reduce the CNVs and subretinal fluid. As of now, three types of anti-VEGF injections are clinically available, including Lucentis®, Macugen® and Eylea®. Selections of drugs depend on patients' ocular and systemic situation. In most of the cases, it requires more than 2 time injections. The number of the times and the types of interval of injections are different by case.
Our medical retina clinic adopts a medical team system, not single attending system. The contents and images of medical treatments are shared with the electronic medical records; the weekly conference is held to examine the cases and for all doctors in the group to share the medical information and to decide the treatment options. Some patients might be confused first because in the medical team treatment system, they will have a different doctor every time, but it is considered the best treatment system. In addition, there are more severe cases in this specialty outpatient clinic compared with normal outpatient clinic, so it often takes much more time on the examination, treatment and explanation. Therefore, patients may wait longer in this clinic and feel inconvenience. Our team tries to shorten waiting time but still provides the careful treatment because we recognize that medical safety should be top priority. We appreciate your understanding and cooperation.