Article initiated by:
Dr Jay Chhablani, Dr. Anupam Basant Bagdi MBBS
All authors and contributors:
Vinay A. Shah M.D.,Robert A Hyde, MD, PhD,Alexander Engelmann, MD,Jennifer I Lim MD,Dr Jay Chhablani,Peter A.Karth, MD,Nikhila Khandwala
Robert A Hyde, MD, PhD
Assigned status Update Pending
by Robert A Hyde, MD, PhD on February 8, 2022.
Peripheral Retinal Degenerations
- 1 Classification of Peripheral Retinal Degenerations
- 1.1 Utility of OCT in diagnosis
- 2 Intra-Retinal Degenerations
- 2.1 Senile Retinoschisis
- 2.2 White-Without-Pressure
- 2.3 White-With-Pressure
- 2.4 Dark-Without-Pressure
- 2.5 Peripheral Cystoid Degeneration
- 2.6 Snowflake Degeneration
- 2.7 Pearl Degeneration
- 3 Vitreoretinal Degenerations
- 3.1 Lattice Degeneration
- 3.2 Snail track degeneration
- 3.3 Retinal Tufts
- 3.4 Peripheral Retinal Tears
- 4 Chorioretinal Degenerations
- 4.1 Paving Stone Degeneration
- 4.2 Peripheral Retinal Drusen
- 5 References
Peripheral retinal degenerations are classified according to the following criteria:
- Location- equatorial, peripheral, or combined
- Pathomorphology- trophic, tractional, atrophic, or combined
- Depth of retinal changes- intraretinal, retinal, vitreoretinal, or chorioretinal
- Risk for retinal detachment
- Prognosis – progressive or stationary
The following are the commonly used classifications of peripheral retinal degenerations based upon depth of retinal changes observed on optical coherence tomography (OCT):
- Intra-retinal Degenerations: senile retinoschisis, white-without-pressure, white-with-pressure, dark-without-pressure, peripheral cystoid degeneration, snowflake degeneration, and pearl degeneration
- Vitreoretinal degenerations: lattice degeneration, snail-track degeneration, retinal tufts, and peripheral retinal breaks
- Chorioretinal degenerations: paving stone degeneration and peripheral retinal drusen
Utility of OCT in diagnosis
Optical coherence tomography (OCT) has been shown to greatly benefit in the diagnosis of peripheral retinal degenerations by characterizing structural elements. Such detail includes the structure, shape and depth of retinal degenerations. Peripheral OCT may further aid in differentiation between types of peripheral retinal degeneration as well associated complications including subclinical retinal detachment, retinoschisis, retinal tears and vitreoretinal adhesions or tractions. Therefore, OCT should be utilized in the initial diagnosis, treatment, and follow-up for peripheral retinal degenerations.
- Definition: senile retinoschisis (SR) is the splitting of layers of the neurosensory retina by thick fluid.
- Prevalence: found in 2-7% of the general population, more common in patients 40 years and older and in hyperopic eyes
- Characteristics: Lesion is a bullous elevation of peripheral retina, found in temporal segment
- Findings: Mostly asymptomatic
- Immobile with movement of eye and produces an absolute field defect
- Complications: may involve posterior pole, may lead to retinal detachment
- Primary cause of retinal detachment in 0.05-2.5% of cases
- Diagnosis: OCT findings include intraretinal hyporeflective cavities with destruction and thickening of the RPE
- Treatment: should be treated when patients are symptomatic, or there is progressive retinal detachment threatening the macula
- Definition: Distinctive white appearance of the peripheral retina without indentation and without mechanical stimulus
- Prevalence: found in up to 30% of normal eyes, often bilateral, more frequently diagnosed in younger patients, may be associated with longer axial length
- Characteristics: Whiter than the retina in white with pressure and the choroidal markings are almost obscured, found in post-equitorial region at the base of the vitreous and ora serrata, whiteness further accentuated with scleral depression, margins are sharply demarcated from normal retina
- Exact cause is unknown one school of thought states it to be a manifestation of peripheral vitreous traction while one believes it to be simply an abnormal reflex from a structurally normal VR interface
- Frequently causes confusion with subclinical RD and Retinoschisis but indentation clearly reveals that retina is still apposed to the RPE.
