What is chorioretinal retinal dystrophy? Peripheral retinal dystrophy: classification, signs, methods of diagnosis and treatment

Laboratory examination peripheral retina eyeball always caused some difficulties due to the fact that it is located at quite a great depth. Nevertheless regular examination peripheral zone of the retina is extremely important, especially for people suffering from high myopia, since they are the risk group for the development of PCRD.

PCRD is a fairly common ophthalmological disease, which is characterized by thinning of the peripheral parts of the retina, which subsequently leads to its ruptures. Peripheral chorioretinal retinal disorders became most widespread in the period from the early 90s to 2010.

During this time, the number of people with this pathology has increased by more than 18 percent. Peripheral chorioretinal dystrophy can affect people with to varying degrees visual acuity. Nevertheless, people suffering from myopia have the greatest predisposition to this disease. This is due to the fact that myopia provokes an increase in the longitudinal axis of the eyeball, as a result of which the peripheral part of the retina suffers (tears may appear).

Researchers, in addition to myopia, name a number of other reasons why degenerative changes retina, among them:

heredity;
long-term disease with retinitis or chorioretinitis;
hypertension;
atherosclerosis;
diabetes;
different types of intoxication;
impaired blood supply to the periphery of the retina;
hard physical labor;
consequences of eye surgery;
consequences of head injuries.

The main cause of chorioretinal dystrophy of the retina is a violation of hemodynamics in the peripheral part of the retina of the eyeball. Even a detailed examination of the fundus is not always able to establish accurate diagnosis, since a standard examination does not allow us to see the full picture of the peripheral zone of the retina. High myopia only enhances chorioretinal vascular disorders, since the length of the eyeball increases slightly, which provokes a thinning of all its membranes.

The following forms of peripheral retinal dystrophy are distinguished:

PCRD already known to us.
as well as PVRD (peripheral vitreochoreoretinal dystrophy).

PVCRD is characterized by more wide range distribution dystrophic changes, which affects not only the retina, but also the vitreous body and the choroid of the eye.

Lattice retinal dystrophy is often a consequence of retinal detachment. This type The disease is often hereditary in the male half of the population. This type of disease is characterized as peripheral chorioretinal dystrophy of both eyes, since it affects immediately both human eyes.

Lattice dystrophy got its name due to the peculiar pattern that is detected when examining the fundus of the eye by an ophthalmologist. Typically, lattice dystrophy appears as a collection of uneven lines that form a lattice pattern.

“Snail track” dystrophy is a type of peripheral chorioretinal dystrophy that, when examined in the fundus, looks like shiny, uneven tracks reminiscent of a snail track. Subsequently degeneration of this type dystrophy, round breaks may appear in the retina.

A predisposition to frost-like dystrophy is most often inherited. Appearance retinal lesions resemble yellowish snow flakes. The peculiarity of this type of dystrophy is that it develops quite slowly and does not often lead to retinal tears.

Cobblestone dystrophy is much more advanced than other types of peripheral chorioretinal dystrophy. Retinal lesions are located mainly in the lower part of the fundus. The breaks and pigment particles combine to resemble tightly packed cobblestones, making this form the disease received this name.

In terms of the range of its location, hand-shaped dystrophy ranks first among all types of peripheral retinal dystrophy. Lesions of the retina of the eye form characteristic cysts, at the site of which ruptures may occur during severe physical activity or serious injuries heads.

Signs and symptoms

Peripheral chorioretinal dystrophy is dangerous because it is quite for a long time it does not manifest itself in any way: the patient may not even suspect that he has such a serious illness. Thus, the patient consults a doctor only if he has characteristic symptoms, which indicates a severe form of the disease.

Symptoms of peripheral chorioretinal dystrophy include the following:

sharp flashes before the eyes;
a sharp decline visual acuity;
the occurrence of scotoma;
spots before the eyes;
"floaters" before the eyes.

As the disease progresses, the patient's field of vision is significantly narrowed, as a result of which the patient cannot perform work that is related to the functioning of peripheral vision. Central vision, as a rule, is not affected: the patient can read, write, and even draw without hindrance.

