peripheral retinal degeneration

Peripheral retinal degenerations refer to areas of the peripheral retina that present a particular structural fragility [7]. These degenerations can manifest in various forms, including lattice degeneration, peripheral cystoid degeneration, and peripheral microcystoid degeneration.

Lattice degeneration is a condition where an area of the peripheral retina becomes very thin, making it weaker and more prone to developing tears or retinal detachment [6][8]. It is commonly found in myopic individuals and can be bilateral in one-third to one-half of affected patients with a familial predilection [4].

Peripheral cystoid degeneration is characterized by clusters of tiny vesicles in the far periphery, representing splitting of the outer retina layers with cystoid spaces [5]. This condition is almost universal over the age of 20 years and can be associated with retinal tears or detachment.

Peripheral microcystoid degeneration is the most common form of peripheral retinal degeneration, seen in almost all patients above 20 years of age. It begins at the ora serrata and extends posteriorly and circumferentially to the level of the retinal nerve fiber layer [12].

These peripheral retinal degenerations can be asymptomatic but may have a small presentation that can lead to retinal detachment or other complications [9][11]. The standard of care for diagnosing and monitoring these conditions is dilated fundus examination, but current technologies like OCT may aid in differentiation between types of peripheral retinal degeneration and associated complications.

It's worth noting that peripheral drusen and peripheral reticular degeneration (PRD) are also common peripheral retinal findings that can be seen in patients with or without macular degeneration [2]. However, they are distinct conditions with different phenotypes and should be treated as such.

Peripheral retinal degeneration can manifest in various ways, and its symptoms may not always be immediately apparent. Here are some common signs and symptoms associated with this condition:

• Floaters: Small, dark spots or threads that float across your visual field, often more noticeable when looking at a bright background [8].
• Flashing lights: Brief, sudden flashes of light in your peripheral vision, which can be caused by the vitreous gel in the eye pulling on the retina [2].
• Blurred or altered vision: In some cases, peripheral retinal degeneration may cause blurred or distorted vision, particularly if it progresses to a more advanced stage [11].
• Blind spots: Small areas of blindness or visual loss in your peripheral vision, which can be caused by retinal tears or detachment [8].
• Distortions in vision: Straight lines may appear crooked or wavy due to the degeneration of the retina's outer layers [11].

It's essential to note that some people with peripheral retinal degeneration may not experience any symptoms at all, especially if the condition is mild. However, it's crucial to have regular eye exams to detect any potential issues early on.

In cases where lattice degeneration is present, which can be a type of peripheral retinal degeneration, symptoms may include:

• No symptoms: Lattice degeneration often has no noticeable symptoms until it progresses to more advanced stages [14].
• Floaters and flashing lights: As mentioned earlier, these are common symptoms associated with lattice degeneration [6].

If you're experiencing any unusual vision changes or concerns, it's always best to consult an eye care professional for a thorough examination and guidance.

Peripheral retinal degenerations are a group of conditions that affect the outer layers of the retina in the periphery, and can lead to vision loss if left untreated. Diagnostic tests for peripheral retinal degenerations include:

• Optical Coherence Tomography (OCT): This non-invasive imaging test uses low-coherence interferometry to produce high-resolution images of the retina. OCT can help diagnose peripheral retinal degenerations by characterizing structural elements, such as the structure, shape, and depth of retinal changes [10].
• Ultrasound Biomicroscopy (UBM): This diagnostic tool uses high-frequency sound waves to create detailed images of the eye's internal structures. UBM can aid in the diagnosis of peripheral retinal degenerations by elucidating the size and location of retinal changes [14].
• Fluorescein Angiography (FA): This test involves injecting a fluorescent dye into the bloodstream, which is then visualized using a specialized camera. FA can help diagnose peripheral retinal degenerations by analyzing the blood supply to the retina [7].
• Electroretinography (ERG): This test measures the electrical activity of the retina in response to light. ERG can help assess the function of different retinal cells and diagnose conditions affecting the periphery of the retina [6].

In addition to these tests, a comprehensive eye examination by an ophthalmologist or optometrist may also be necessary to diagnose peripheral retinal degenerations.