- Diagnosis: OCT shows white areas correspond to hyperreflective outer retinal layers and ellipsoid zone, no vitreous traction
- Treatment: low risk for association with retinal detachment, so patients are examined every 1-2 years
- Definition: Distinctive milky white or opalescent appearance of the peripheral retina that is observed in many normal eyes when examined with scleral depression
- Must be carefully distinguished from a subclinical peripheral RD
- Findings: retina appears normal without depression
- Infero-nasal quadrant least likely to be affected
- Prevalence: seen in around 30 to 35% of eyes examined with scleral depression
- Incidence increases with age, no sex predilection
- Complications: benign condition, not associated with retinal breaks
- Definition: flat, brown fundus lesion with well-defined margins in the equator of peripheral retina
- Findings: can be found posterior to area of white-without-pressure and may look like retinal tear, posterior to ora serrata
- Symptoms: usually none
- Diagnosis: OCT findings show hyporeflectivity of the ellipsoid zone
- Treatment: usually benign, follow patient for routine examinations
Peripheral Cystoid Degeneration
- Definition: multiple small intraretinal microcystoid cavities, most frequently seen in temporal peripheral retina
- Characteristics: yellow tiny vesicles with blurred borders on gray background
- Typical: occurs in all adults, may be complicated by fusion of cysts, development of cavities in the outer plexiform layer, and flat senile retinoschisis
- Reticular: occurs in 18% of adults, may be complicated by bullous retinoschisis with cavities found in the retinal nerve fiber layer. This form is almost always found posterior to typical PCD and tends to follow the retinal vessels
- Definition: small yellowish dots in the peripheral retina, appear white due to light reflection
- Findings: may span wide band in more than one retinal quadrant, most often in superotemporal quadrant
- may be combined with other degenerations (e.g. retinoschisis, lattice, white-without pressure)
- Prevalence: rare
- Complications: retinal tears, retinal holes and retinal detachment
- Definition: congenital retinal degeneration associated with white beads on the retina
- Prevalence: found in up to 20% of patients
- Characteristics: ora pearls appear like drusen, found between the retinal pigment epithelium and Bruch’s membrane or floating above RPE
- Diagnosis: OCT findings show hyporeflective cavity with vitreous layers attached to top of lesion
- Definition: retinal thinning with loss of neurosensory layer, vitreoretinal adhesions at margin of lesion
- Prevalence: found in 6-8% of patients
- Characteristics: retinal thinning with fibrosis and vitreous liquefaction over the lesion
- Typical: well-outlined thinning with white crossing lines
- Atypical: found adjacent to vessels in radial pattern
- Findings: oval or linear pattern of lesions, may be one lesion or multiple, may have yellow deposits, pigment, atrophic holes, or retinal tears
- Complications: risk for retinal detachment and rhegmatogenous retinal detachment due to vitreous traction
- Retinal detachment found in 14-35%
- Treatment: most commonly prophylactic laser treatment recommended in patients with vitreous traction and retinal tears associated with flashes and floaters
Snail track degeneration
- Definition: groups of glistening white dots (which have been compared to frost granules or salt), may be early stage of lattice degeneration
- Prevalence: Found in 10% of generation population, more commonly in myopic eyes (40%)
- Characteristics: retinal thinning with vitreous liquefaction above the lesion, associated vitreoretinal tractions
- Findings: more often in superotemporal and superonasal quadrants
- Histologically, this lesion consists of degeneration of the neural elements of retina leading to an atrophy of the tissues with lipid deposits in the internal retinal layers
- Complications: may lead to retinal tears in up to 54% of patients, retinal holes
- Diagnosis: OCT findings show irregular retinal surface, vitreous destruction, vitreoretinal adhesions with traction at the margins
- Definition: area of retinal degeneration caused by attachment to and pulling of the vitreous
- Types include cystic, non-cystic and zonular traction tufts
- Prevalence: non-cystic tufts present in up to 72% of adults, cystic present in up to 5% of adults, zonular traction tufts are present in up to 15% of adults
- Complications: vitreous traction can lead to retinal tear and retinal detachment
- Treatment: prophylactic laser treatment not recommended by majority of physicians, routine follow-up
Peripheral Retinal Tears
- Definition: isolated tear due to defect in sensory retina from traction of vitreous after acute posterior vitreous detachment
- Prevalence: 9-12% of general population
- Characteristics: either retinal tear or retinal hole, retinal holes due to atrophic changes in neurosensory retina
- Complications: high risk of rhegmatogenous retinal detachment, occurs in 3-18% of patients
- Treatment: retinal tears with symptoms on presentation should be treated with prophylactic laser treatment, most commonly transpupillary retinopexy
Paving Stone Degeneration
- Definition: multiple rounded punched-out areas of choroidal and retinal atrophy
- Characteristics: Lesions are yellow-white in color with due to sclera being partly visible through the atrophic choroid, discrete margins that may be pigmented, may become confluent
- Findings: Located between ora and equator with size of one to several disc diameters
- More common in infero-nasal and temporal quadrants
- Large choroidal vessels seen running through the base
- Prevalence: present in 4-28% of patients, bilateral, no sexual predilection, increasingly common with age
- Complications: Benign lesions not associated with complications
Peripheral Retinal Drusen
- Definition: extracellular protein and fat deposits between RPE and Bruch’s membrane, due to degeneration of RPE cells
- Characteristics: looks like crystals
- Findings: small, round-shaped, clearly outlined
- Prevalence: commonly found in patients 40 years or older
- Complications: benign degenerations
- Treatment: prophylactic laser treatment not indicated
- Campagnoli T.R., Smiddy W.E. (2016) Peripheral Retinal Abnormalities. In: Medina C., Townsend J., Singh A. (eds) Manual of Retinal Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-20460-4_49.
