Peripheral Retinal Pathology Including Holes, Tears, Lattice Degeneration, Detachments, Pigmented Lesions and Masses

The retina can be divided into two main anatomic regions – the macula and the peripheral retina. The macula is in the center of the retina and is responsible for our fine, central, and color vision. The peripheral retina comprises over 90% of the retina and is responsible for our peripheral and night vision. Although macular diseases such as age-related macular degeneration (AMD) and diabetic macular edema are more common and generally more serious, the peripheral retina can also manifest important and sometimes dangerous conditions. For example, a retinal tear or retinal detachment can be found in the peripheral retina. The following describes other conditions that your doctor may find while examining your peripheral retina.

Lattice Degeneration

Lattice degeneration describes a condition in which an area of the peripheral retina is very thin. Lattice degeneration is common and is usually found in myopic (nearsighted) individuals.

What are the risks of lattice degeneration?

Since the retina overlying lattice degeneration is thinner than normal it can be predisposed to developing tears or holes. The tears and holes may then lead to retinal detachment in some patients. Lattice degeneration is found in 10% of the general population but 40% of people with retinal detachments are found to have lattice degeneration in the peripheral retina.

What are symptoms of lattice degeneration?

Lattice degeneration may be found on routine examination of the retina and some patients may not have any symptoms at all. Common symptoms may include floaters and flashing lights.

How is lattice degeneration treated?

Lattice degeneration associated with retinal tears is treated with barrier laser in the office to decrease the risk of the development of retinal detachment. Patients with lattice degeneration who have symptoms of floaters and flashing lights are also generally given preventative barrier laser to prevent any future progression of retinal tears or retinal detachment. If a patient has lattice degeneration but no symptoms they are typically monitored with careful examination at least annually. Patients are advised to call immediately if they do experience a sudden onset of floaters or flashing lights.

White without pressure

White without pressure (WWP) describes a finding that your doctor may see when he examines the peripheral retina. WWP is found in 15-30% of the population and is characterized by a discrete whitish-gray area in the far peripheral retina that is bordered by a dark line. To the inexperienced observer the area of WWP may initially look like a shallow retinal detachment or retinal tear but WWP does not usually lead to problems and does not require any treatment although observation is recommended.

Retinoschisis

Retinoschisis literally means splitting of the retina. This can occur in the macula or the peripheral retina. When retinoschisis occurs in the peripheral retina it may initially appear to be a retinal detachment. However, unlike a retinal detachment, retinoschisis is asymptomatic and is generally non-progressive. About 5% of the general population has retinoschisis and it is usually found in both eyes. In rare instances retinoschisis can progress into the macular region or develop into a retinal detachment. Observation is recommended to monitor the schisis and make sure that the peripheral schisis does not progress into the macula or develop into a combined retinoschisis and retinal detachment. If the schisis does develop into a retinal detachment it is treated with surgical intervention – usually a pars plana vitrectomy and/or a scleral buckle.

CHRPE (please see section on congenital retinal defects)

Choroidal Nevus

The choroid is a layer of blood vessels that is under the retina. Sometimes a tumor of this layer can develop and is called a choroidal nevus. A nevus does not generally cause any symptoms and can only be seen by your doctor during a dilated eye examination. A nevus is similar to having a mole or freckle on your skin except that it is under the retina. In the majority of cases the nevus remains benign and does not cause any problems. However in rare instances a choroidal nevus may develop into a malignant melanoma. Your doctor will take a photo of the nevus and monitor its condition to make sure it does not change size, shape, or color over time.

Tumors

A tumor refers to an abnormal growth of tissue. Tumors may be benign or malignant and they may also manifest in the peripheral retina. These include choroidal nevus (see above), malignant melanoma, metastatic tumors (usually from breast, lung, or prostate cancer), hemangioma, retinoblastoma, lymphoma, adenoma, melanocytoma, and osteoma to name a few. For more information please see our section on ocular oncology.

Retina Consultants of Houston is specialized in managing peripheral retinal abnormalities and has state-of-the-art imaging and equipment to document, follow, and if needed, provide treatment for any of these conditions.