Jordan Eye Center
Dr Muataz Mohammad Harara practises ophthalmology with a focus on retinal and vitreous disease. His work includes retinal treatment and injections, cataract and…
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The retina is the thin neural layer lining the back of the eye. It receives light and converts it into signals carried to the brain, and at its centre lies the macula, responsible for fine vision, reading and recognising faces. Treating retinal disease is not a single procedure but a set of options chosen according to the disease, its location and its stage: careful observation, laser photocoagulation, injection of medication into the eye, intraocular surgery to remove the vitreous gel, a scleral buckle, or a combination of these. The conditions most often treated include diabetic retinopathy through its stages, age-related macular degeneration in both dry and wet forms, retinal vein occlusions, retinal tears and detachment, macular hole and epiretinal membrane, inflammation of the retina and choroid, inherited retinal degenerations, and the retinal changes of high myopia. Each follows a different course at a different speed, which is why accurate diagnosis is half of the treatment. Some symptoms must never be postponed and should be treated as an emergency: **sudden flashes of light, a new dense floater or shower of floaters, or a black curtain blocking part of your field of vision all require an eye examination the same day, and delay costs sight that cannot be recovered**. The same applies to sudden painless loss of vision in one eye, straight lines appearing bent or distorted when reading, and a blind spot in the middle of your field of vision. The limits of treatment must be entirely clear. There is no single treatment that repairs all retinal disease, and **retinal nerve cells that die are not replaced**, so in many conditions the aim is to halt deterioration and protect what remains rather than to recover what is gone. Spectacles do not correct visual loss arising from the retina, because the problem lies in the receptor itself and not in focusing. One widespread myth deserves correction: **eye supplements do not treat wet macular degeneration, are no substitute for injections, and do not treat diabetic retinopathy**; their role is limited to selected situations decided by an ophthalmologist alone. The most dangerous thing a retinal patient can do is stop attending follow-up once vision feels stable, because many of these diseases progress silently. Suitability for any treatment is determined by dilated examination and cross-sectional imaging, not by reading.
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Procedure steps
- 1
Vision measurement and anterior examination
Visual acuity is measured precisely in each eye separately, eye pressure is checked, and the front of the eye is examined at the slit lamp to exclude other causes of poor vision such as cataract or corneal problems, because a proportion of patients present with what looks like a retinal complaint that in fact arises at the front of the eye, and the reverse is equally true.
- 2
Dilated fundus examination
The pupil is dilated with drops and the back of the eye is examined with special lenses, including a complete sweep of the peripheral retina for tears, thinning or detachment. There is no substitute for this examination: neither the patient's complaint nor the level of visual acuity is enough to judge the retina, because large areas can be damaged without producing any symptom at all.
- 3
Cross-sectional imaging and angiography
Cross-sectional retinal imaging shows the layers of the retina and any fluid, membrane or macular hole in high detail, and dye angiography may be added to define leakage and areas of poor perfusion, or ultrasound used if bleeding blocks the view. These images determine which treatment is appropriate and serve as the baseline for comparing the response later.
- 4
Choosing the appropriate treatment
Treatment is selected according to the diagnosis: careful observation in stable disease, laser to seal a tear or treat ischaemic areas, intraocular injections for macular oedema and new vessels, vitreoretinal surgery for dense bleeding, detachment and epiretinal membrane, alongside control of diabetes and blood pressure where present. The benefit, limits, risks and expected number of sessions are explained to you before you consent.
- 5
Long-term follow-up and vision support
Regular review visits with imaging are scheduled, because most retinal diseases are chronic and progress silently, and the plan is adjusted according to the findings. Where visual loss is permanent, low-vision aids, lighting advice, text magnification and training to make the best use of remaining sight are offered, and the fellow eye is examined too, since it is often at risk of the same disease.
Before the procedure
Bring someone to take you home, since you will not be able to drive after dilation, and bring sunglasses along with your current glasses and their prescription. Before the visit, write down your symptoms precisely: whether the loss of vision was sudden or gradual, in one eye or both, whether straight lines look bent, whether there is a blind spot, shadow, flashes or floaters, and when each began. Bring previous reports and any retinal photographs or scans you have, plus a complete list of your medicines. If you have diabetes, bring your glycated haemoglobin result, recent glucose and blood pressure readings and any kidney reports, and state how long you have had diabetes. Tell the doctor about any previous eye surgery, laser or injections, about retinal disease in the family, and about any blow to the eye.
After the procedure
After the examination your vision will be blurred and your eyes light-sensitive for several hours, so do not drive and wear sunglasses. Follow your treatment, drops and appointment schedule exactly as prescribed, and do not judge success by how you feel alone, because much of the improvement or deterioration is measured on imaging rather than by sensation. If you have diabetes or high blood pressure, controlling them with your doctor is a core part of treating your eye. **Seek same-day review for sudden flashes of light, a new shower of dense floaters, a curtain or dark shadow blocking part of your vision, sudden loss of sight in one eye, distortion of straight lines, or severe eye pain with redness and falling vision.** **Do not wait to see whether it settles by itself, because delay with these signs costs sight that cannot be recovered.** Continue regular follow-up even when your vision feels stable.
Expected duration
A full assessment visit with dilation and imaging usually takes one to two hours, most of it waiting for drops and completing the scans. Blurred vision afterwards lasts four to six hours. Treatment follows the disease: one or more laser sessions, repeated injections over months and years, or surgery with recovery over weeks, while follow-up usually continues for life.
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