- Engstrom RE, Glasgow BJ, Foos RY, Straatsma BR. Degenerative Diseases of the Peripheral Retina. Duane's Ophthalmology. Chapter 26. 2006 Edition.
- Ghazi NG, Dibernardo C. Optical coherence tomography of peripheral retinal lesions in enucleated human eye specimens with histologic correlation. Am J Ophthalmol. 2006;141(4): 740-2.
- Kothari A, Narendran V, Saravanan VR. In vivo sectional imaging of the retinal periphery using conventional optical coherence tomography systems. Indian J Ophthalmol. 2012 Jun; 60(3): 235-9.
- Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. Am J Ophthalmol. 2003 Jul;136(1):155-60.
- Shaimova VA. Peripheral retinal degenerations: Optical coherence tomography and retinal laser coagulation. 2nd ed. Springer International Publishing; 2017.
- Shaimova VA, Pozdeeva OG, Shaimov TB, et al. Optical coherence tomography in peripheral vitreoretinal degenerations diagnostics. Ophthalmology. 2013;10(4):32-9.
- American Academy of Ophthalmology. (2020). Basic and clinical science course, Book 12 Retina and Vitreous, 2020-2021.
PRPD is characterized by a reticular pigmentation that forms a polygonal, netlike arrangement of hyperpigmented lines forming geometric patterns in the peripheral fundus.What causes peripheral lattice degeneration? ›
What Causes Lattice Degeneration? The exact cause of lattice degeneration has yet to be determined, but in a number of cases, the condition is linked to low blood flow or problems with inadequate blood flow to the eyes. It is generally genetic in nature and more likely to occur in people who are myopic (nearsighted).What is lattice degeneration of peripheral retina? ›
Lattice degeneration is a common peripheral retinal degeneration that is characterized by localized retinal thinning, overlying vitreous liquefaction, and marginal vitreoretinal adhesion. The condition is associated with atrophic retinal holes, retinal tears, and retinal detachments.What is retinal degeneration? ›
Retinal degenerations encompass a complex group of disorders that lead to the loss of photoreceptors, the light sensing cells of the eye. Such disorders are the leading cause of untreatable sight-loss in the industrialised world, and currently there is a lack of effective treatments.What causes peripheral retinal drusen? ›
This condition is caused by abnormal blood vessels that break, bleed, or leak fluid into the macula and may cause sudden and severe loss of vision.Is there a cure for retinal degeneration? ›
For now, there's no way to reverse damage from dry macular degeneration. However, there are many clinical trials in progress. If your condition is diagnosed early, you can take steps to help slow its progression, such as taking vitamin supplements, eating healthy and not smoking.Should I be worried if I have lattice degeneration? ›
In summary, lattice degeneration is a relatively common condition that affects the retina, especially in nearsighted people. While its presence increases the risk of a retinal tear or detachment, the vast majority of patients will never experience symptoms or complications from their lattice degeneration.Should I worry about lattice degeneration? ›
When lattice degeneration is present, the retina is more vulnerable to developing tears, breaks, or holes that could ultimately lead to a visually debilitating condition called a retinal detachment. For this reason, once diagnosed lattice degeneration should be closely monitored.Will you go blind from lattice degeneration? ›
In the vast number of cases, lattice degeneration is a relatively benign condition. It becomes a concern if it leads to a retinal tear or detachment. These are very serious conditions that can lead to permanent vision loss and even blindness.Can you live with lattice degeneration? ›
In general, the prognosis for lattice degeneration is positive. Most people who get lattice degeneration do not develop complications and don't require any treatment. Experts believe the condition progresses, but slowly. The prognosis is also good in the rare case that you do get a retinal detachment.
