Retinal and Vitreous Disease
Retinal and vitreous disease is the area of ophthalmology concerned with disorders of the neurosensory retina, its blood supply, the macula, and the vitreous body that fills the posterior segment of the eye. Because the retina converts light into the neural signals of sight, diseases here are leading causes of irreversible visual loss worldwide, and the area spans both medical retina (vascular, degenerative, and inflammatory conditions) and surgical retina (detachment and vitreoretinal interface disorders).
Definition
Retinal and vitreous disease comprises pathological conditions of the retina (the light-sensitive neural tissue lining the inner eye), the macula (its central high-acuity region), the retinal and choroidal vasculature, and the vitreous gel, including vascular, degenerative, mechanical, and proliferative processes that threaten vision.
Scope
This entry orients the reader to the major categories of posterior-segment disease: diabetic retinopathy and other retinal vascular conditions, age-related and inherited macular degeneration, rhegmatogenous and tractional retinal detachment, and the proliferative scarring response of the vitreoretinal interface. It is a reference overview that frames how these conditions relate to one another and to the broader discipline of ophthalmology; detailed mechanisms and evidence are developed in the topic entries beneath it.
Sub-topics
Core questions
- How do vascular, degenerative, and mechanical processes each lead to retinal dysfunction and visual loss?
- What distinguishes medical retina from surgical retina in clinical practice?
- Why are macular diseases disproportionately damaging to central vision?
- How do imaging modalities such as optical coherence tomography and fluorescein angiography reveal retinal structure and perfusion?
Key concepts
- Neurosensory retina and macula
- Blood-retinal barrier
- Retinal and choroidal circulation
- Vitreous body and vitreoretinal interface
- Medical retina versus surgical retina
- Macular versus peripheral retinal disease
- Optical coherence tomography and angiographic imaging
Mechanisms
The retina is metabolically demanding and dependent on two circulations: the inner retina is supplied by the central retinal artery and the outer retina by the choroid. Disruption of the blood-retinal barrier produces leakage, oedema, and ischaemia, which underlie the vascular retinopathies; chronic ischaemia can drive pathological neovascularisation. Degenerative disease of the macula and retinal pigment epithelium, as in age-related macular degeneration, damages the outer retina central to acuity. Mechanically, a break in the retina with traction or fluid passage from a liquefying vitreous causes the neurosensory retina to detach from the underlying epithelium, and a fibrocellular wound-healing response at the vitreoretinal interface can contract and re-detach the retina. Across these processes the common endpoint is loss of photoreceptor function (antonetti-2012; mitchell-2018; haddad-2003).
Clinical relevance
Retinal and vitreous diseases are among the principal causes of blindness and low vision globally, and recognising their categories is foundational for ophthalmic practice and for appraising the large clinical-trial literature on retinal therapeutics. This entry describes the structure of the field for reference and education; it is not a source of diagnostic protocols or individualized treatment recommendations.
Epidemiology
The burden of retinal disease is large and rising with population ageing and the global increase in diabetes. Age-related macular degeneration was projected to affect on the order of 196 million people by 2020 and 288 million by 2040 in a systematic review and meta-analysis, and diabetic retinopathy affects roughly a third of people with diabetes, making these two conditions dominant contributors to the area's public-health importance (wong-2014; antonetti-2012).
Evidence & guidelines
Much of the evidence base in this area derives from large randomised trials and longitudinal cohorts in diabetic retinopathy, macular degeneration, and vein occlusion, summarised in major narrative and systematic reviews; specific guideline statements and trial detail are developed in the topic entries rather than this overview (antonetti-2012; mitchell-2018; wong-2014).
History
The retina became directly observable with the invention of the ophthalmoscope in the nineteenth century, which transformed the study of fundus disease. The twentieth century saw the development of retinal photocoagulation, vitrectomy surgery for vitreoretinal disorders, and fluorescein angiography for imaging perfusion. In the twenty-first century optical coherence tomography and anti-vascular-endothelial-growth-factor pharmacotherapy reshaped the management of macular and vascular retinal disease, and the literature on these advances anchors the modern field (mitchell-2018; antonetti-2012).
Related topics
Seminal works
- antonetti-2012
- mitchell-2018
- wong-2014
- haddad-2003
Frequently asked questions
- What is the difference between medical retina and surgical retina?
- Medical retina covers conditions managed chiefly with drugs, laser, or observation, such as diabetic retinopathy and macular degeneration, while surgical retina covers conditions such as retinal detachment that typically require vitreoretinal surgery; many subspecialists practise across both.
- Why are macular diseases especially serious for vision?
- The macula is the central region of the retina responsible for sharp, detailed, and colour vision, so disease there disproportionately impairs reading, face recognition, and fine tasks even when the peripheral retina is intact.