Adults with retinitis pigmentosa (RP) should take 15,000 IU vitamin A supplement daily. Studies show’s vitamin ‘A’ supplement helps to slow down the progression of RP by 20%.

Retinitis pigmentosa supplement treatment

Another study shows adults with RP should avoid taking high doses of vitamin E supplements. It shows that the disease progress faster in patients on 400 IU vitamin E supplement daily.

Adults interested in vitamin A supplementation should first:

• Consult eye care professional regarding vitamin A supplementation.
• If people have liver disease or abnormally high level of vitamin A in blood, they will need to adjust their vitamin A intake.
• Take vitamin A palmitate instead of beta-carotene, because beta-carotene (natural precursor of vitamin A) breaks down differently by each person.
• Have balanced diet, without showing interest, especially in vitamin A.
• Avoid taking high dose of vitamin E supplements.

People will make a common mistake of thinking that vitamin A supplementation in excess (more than recommended 15,000 IU) will provide greater benefits. In excess of 25,000 IU of vitamin A, taken for a long time can be toxic and may cause liver disease.

Only treatment available for retinal detachment is to reattaching the retina by surgery. Otherwise, complete loss of vision is almost certain.

Surgery for retinal detachment

Pneumatic retinopexy – is an outpatient procedure recommended for a relatively uncomplicated detachment with the tear located in the upper half of the retina. This procedure is performing with local anesthesia, usually starts with cryopexy to treat the retinal tear. Then expandable gas bubble is passing into vitreous cavity; the gas expands in few days, and it flattens the retina so that the fluid can press out from beneath it. Now the retina can reattach itself to the back wall of the eye. The gas bubble is slowly disappeared after few weeks (absorbed by the eye).
Scleral buckling - is the most common way to treat retinal detachment. Fine-band of silicone rubber or sponge is stitching onto the outside white of the eye (the sclera) in the area where the retina has detached. Laser or freezing treatment is useful to scar the tissue around the retina. The bands are leaving on the eye and should not be noticeable after the operation.

Vitrectomy – a jelly-like substance “vitreous” in the eye is removing and replacing with either a gas or silicone bubble. This holds the retina in a position from the inside. Tiny dissolving stitches are useful to close the wound. Retinal holes or tears can seal using either lasers or cryotherapy (freezing treatment). After the procedure, the patient will advise to keep their head in a certain position and to avoid travel by air for a while.

Surgery to correct retinal tears

Retinal tear or hole has diagnosed at an early stage, before it progressed to the detachment retina, the following procedures may recommend:

• Laser’s photocoagulation - It is a procedure usually performed on an outpatient basis. A laser beam is passing through a contact lens or ophthalmoscope used for this procedure. The laser beam makes burns around the retinal tear, and seals the leakage of fluid; thus, stops any further detachment. It needs no surgical incision and only causes minor irritation to the eye.
• Retinal Cryopexy (Freezing) - Retinal cryopexy is also called as retinal cryotherapy, performed on an outpatient basis. After local anesthetic, this procedure uses an intense cold probe place at the affected retinal tear to induce a chorioretinal scar and to destroy retinal or choroidal tissue. That helps to secure the retina to the eye wall. This procedure is recommending for difficult to reach retinal tears, usually along the retinal edge. This procedure may cause redness and eye inflammation for some time.

There are a few chances of complications during or after surgery, they are rare chances. They include: double vision, eye allergy (due to the medicine used), bruising around the eye, eye infection, eye bleeding, cataract (cloudy lens), glaucoma (increased eye pressure), immune system reaction affecting the other eye, and more holes/tires in the retina.

Sometimes, more than one surgery may need to refit the retina. Surgery is not always successful in retinal reattachment. Vision after surgery depends on the part affected.

Tips to retinal detachment

There are some ways to cope with impaired vision due to retinal detachment:

• At the home lit with proper light for reading and other activities.
• Inform friends and family members regarding vision problems so that they can help.
• Correct the vision with glasses for retinal detachment. Furthermore, keep an extra glass.
• Connect to others with impaired vision it can be helpful.

Recovering from retinal detachment

After surgery, eyelids may feel itchy, sticky, eye bruising and discomforts, it will go away in a couple of days. Simple painkillers can relieve the discomfort.

A day after the operation, eye drops will give to treat swelling and to prevent infection. You should not rub the eye; it is usual to feel itching while it heals; it takes two to six weeks. Vision will be very blurry, and it is only temporary.
Eyesight cannot always completely restore. This depends largely on how much of the retina was detached and for how long.