Lattice degeneration is typically treated with laser to strengthen the retina in areas where it is weak. Side effects are reasonably uncommon, but the risk of side effects increases with the amount of lattice and treatment required. Possible side effects include an increase in pupil size in the treated eye.What are the signs of lattice degeneration? ›
- new floaters.
- flashing lights.
- a shadow or gray curtain blocking a part of your vision.
- blurry vision or change in vision.
There are two types — wet macular degeneration and dry macular degeneration. Many people will first have the dry form, which can progress to the wet form in one or both eyes. Retinitis pigmentosa. Retinitis pigmentosa is an inherited degenerative disease.How is retinal degeneration diagnosed? ›
Your eye doctor will put drops in your eyes to dilate them and use a special instrument to examine the back of your eye. He or she will look for fluid or blood or a mottled appearance that's caused by drusen. People with macular degeneration often have many drusen — yellow deposits that form under the retina.How do you reverse retinal degeneration? ›
No treatments can reverse macular degeneration, but some can help prevent the condition from worsening. The treatment for this condition varies according to the stage and type. However, there is currently no method to help with early-stage macular degeneration.What is the difference between drusen and PED? ›
There is no established criterion to differentiate large drusen from drusenoid PEDs, but the Age-Related Eye Disease Study defined a large druse as measuring more than 125 μm and a drusenoid PED as measuring more than 350 μm .Can vitamins help drusen? ›
The AREDS2 vitamins are helpful for people whose retinas have a certain number of white spots called drusen, which can be seen by the ophthalmologist during a dilated eye exam.What is the difference between drusen and macular degeneration? ›
Drusen are the defining feature of macular degeneration. These small yellow or white spots on the retina can be detected by an ophthalmologist during a dilated eye exam or with retinal photography. People with more than a few small drusen are said to have early age-related macular degeneration (AMD).Is retinal degeneration common? ›
Dry macular degeneration is a common eye disorder among people over 50. It causes blurred or reduced central vision due to the breaking down of the inner layers of the macula (MAK-u-luh). The macula is the part of the retina that gives the eye clear vision in the direct line of sight.Do eye vitamins help macular degeneration? ›
These xanthophylls aid in eye health and have been shown to reduce the risk of several eye-related complications [9,10,11,12]. Vitamins A, C, and E are the most effective vitamins for reducing the risk of macular degeneration .
- Regular dilated eye exams. ...
- Eat plenty of vitamin and nutrient-rich foods. ...
- Quit smoking. ...
- Control blood sugar, pressure and cholesterol. ...
- Know your family history. ...
- Protect your eyes from UV rays.
When a patient with lattice degeneration is considered for cataract surgery, one management option includes prophylactic treatment. Given the low incidence of retinal detachment, it is unnecessary to treat all patients with lattice degeneration prophylactically.What foods are good for your retina? ›
- Carrots. Carrots contain beta-carotene, which the body uses to make vitamin A. ...
- Kale. Dark green leafy vegetables like kale, spinach and broccoli are rich in the antioxidants lutein and zeaxanthin, which are present in high concentrations in the retina. ...
- Red peppers. ...
- Salmon. ...
Worse or less clear vision. Your vision might be blurry, and it may be hard to read fine print or drive. Dark, blurry areas in the center of your vision. Rarely, worse or different color perception.What are the three stages of macular degeneration? ›
Early-stage AMD: Medium-sized drusen deposits and no pigment changes, no loss of vision. Intermediate AMD: Large drusen and/or pigment changes. There may be mild vision loss, but most people don't experience any problems. Late-stage AMD: Dry or wet macular degeneration that causes vision loss.What are the three most common ways to diagnose macular degeneration? ›
- Visual field test: An Amsler grid has a grid of straight lines with a large dot in the center. ...
- Dilated eye exam: Eye drops dilate, or widen, your pupils. ...
- Fluorescein angiography: Your healthcare provider injects a yellow dye called fluorescein into a vein in your arm.