Diagnostics

The diagnosis of peripheral chorioretinal dystrophy of the retina can only be made on the basis laboratory research, appointed qualified ophthalmologist, which should be contacted immediately when the first signs of the disease occur. A number of diagnostic measures taken for chorioretinal disorders include:

ophthalmoscopy.
perimetry.
visometry.
refractometry.
ultrasound examination of the eye.

Treatment

After making a diagnosis, the doctor prescribes treatment for retinal CPRD, which varies depending on the stage of the disease and the individual characteristics of the patient. If the process of development of peripheral chorioretinal dystrophy has not gone too far and the disease is at the initial stage, measures are taken to slow down the degenerative processes of destruction of the structure of the retina of the eye. To this end ophthalmologist may prescribe therapy using the following drugs:

vasodilators;
angioprotectors;
corticosteroids;
diuretics;
biogenic stimulants;
antioxidants;
medications that have a positive effect on metabolism.

Often, in addition to the main treatment, they are prescribed special complex vitamins containing lutein, which help relieve eye strain. Deterioration of vision with age is often associated with a lack of lutein in the body. It is for this reason that patients over the age of 45 need to replenish its reserves by regularly taking vitamins that contain this substance. Beneficial effect on human visual function vitamin complexes which include vitamin C, E, as well as zinc.

Physiotherapy methods such as:

phonophoresis.
electrophoresis.
ultrasound.
microwave therapy.
laser intravenous irradiation blood.

Often, large ophthalmological centers offer this method of combating chorioretinal dystrophy and its consequences such as retinal detachment using laser coagulation. The essence of the procedure is to cauterize particularly problematic areas of the retina of the eye, which prevents its further delamination. Laser coagulation is used even for elderly people and small children, since it is practically painless and bloodless.

Consequences

If the patient contacts an ophthalmologist in a timely manner, the prognosis will be favorable. The problem in diagnosing and treating chorioretinal dystrophy is that the patient consults a doctor only if there are characteristic symptoms, such as “lightning” and “floaters” before the eyes, which indicates retinal dissection.

Delay in treatment in this case can lead to vision loss.

Retinal detachment can lead to the formation of chorioretinal scars at the junction of the retina and choroid eyeball.

Prevention

Preventive measures to prevent retinal detachment caused by chorioretinal disorders should be aimed at timely detection and treatment of the disease. To do this, patients with myopia and other visual impairments who are at risk need to visit an ophthalmologist at least once a year.

The rest of the time for correction visual function patients should use glasses and contact lenses. In addition, patients at risk should avoid heavy physical activity.

The study of peripheral parts is a difficult process, often causing some difficulties. This is due to its location - deep in the eye, but it is there that a fairly common ophthalmological disease, called peripheral chorioretinal dystrophy, can develop. With it, the affected areas of the retina become much thinner, gaps form, which leads to very serious complication- retina.

Typically, this disease more often affects people suffering from eye pain, because longitudinal stretching of the eye can provoke severe changes in the retina, as well as other tissues of the organ of vision. It has been found that people with more high degree Myopia has a high likelihood of causing retinal dystrophy.

Classification of PCRD

Peripheral dystrophy retinal damage can be acquired as well as hereditary. It is detected with equal frequency in both young and elderly people. The area of localization of the disease is decisive for its type. This is how it is customary to distinguish:

Chorioretinal dystrophy - involving the retina and;

Vitreoretinal dystrophy - involving the retina and.

At the same time, peripheral dystrophy is divided into: lattice, cystic, frost-like.

Signs of the disease

The initial stage of dystrophy is asymptomatic with no patient complaints, which makes the disease especially dangerous. After all, a person pays attention to changes in vision only during the period of complications - ruptures and retinal detachment. The process of detachment is accompanied by the appearance of unexpected flashes, lightning, and fluttering “flies” before the eyes. In addition, a sign of the developed disease is a sharp drop in visual acuity and a voluminous spot that appears before the eyes. If these manifestations occur, you must immediately contact an ophthalmologist, otherwise irreversible blindness may occur.

Video of a specialist about PCRD

Diagnosis of peripheral retinal dystrophies

In the diagnosis of peripheral dystrophy, a three-mirror Goldmann lens is used, which makes it possible to examine areas invisible with a conventional ophthalmoscope, which reveals the most dangerous disorders. The inspection is carried out with an expanded view. Often, for a more detailed study of the affected area, a method is used that involves retracting the retina to the middle, which makes it possible to inspect peripheral areas.