Any of the following symptoms after surgery need immediate attention: Heavy eye pai, Vision loss, or Increasing eye redness.

Retinal detachment is painless and always has visual symptoms appear before it develops into retinal detachment.

Warning symptoms of Retinal detachment

• Shadow or black curtain in front of the visual field
• Appearance of floaters; small bits of debris, dark spots, or string in the vision field
• Sudden blurry vision
• Sudden light flashes in one or both eyes
• Cloudy vision as blood vessels bleeds

Immediate medical care is advisable if suddenly increase in floaters or light flashes in the visual field.
Many people do not realize the danger of the retinal detachment warning signs and hope that the symptoms will be disappeared. Sometimes retinal detachment symptoms weaken temporarily; it does not mean the problem is recovering. However, it means to follow by a vision loss in the next few days or weeks. Surgeries performed at an advanced stage of retinal detachment may have increased chances for failure, and the vision loss becomes permanent.

The retinal detachment causes are holes or tears in the retina, other health conditions, and eye injuries.

What causes retinal detachment?

Some of the common causes of retinal detachments are:

• Holes or tears in the retina,
• Other health conditions
• Eye injuries

Holes or tears in the retina causes retinal detachment

This happens particularly to people with short sightedness and having thin retina. It the retina has holes or tears in it, fluid in the eye can enter underneath the retina and can detach it from the lining of the eye.

Other health conditions that cause retinal detachment

• Advanced diabetes
• Eye inflammation, such as sarcoidosis or cytomegalovirus retinitis
• Shrinkage of the jelly-like vitreous that is filled inside the eye

Eye injuries that cause retinal detachment

• Trauma
• Complications of eye surgery performed for other eye problems

Retinal detachment cannot be caused by heavy lifting or too much of eyestrain.

Posterior vitreous detachment (PVD)

PVD can also know as the vitreous collapse. With ageing, vitreous may shrink or become liquid. PVD usually does not cause any serious eye problems, but it can develop some visual symptoms such as light flashes (when eyes are closed) and floaters.

Most of the retinal tears are causing by PVD, when not treated may lead to retinal detachment. This can eventually affect the entire retina, causing complete vision loss in the affected eye.

Nutritional supplement is a treatment for dry macular degeneration. It may also help prevent both wet and dry types. However, you should not try to self-treat vision problems.

AREDS Macular degeneration supplement formula

The Age-Related Eye Disease Study (AREDS) found that a combination of antioxidant vitamins with zinc helps to slow down the progression of intermediate macular degeneration. The National Eye Institute recommends that people with intermediate AMD or with advanced AMD (wet or dry) in one eye but not in the other can take this supplement each day. However, this supplement will not help prevent AMD, or it slows down the progression in those with early AMD.

The AREDS formula contains:

• Vitamin C (500 mg per day)
• Vitamin E (400 IU per day)
• Beta-carotene (15 mg per day, or 25,000 IU of vitamin A)
• Zinc (80 mg per day)
• Copper (2 mg per day, to prevent copper deficiency that is caused due to extra zinc)

Zinc may be harmful to a dose of 80 mg, so it is advisable to take this combination only under doctor’s supervision.

Xanthophylls (Lutein and zeaxanthin) - High levels of these two carotinoids (antioxidants that give plants orange, red, or yellow color) in the blood may help protect against AMD, either by acting as antioxidants or by protecting the macula from damage due to light. Some study shows that people with AMD, who took lutein, had less vision loss.

NEI is currently conducting a clinical trial, AREDS2 to study whether increasing the in take of xanthophylls (lutein and zeaxanthin) and fish oil (omega-3 polyunsaturated fatty acids) will help to prevent the development of advanced AMD. The evidence base suggests that increasing the intake of lutein and zeaxanthin and omega-3 fatty acids may prevent AMD progression.

Wet macular degeneration treatment options are Angiogenesis Inhibitors, Laser Photocoagulation, and Photodynamic Therapy.

Macular degeneration treatments

• Angiogenesis Inhibitors - Lucentis (ranibizumab injection) and Macugen (pegaptanib sodium injection)
• Laser Photocoagulation
• Photodynamic Therapy

Angiogenesis Inhibitors

The two most common angiogenesis inhibitors are Lucentis (Generic name: ranibizumab injection) and Macugen (Generic name: pegaptanib sodium injection). Angiogenesis inhibitors are effective for wet age-related macular degeneration (abnormal growth of fragile blood vessels eventually damage macula).