Eye injections are a treatment for many eye conditions including wet AMD. They are not a cure. If you stop the injections, you increase the risk of regrowth of abnormal blood vessels. Over the span of weeks to months, you may lose your central vision permanently.What is the best eye injection for macular degeneration? ›
The most common and effective treatment for wet age-related macular degeneration (wet AMD) is called anti-VEGF therapy. Your doctor gives you this therapy through an injection directly into your eye.What are the best eye drops to use for macular degeneration? ›
The most popular medications for treating acute wet macular degeneration now are Avastin, Eylea, Lucentis, and Macugen because they help stop the development of leaky blood vessels in your eye. Although some people may only require therapy once every three months, Lucentis is administered once per month.Who is the best doctor to treat macular degeneration? ›
With Macular Degeneration, you need a medical specialist called a retinologist because the macula is part of the retina.
Treatment of wet AMD requires monthly or bimonthly injections of drugs called anti-VEGF — or anti-vascular endothelial growth factor — into the eye. Anti-VEGF agents can slow or stop the growth of the leaky blood vessels and, in most cases, effectively stave off further vision loss.Can laser eye surgery fix macular degeneration? ›
Laser photocoagulation is a type of laser surgery for the eyes. It is done to treat age-related macular degeneration (AMD). AMD is a condition that can lead to loss of vision.What is peripheral reticulation in the lungs? ›
Reticulation results from thickening of the interlobular or intralobular septa and appears as several linear opacities that resemble a mesh or a net on HRCT scans. 7. The presence of reticulation is indicative of interstitial lung disease.What is age-related reticular degeneration of retina? ›
What is AMD? Age-related macular degeneration (AMD) is an eye disease that can blur your central vision. It happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision. The macula is part of the retina (the light-sensitive tissue at the back of the eye).What does reticular pattern mean? ›
The reticular appearance refers to a collection of innumerable small linear opacities that together produce an appearance resembling a “net”. The pattern can be fine, medium or coarse. Fine and medium patterns are shown here. Reticular patterns represent interstitial lung disease.Is macular degeneration peripheral or central? ›
Age-related macular degeneration (AMD) is a disease that affects a person's central vision. AMD can result in severe loss of central vision, but people rarely go blind from it. Risk factors for AMD include being 50 and older, smoking, having high blood pressure and eating a diet high in saturated fat.Is lung scarring always progressive? ›
Most interstitial lung diseases result in progressive scarring of the lung tissue. Once that occurs, it's generally irreversible. Effective treatments for interstitial lung disease can stop or slow the progression of the scarring.What is the most common treatment for interstitial lung disease? ›
Many people diagnosed with interstitial lung diseases are initially treated with a corticosteroid (prednisone), sometimes in combination with other drugs that suppress the immune system. Depending on the cause of the interstitial lung disease, this combination may slow or even stabilize disease progression.How do people live with interstitial lung disease? ›
Treatment options for interstitial lung disease
Supplemental oxygen can help you increase your oxygen levels, if they're low. Pulmonary rehabilitation may help improve your activity levels and ability to exercise. Anti-inflammatory drugs, such as the steroid prednisone, can reduce inflammation in the lungs.
Interstitial lung and fibrotic abnormalities have been described after infection by other coronaviruses, such as SARS-CoV-1 in 2002 and MERS-CoV in 2012, in approximately one third of patients [15, 16]. View this table: View inline. View popup.
The term refers to the hazy, white-flecked pattern seen on lung CT scans, indicative of increased density.What causes reticular pattern? ›
Common causes of a reticular pattern include usual interstitial pneumonia, nonspecific interstitial pneumonia, fibrosis associated with collagen vascular disease, chronic hypersensitivity pneumonitis, sarcoidosis, and asbestosis.Do you lose peripheral vision with macular degeneration? ›
Macular degeneration doesn't affect side (peripheral) vision, so it rarely causes total blindness.What is the newest treatment for macular degeneration? ›
The Food and Drug Administration (FDA) has approved a new drug for treating two conditions that cause vision loss. The drug Vabysmo (faricimab-svoa) treats wet age-related macular degeneration (AMD) and diabetic macular edema (DME), two of the leading causes of vision loss.What is the difference between macular degeneration and macular degeneration? ›
Macular degeneration involves the breakdown of or damage to the macula typically associated with age (dry macular degeneration) or with the growth and leakage of abnormal blood vessels (wet macular degeneration). In contrast, macular pucker is the result of scar tissue on the retina.