With initial modifications of the retina, treatment is not necessary, but this period requires dispensary observation behind the patient and periodic photographing of the periphery using a slit lamp.

Treatment and prevention of peripheral dystrophies

Establishing a diagnosis of peripheral retinal dystrophy requires long-term observation of the disease or laser treatment. In the case of laser treatment, the affected areas of the retina are separated from the center with an artificial barrier, which prevents further detachment. This method is considered to be particularly effective, because it eliminates the need to use surgical intervention. Laser treatment, at its core, is effective prevention retinal detachment. This procedure does not cause pain, is easily tolerated, takes less than 15 minutes. It is performed on an outpatient basis and does not cause any damage to the patient’s vision. In the later stages of the disease, complex surgical intervention, which in advanced cases often does not give the expected result, and it is not possible to completely restore vision.

Prevention of this disease is mandatory for patients suffering from myopia; diabetes mellitus; children born after difficult births; persons with a genetic predisposition to peripheral dystrophies.

PCRD and pregnancy

Peripheral retinal dystrophies may serve as a contraindication to childbirth naturally. To prevent the retina during the pressing period (or during Everyday life) carry out PPLC - preventive peripheral or delimiting laser coagulation retina (depending on the severity of changes in the fundus). They can be performed during pregnancy - there are no contraindications.

It is worth understanding that the ophthalmologist’s opinion is only one of the factors that the obstetrician takes to decide on the method of delivery (along with the size of the pelvis, fetus, etc.).

Where to go for treatment

Laser treatment for peripheral retinal dystrophies is available today in many large ophthalmology centers. And yet, choosing a clinic for yourself is a very important moment, because the prognosis for recovery, as well as the result of treatment, will largely depend on the quality of the examination and the professional skills of the attending physician.

By contacting any of the well-known eye clinics Moscow, you are guaranteed to see excellent diagnostic doctors, and then, according to indications, you will be referred to a highly qualified specialist in laser surgery. Only the best professionals with extensive experience behind them work in ophthalmological centers clinical practice. And the technical equipment of the clinic allows us to guarantee excellent results even in the most difficult cases eye diseases.

Retinal dystrophy - extremely dangerous disease, characterized by a chronic progressive process of destruction of eye tissue. The impetus for the development of dystrophy can be a violation of metabolic processes and the appearance in tissues of qualitatively and quantitatively changed metabolic products.

Retina human eye is a very thin layer of nervous tissue located between the vitreous body and the choroid of the eyeball. It plays an important role in the perception, transformation, transmission to the brain and processing of visual images received by a person. When the retina is damaged, problems with vision occur (up to its complete loss).

Causes of development of retinal dystrophy

Retinal dystrophy can be either an acquired disease or caused by a hereditary genetic factor.

Factors that increase the risk of developing the disease:

eye injuries;
serious illnesses internal organs(liver, kidneys, adrenal glands, etc.);
scleroderma;
rheumatoid arthritis;
complications caused by or ARVI;
other eye diseases (for example, or);
disruption of blood supply to cells;
infectious diseases;
pregnancy;
diabetes;
intoxication;
hormonal imbalance;
elderly age;
smoking;
dysfunction of the thyroid gland;
poor nutrition;
weight disorders;
elevated cholesterol levels, etc.

Chorioretinal retinal dystrophy

One type of dystrophy is chorioretinal retinal dystrophy (age-related macular degeneration), which is accompanied by a slowly progressive, chronic process of loss of central vision in both eyes. The disease predominantly develops in people over 50 years of age. Moreover, it is diagnosed in women more often than in men. Even the most complex forms of the disease do not lead to complete loss of vision, since with this type of dystrophy the peripheral vision. Chorioretinal retinal dystrophy can be of two types:

On initial stages chorioretinal retinal dystrophy does not appear, and visual acuity remains normal. Later symptoms Dry type retinal dystrophies are expressed as follows:

accumulation of colloidal substance occurs between Buch's membrane and pigment epithelium retina;
pigment redistribution occurs;
the pigment epithelium atrophies;
the choriocapillaris layer atrophies;
Doubling of objects begins, their clarity decreases when viewed at close range;
Blind spots form in the field of vision.