References:

[10] - Context 10: Optical coherence tomography (OCT) has been shown to greatly benefit in the diagnosis of peripheral retinal degenerations by characterizing structural elements. [6] - Context 6: Electroretinography is a test that measures your retina's response to light. It checks the function of different retinal cells. [7] - Context 7: Fluorescein Angiography (FA) is a diagnostic test that utilizes a specialized camera and a fluorescein dye to analyze the blood supply to the retina. [14] - Context 14: Ultrasound biomicroscopy can aid in the diagnosis by elucidating the size and location of retinal changes.

Treatment Options for Peripheral Retinal Degeneration

Peripheral retinal degenerations can be treated in various ways, depending on the severity and type of degeneration. While there are no clear guidelines for retinal screening and management of these degenerations, treatment options do exist.

• Laser Photocoagulation: This is a common treatment for peripheral retinal degenerations, particularly lattice degeneration. Laser photocoagulation involves using a laser to treat the affected area, which can help prevent further degeneration and reduce the risk of complications such as retinal tears.
• Prophylactic Laser Treatment: For retinal tears with symptoms on presentation, prophylactic laser treatment is recommended. This typically involves transpupillary retinopexy.
• Anti-VEGF Injections: While primarily used to treat wet age-related macular degeneration (AMD), anti-vascular endothelial growth factor (anti-VEGF) injections may also be used to treat certain types of peripheral retinal degenerations.

Other Treatment Options

• Surgery: In some cases, surgery may be necessary to repair a retinal tear or detachment.
• Gene Therapy: Gene therapy products, such as Luxturna, have been approved for the treatment of specific types of retinitis pigmentosa. However, these treatments are typically reserved for more severe forms of peripheral retinal degeneration.

Monitoring and Follow-up

Regular monitoring with dilated fundus examinations is essential to track the progression of peripheral retinal degenerations. After laser photocoagulation, a follow-up examination after 14 days is recommended to ensure that the adhesive force between the retina and choroid has increased.

References:

• [1] No treatment is needed for lattice degeneration aside from regular monitoring with dilated fundus examinations.
• [11] Treatment: retinal tears with symptoms on presentation should be treated with prophylactic laser treatment, most commonly transpupillary retinopexy.
• [12] Time interval between treatment of peripheral retinal degeneration and follow-up examination or intraocular treatment.

Peripheral retinal degeneration refers to a group of conditions characterized by thinning, atrophy, or other changes in the peripheral retina. The differential diagnosis for these conditions is extensive and includes various diseases that can present with similar symptoms.

Common Differential Diagnoses:

• Lattice degeneration: A common form of peripheral retinal degeneration, characterized by oval or linear patches of retinal thinning (6).
• Retinoschisis: A condition where there is a splitting of the retina's inner layers, which can be differentiated from retinal detachment by the presence of absolute scotoma (14).
• Cobblestone/pavingstone degeneration: A type of peripheral retinal degeneration characterized by a cobblestone-like appearance on fundus examination (8).
• Vitreous degeneration: A condition where the vitreous gel in the eye becomes liquefied or shrunk, which can be associated with peripheral retinal degeneration (7).

Other Differential Diagnoses:

• Retinal detachment: A condition where the retina separates from the underlying tissue, which can be differentiated from retinoschisis by the presence of a fluid-filled space between the retina and the choroid.
• Choroidal nevus: A benign growth on the choroid layer of the eye, which can be confused with peripheral retinal degeneration (4).
• Melanocytoma: A rare tumor that arises from melanocytes in the choroid layer, which can present with similar symptoms to peripheral retinal degeneration (4).
• Malignant Melanoma: A type of cancer that originates from melanocytes, which can be a differential diagnosis for peripheral retinal degeneration (4).

Genetic and Inherited Causes:

• Retinal dystrophies or inherited retinal diseases (IRD): A group of degenerative disorders of the retina with clinical and genetic heterogeneity, which can present with similar symptoms to peripheral retinal degeneration (13).
• Best disease: A rare inherited disorder that affects the retina and choroid layer, which can be a differential diagnosis for peripheral retinal degeneration (10).

References:

(4) Bedi N., Shah M., Association of peripheral retinal degeneration with retinal ... (6) Jul 26, 2021 — Lattice degeneration is a common, atrophic disease of the peripheral retina characterized by oval or linear patches of retinal thinning. (7) Vitreous degeneration (8) Cobblestone/pavingstone degeneration (10) The present cases showed similar pigmentary degeneration in the ... (13) Retinal dystrophies or inherited retinal diseases (IRD) (14) Differential Diagnosis.