How Angiogenesis Inhibitors does work? It is an antibody fragment, which can bind to, and stops the activity of human vascular endothelial growth factor (VEGF), VEGF is a protein believed to be responsible for the formation of these fragile blood vessels. Angiogenesis Inhibitors (Lucentis or Macugen) is injecting into the vitreous portion of the eye (the clear jelly like substance between the lenses back to the retina). In macular degeneration, VEGF is continually producing; so routine administration of Lucentis over a period is required.

Possible side effects of Lucentis: hemorrhage of the conjunctiva, eye pain, increased eye pressure, and inflammation of the eye. Other rare side effects include severe inflammation of the interior of the eye, retinal detachment, retinal tear, increased eye pressure, and traumatic cataract.

Possible side effects of Macugen: eye inflammation, blurred or changes in vision, cataracts, eye bleeds, eye swells, eye discharges, irritation or discomfort in the eye and spots in the vision.

Laser Photocoagulation

Laser’s photocoagulation was the first treatment used for wet macular degeneration. It is an outpatient procedure performed by first numbed the eye and the abnormal leaky blood vessels are heated, sealed, and destroyed using high-energy lasers. This can help prevent or at-least slow further damage, but it results in a permanent blind spot. Successful laser photocoagulation is a one-time treatment, but if new blood vessels grow, it needs to repeat.
Possible side effects are mild pain during and shortly after the procedure, relieved by taking nonprescription pain medication. Reduced vision and retina scarring may also occur.

Photodynamic Therapy (PDT)

Photodynamic therapy using Visudyne (Generic name: verteporfin) is used for the treatment of wet macular degeneration characterized by the new growth of fragile and abnormal blood vessels or neovascularization. PDT is treatment that is more effective if the area of abnormal blood vessel growth and bleeding is in the fovea, at the center of the macula. Photodynamic therapy (PDT) is performing by injecting Visudyne, a light-sensitive drug into a vein in the arm. The drug circulates in the bloodstream and is absorbing by the fragile blood vessels growing underneath the macula. A low intensity, non-thermal or cold laser is shining at the retina for a little over a minute. This activates Visudyne to destroy the abnormal blood vessels and inhibit the neovascularization. PDT has an advantage of using cold laser, which does not damage the retina or other cell layers beneath the abnormal vessels. PDT helps to stabilize the vision, but it will not restore lost vision or improve vision. Treatments are need for every three months and repeated many times to prevent the re-growth of the abnormal vessels (approximately 6-7 treatments over 2-3 years). PDT treatment takes about 20 minutes, and it is painless.

Because the drug is light-activate, patients are advice to avoid exposing their eyes or skin to sunlight or bright light for up to five days after treatment.

Possible side effects of PDT are headache, injection site reaction, and blurred or reduced vision.

Macular degeneration test can perform using Amsler grid, if macular degeneration is suspect after this test, then visit doctor immediately.

Amsler grid Macural degeneration test

Amsler grid is a simple test, which may help to detect changes in the sight that otherwise, may not notice. If you need a reading glass, please wear them while test using the Amsler grid.

• Hold the Amsler grid 14 inches (36 centimeters) in front of the eyes in good light.
• Cover one eye.
• Look directly at the center dot with the uncovered eye.
• While looking at the center dot, determine whether all the lines in the grid appear straight, all intersections are at perfect right angles; all the squares should be the same size and have the same contrast.
• Repeat the above steps with the other eye.
• If any part of the grid is missing or looks wavy, blur or dark, contact the eye doctor immediately.

Eye doctors use Amsler grid to detect vision problems due to the macula damage (the central part of the retina) or the optic nerve. Macular degeneration, glaucoma or other eye diseases may cause this damage. Amsler grid is helpful in detecting these problems. An early diagnosis and treatment help to limit or slow down the vision loss.

If a person is at risk for macular degeneration or other eye diseases, then can use this chart at home to monitor the vision. However, using this chart does not mean to skip regular visits to the eye doctor.

Dry macular degeneration usually develops gradually and painlessly. In addition, wet macular degeneration progresses rapidly causing vision loss.