With the development of wet type dystrophy, the following occurs:

periodic occurrence of refractive errors (for example, farsightedness);
shapes, straight lines, and sizes of objects are distorted;
formation of translucent spots in the field of view;
there is a slight dome-shaped elevation of the retina in the area of its detachment;
a sharp decrease in vision is possible (usually at the stage of neovascularization);
the formation of a focus of pigment accumulation (can be light pink or gray-brown);
neoplasm of vessels (which can rupture, forming subpigmented or subretinal - rarely hemophthalmos can form);
cystic changes in the retina;
formation of fibrous tissue;
the appearance of scars.

Peripheral retinal dystrophy

Peripheral retinal dystrophy is another type of dystrophy. It represents degenerative changes in the retina of the eye, localized in its peripheral parts and not affecting the macular zone (the area of clearest vision). The disease is hereditary and genetic in nature and very often develops in myopic people.

Video: Peripheral retinal dystrophy - says an ophthalmologist

Peripheral retinal dystrophy can have the following types:

"lattice" dystrophy;
dystrophy of the “snail track” type;
degenerative retinoschisis;
“white without pressure”;
small cystic degeneration;
"snowflakes";
"cobblestones";
honeycomb degeneration;
paraoral pigmentary degeneration.

Retinal pigmentary dystrophy

One of the rarest types of dystrophy is retinal pigmentary dystrophy, caused by a hereditary genetic factor. Can be transmitted in the following ways:

Video: Retinal dystrophies: central and peripheral

from mother to son with an X chromosome;
through transmission of disease genes from both parents (autosomal recessive mode);
through the transmission of a pathological gene to a child by one of the parents (autosomal dominant method).

Retinitis pigmentosa affects men more often than women.

Symptoms of this type of retinal dystrophy are:

poor vision in the twilight (both eyes see poorly);
frequent trips, collisions and loss of balance in low light conditions;
gradual narrowing of the peripheral visibility zone;
increased eye fatigue.

Treatment of retinal dystrophy

Depending on the type of disease and the cause of its development, an individual treatment is selected for each patient. complex therapy. The decisive factors in determining it are:

how long ago the retina began to detach;
size of detachment;
number of breaks in the detachment;
locations of ruptures, etc.

The main treatment method for retinal dystrophy is laser surgery. Cryopexy (cold exposure) can also be used to close a retinal tear. To improve sealing performance, a silicone seal is sutured to the eyeball, shaped like a cord. By applying pressure to the wall of the eye, it allows the detached retina to be brought closer to the choroid.

The surgical procedure may be as follows:

local filling of the retina in the area of the gap (necessary for partial retinal detachment);
circular filling (necessary in cases where the retina is completely detached);
vitrectomy (removal vitreous followed by its replacement with liquid silicone, saline solution, perfluorocarbon compound in the form of liquid or gas);
laser coagulation (allows you to limit the areas of retinal rupture, the areas of greatest thinning).

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Chorioretinal dystrophy is a serious illness that affects many older people, mainly women. It affects the most subtle and complex structures of the eye - individual layers of the choroid and retina, which are directly involved in the formation of vision. Therefore, after some time, a person loses the ability to see normally, and modern medicine does not have methods that could completely eliminate this pathological process.

General information

This is a disease in which involution (reverse development) of important eye structures occurs:

pigment cells that capture light rays;
choriocapillaris layer in the choroid;
intermediate vitreous plate (Bruch's membrane);
sometimes the posterior portion of the vitreous is also involved in the process.

The disease has another name. Due to irreversible age-related changes a person gradually loses vision, but, as a rule, does not go completely blind. However, his ability to work with small objects, drive vehicles, read, and write is gradually becoming impossible.

Why do these appear? pathological changes, is not always clear, but it is assumed that the main causes are previous physical and chemical injuries eye, atherosclerosis, infectious diseases, circulatory and metabolic disorders.

Sometimes the disease occurs as a congenital disease, transmitted in an autosomal dominant manner.

