Medical retina: what the specialty covers, conditions treated and what to expect

The retina is the thin light-sensing layer at the back of the eye, and the macula is its central part, responsible for reading, recognising faces and fine detail. Medical retina is the part of ophthalmology that looks after diseases of these tissues using imaging, medicines and laser. Operations such as vitrectomy for detachment belong to the neighbouring vitreoretinal surgery specialty, and the two services usually work as one team.

The specialists are consultant ophthalmologists who have completed medical school, foundation training and a long ophthalmology training programme, often followed by a retina fellowship. They work alongside optometrists, nurse injectors, ophthalmic photographers and clinic coordinators. A good deal of monitoring and injecting in the NHS is done by trained non-medical staff under consultant supervision, which is how large numbers of patients can be seen on a regular schedule.

Much of the work is long term. Retinal disease is usually chronic, so the relationship is typically measured in years of scans, injections and reviews rather than a single procedure.

The NHS describes age-related macular degeneration (AMD) as a common condition that affects the middle part of vision and usually first appears in people in their 50s. It says AMD does not cause total blindness but can make reading and recognising faces difficult, and that it has been linked to ageing, smoking, high blood pressure, being overweight and family history.

• Wet AMD, where abnormal blood vessels leak under the macula, is the form that responds to injection treatment and needs prompt assessment.

• Dry AMD, which changes more slowly; the NHS says there is currently no treatment for dry AMD, but low vision support and lifestyle advice are available.

• Diabetic retinopathy and diabetic macular oedema, caused by damage to small blood vessels from high blood glucose.

• Retinal vein occlusion, a blockage in a vein draining the retina that can cause swelling of the macula and sudden or gradual blurring.

• Central serous chorioretinopathy, macular hole, epiretinal membrane and inherited retinal dystrophies, which are monitored or treated according to the individual picture.

• Inflammatory eye disease affecting the retina, which is often shared with a uveitis service.

A first visit usually starts with a vision test, drops to widen the pupils and a look at the back of the eye. Because the drops blur vision for some hours, the NHS advises people attending diabetic eye screening to plan how they will get home rather than drive, and the same sensible precaution applies to a retina clinic.

For wet AMD the NHS lists injections of a medicine (anti-VEGF) given directly into the eye, with light treatment to destroy the vessels as another option. For proliferative diabetic retinopathy, the NHS lists laser treatment on the blood vessels at the back of the eye, regular anti-VEGF injections, a steroid implant that releases medicine slowly, and eye surgery to remove scar tissue or blood.

Injections are given in a clean procedure room after numbing drops, and each takes only a few minutes, although the visit as a whole can be long because of scans and checks. Courses usually involve a loading phase of regular injections followed by a schedule adjusted to your scan results. Many people are treated in both eyes over time.

The NHS is clear that sight lost to diabetic retinopathy cannot be cured, and that the aim of treatment is to stop vision getting worse, so keeping blood glucose, blood pressure and cholesterol well controlled is part of the plan.

The NHS says diabetic eye screening is not the same as a regular optician eye test and looks specifically for diabetic retinopathy, often before changes are noticed. People with diabetes aged 12 or over are invited every 1 or 2 years. Screening results decide whether you stay in routine screening, move to more frequent monitoring or are referred to a hospital eye service.

If vision changes cannot be reversed, certification as sight impaired, low vision aids and rehabilitation officers can help you keep your independence. These services are available through hospital eye clinics and local councils and do not depend on having private care.

Most referrals come from an optometrist, diabetic screening service or GP, and urgent suspected wet AMD is meant to be seen quickly. NHS hospital eye services are heavily used and follow-up intervals are sometimes stretched, which is a common reason people consider private care for scans or injections.

Private medical retina clinics typically offer OCT-led assessment and injections for the same conditions. Costs vary and an injection course can run for years, so it is worth asking what a monitoring visit, a scan and each injection cost separately, and whether a switch back to the NHS is possible if your circumstances change. You do not usually need a GP letter, but sending the NHS eye records helps the new team.

• Your glasses, a list of medicines (including blood thinners) and, if you have diabetes, recent HbA1c and blood pressure readings.

• Previous eye letters, scans and the date and drug of any earlier injections.

• Someone to take you home, since pupil drops blur vision for some hours.

• Ask which condition is being treated, which eye, how often review will be, and what a stable result looks like.

• Ask what changes in vision should prompt you to call before the next appointment.

The NHS lists sudden new floaters, flashes of light, a dark curtain or shadow across vision and sudden blurred vision as reasons to get help from NHS 111, and says retinal detachment needs to be treated quickly to stop it permanently affecting sight. If you have diabetes and your eyesight suddenly gets worse, the NHS advises an urgent GP appointment or NHS 111. Sudden complete loss of vision in one eye, severe eye pain with headache or vomiting, or any eye injury should be treated as an emergency: go to A&E or call 999.