Symptoms of macular degeneration

• Need for brighter light than usual for reading or doing close work
• Difficult to adapt for low light levels, such as entering a dimly lit place from a well-lit area.
• Increased blurry vision when reading printed words
• Decreased intensity or brightness of colored objects
• Difficulty to recognize faces
• Gradual increase in the unclear, confusing and/or misty overall vision
• Blind spots or blurred center vision, combined with a drop in the sharpness (acuity) of the vision

One eye may have poor wavy vision, while the other eye remains fine for years. It may be difficult to notice any or much change because the good eye compensates for the weak one. The vision and lifestyle begin to be dramatically-affect when it develops in both eyes.

Visual hallucinations - Macular symptom

Some with macular degeneration may experience visual hallucinations (such as unusual patterns, geometric figures, animals or even faces) as their vision loss becomes more severe. People may be afraid to express these symptoms with the doctors or friends or family for fear that they may consider crazy. However, such hallucinations are common among macular degeneration patients.

Macular degeneration is of two types; they are dry and wet macular degeneration. Dry macular degeneration type is the most common one.

Type of Macular degeneration

• Dry macular degeneration
• Wet macular degeneration

It is possible for a person to suffer from both forms, affecting one or both eyes, and it progresses slowly or rapidly. Dry macular degeneration may progress to cause vision loss without changing into the wet-form. However, it is also possible for the early stage of macular degeneration of dry-form to change into the wet form when advances. Macular degeneration is the leading cause of vision loss in people over 60 years of age.

Dry Macular Degeneration

It is the most common type diagnosed in 85-90 percent of cases, in which the photosensitive cells of the macula slowly break down. Extra-cellular waste products of metabolism “Drusen” is a yellow deposit, forms under the retina between the retinal-pigmented epithelium (RPE) layer and the Bruch's membrane. Drusen is often finding in the eyes of aged people, but an increased size or number is the first sign of macular degeneration. Over time, drusen is associated with macula deterioration and the death of RPE and photoreceptor cells, causing blurred or spotty vision. This macular degeneration does not cause any pain, but in its early stages, there may be a slightly blurry vision. However, as more and more of the cells die, central vision worsens over time. In severe cases can cause profound vision loss, affecting the quality of life.

The dry form of macular degeneration has three stages:

1. Early - patients have many small drusen or a few medium-sized drusen. There is no vision loss or any other symptoms at this stage.
2. Intermediate - patients have many medium-sized drusen or few large drusen. They need bright light for reading, blur spot may appear in the visual field.
3. Advanced - patients have a large number and/or size of drusen deposits, and breakdown of RPE, photoreceptor cells, and Bruch membrane. Blurry spot occurs in the center of the visual field and can become larger and darker, gradually causing a complete loss of central vision.

Wet Macular Degeneration

It is a rare form of macular degeneration accounts for approximately 10% of the cases of age-related macula degeneration, but results in 90% of the cases of legal blindness. It develops, when abnormal blood vessels grow behind the macula as RPE and photoreceptor cells die. The Bruch’s membrane begins to break down near drusen deposits, and new fragile blood vessels grow called neovascularization. That can leak fluid and blood, resulting in scarring of the macula and has the potential for rapid, severe damage. Straight vision can become poor or lost entirely in a short period, even within days or weeks. All wet macular degeneration is considering advanced stage.

Eye allergy is an eye problem, when the eye is overreacting to a substance by considering it as harmful, but actually, it may not be.

Eye Allergies

Let us take dust; it is not harmful to most of the peoples and everyone frequently come across dust conditions, still some oversensitive allergic individuals may produce excessive tears and mucus to protect against dust mites.
About 40 percent of peoples have allergy symptoms; out of this, 75 percent of those symptoms affect the eyes.

Types of Eye allergies

Most cases of eye allergies affect the conjunctiva (which is the tissue lining that covers the surface of the eyeball and the inner layer of the eyelids) is commonly called as allergic conjunctivitis. There are two types of allergic conjunctivitis, they are:

• Seasonal allergic conjunctivitis (SAC)
• Perennial allergic conjunctivitis (PAC)

Seasonal allergic conjunctivitis (SAC) and Perennial allergic conjunctivitis (PAC) is mostly triggered by an immune reaction involving a sensitized individual and an allergen (SAC is mostly triggered by the pollens and PAC is mostly triggered by the animal dander, feathers and dust mites). Simply, this means that if allergic to a particular substance, then if come into contact with those substances can trigger an allergic reaction, such as itching, sneezing, etc.