Possibly a provoking effect of harmful physical factors– ultraviolet radiation and free radicals.
According to statistics, women are more likely to get sick in old age and in the presence of predisposing factors: light eyes, immune or hormonal imbalances, increased arterial pressure, and a tendency to bad habits.
Types of disease
Depending on the course of the disease and the complex of its manifestations, the following forms of pathology are distinguished:
Dry non-exudative atrophic chorioretinal dystrophy of the retina is an early form and affects the cells of the pigment layer. The ability to see fades gradually, and after five years the pathology affects the tissues of both eyes.
The wet (exudative) form develops as a complication of the dry form in approximately 10% of patients, passes rapidly and severely, with detachment of the nervous and pigment layers, the formation of scars and hemorrhages. It begins when visual acuity is still fairly good, and later may be accompanied by astigmatism, farsightedness, and myopia. This is followed by deformation and dysfunction of the adjacent tissue layers.

With central chorioretinal dystrophy of the retina (abbreviated as CCRD), the central portion of the layers of the eyeball is affected.
Peripheral chorioretinal dystrophy (PCRD) is a lesion of peripheral areas. There are separate varieties of it: in the form of a “snail trail” (with glittering whitish streak-like inclusions), lattice (with the formation of alternating dark and light stripes, reminiscent of a staircase), frost-like (with deposits in the form of snowflakes), in the form of a “cobblestone pavement” (with noticeable large lumps of pigment), small cystic (with the formation and possible fusion of small cysts).

Peripheral vitreochorioretinal dystrophy (PVCRD) is a disease of peripheral areas involving the vitreous. With this type, adhesions often form, which increase the likelihood of ruptures in the layer of light-sensitive cells. PVHRD is more common in patients with myopia.

Symptoms and diagnosis
A patient may suspect that he has such a disease based on the following symptoms:
distortion of lines that are actually straight;
blurred image;
double vision;
the appearance of flashes of light in the field of view;
blind spots in the field of vision;
difficulties in reading and writing.

All these manifestations indicate that pockets of damaged tissue have appeared in the eye, which interfere with the perception of the picture of the surrounding world and the transmission of information to the brain.

After the first manifestations, you need to consult an ophthalmologist. To make a diagnosis, he may prescribe the following examinations:
checking visual acuity, including using traditional tables;
ophthalmoscopy – instrumental examination the fundus, its vessels, light-sensitive cells and the place of their contact with the optic nerve;
Amsler test - testing the patient’s ability to correctly evaluate straight and curved lines: in images where healthy people see a straight grid, people with macular degeneration see distortions;
laser scanning tomography - definition anatomical features structures that may be damaged due to degenerative processes;

perimetry – study of the boundaries of the visual field;
campimetry – determination of the central visual field;
electroretinography – examination functional state light-sensitive cells, based on fixation of electrical potentials when stimulated by light;
fluorescein angiography of retinal capillaries - examination of the vessels of the eyeball using a fluorescent dye, which is injected into the cubital vein and enters the capillaries of interest to the doctor through the bloodstream.

When examining a patient, the doctor can detect retinal drusen of colloidal substance (in the dry form), pigment recombination, and necrosis of adjacent tissues between the pigment layer and Bruch’s membrane. An eye test reveals a blind spot in the center of the visual field.
At a certain stage of the course wet form the retina becomes dome-shaped, which precedes its detachment (although sometimes it returns to its original position).
The last stages of development are manifested during diagnosis by focal accumulation of pigments and newly formed capillaries.

The retina protrudes towards the vitreous body in the form of a cyst. The condition is accompanied by hemorrhages of the eyeball and very low ability to see.
Treatment and prognosis
Treatment of chorioretinal dystrophy includes several components and techniques, but all of them can only slow down the course of the disease, but not cure it completely.
Drug therapy for non exudative form includes the administration of anticoagulants and antiplatelet agents intravenously or in the form of parabulbar injections. Required medications for supporting normal condition vessels of the body, including the affected choroid. Hormonal and multivitamin therapy is prescribed. In the exudative form, other measures are added aimed at eliminating edema and newly formed membranes.

How additional procedures may be prescribed:
photodynamic therapy is a procedure based on alternating exposure of the eye to light of different colors;
electrical stimulation and magnetic stimulation of the retina;
laser therapy - laser coagulation, cauterization of the retina to prevent further damage;
vasoreconstruction in the area of the photosensitive layer;
vitrectomy – removal of part of the vitreous body if it is affected due to the development of PVCD;
revascularization - restoration of the capillary network and normal blood supply.

Central chorioretinal dystrophy, like all its other varieties, requires constant medical supervision, so you should visit an ophthalmologist at least twice a year.
If the disease develops during pregnancy, then visits to the ophthalmologist in the first and third trimesters, as well as after childbirth, are mandatory to monitor the condition of the eyeball after undergoing stress.

This disease may be impossible to prevent if there is genetic predisposition. But you can reduce the risk of its rapid progression and complications. Any kind of negative influences, maintain visual hygiene, try to cure other diseases on time and before full recovery(in particular, do not ignore sources of infection in organs and tissues). It is very important to eat right, consume foods necessary for visual ability and normal operation vessels. Quitting bad habits significantly reduces the risk of damage to the choroid.

Vision is one of the the most important factors our life. Our mood, well-being and health largely depend on how well we perceive everything in the world around us. , unfortunately, we usually begin to appreciate only when we begin to experience problems with it. Once again I repeat, you shouldn’t put it off and hope that later, the time will come and I will pay attention to it... It’s not uncommon for this to happen later, it may already be too late a stage.

August 2, 2015 . While working at the computer, I noticed that some lines seemed to me to be curved, those that I knew for sure were straight! This immediately alerted me and I immediately called a doctor I knew (endocrinologist) and described my problem. The doctor suggested internal hemorrhage, which is what causes such special effects with vision. And I strongly recommended as soon as possible contact an ophthalmologist.

Such curvature of the lines only happened when I looked with my left eye and closed my right eye. On the same day, I made an appointment with an ophthalmologist in our city, in whom I have the greatest confidence; unfortunately, she could see me only on the 5th, after 3 days.

August 5, 2015 . After examining the fundus by an ophthalmologist, a referral was given to the Fedorovsky Center in Krasnodar; swelling was found in the fundus, but there was no hemorrhage.

August 7, 2015 . Consultation at the Eye Microsurgery Center with laser surgeon E.V. Vasiliev, who performed the operation on me several months earlier, when vision problems had just begun ().

Examinations were carried out during which the laser surgeon determined that the operation was in this case not acceptable. , is not treated with laser in all cases. In my case, as they explained to me, there is only one option - a direct injection of Lucentis into the eye.

An injection of Lucentis is not a cheap pleasure at all, an ampoule of this medicine costs about 50 thousand rubles, the amount of substance in one ampoule is enough for three patients, but in the Fedorovskaya clinic they do not share it. And I had to look for options. Having contacted the same clinic in office 120, dealing with discounted medications and quotas, I learned that only the distribution of quotas for this medicine will be in 2 months.

I found out that at the Krasnodar TRI-Z clinic they are recruiting groups for these injections, August 11, 2015 . I went for a consultation at a branch of this clinic located in our city. There the cost of such an injection is 29 thousand. Here are the surveys of our branch:

The next stage is that I have to go to Krasnodar to this glinika for a consultation with a laser surgeon, who will already assign me to a group of three people, which they form, having previously called, I will go to the consultation August 14, 2015 . and the injection will be okay August 26, 2015 . I'm leaving tomorrow morning, I'll write when I get there...

August 14, 2015 . A consultation with a laser surgeon at the TRI-Z clinic in Krasnodar showed the need for a Lucentis injection, after additional consultation with an anesthesiologist, I was scheduled for August 26th.

Over the weekend, the clinic called me back and said that a place had become available for August 19, I, of course, agreed, although I had to speed up in terms of collecting the required documents and tests that I must provide before this procedure:

Fluorography
Analysis of urine
General blood analysis
Doctors' permission:
- therapist
- Dentist
Hepatitis marker
ECG with interpretation

Much of what is required can be completed in the clinic itself. The cost of the Lucenis injection itself in a group of three people is 30 thousand rubles. but for this you need to wait for the formation of the group. Injection without group 86 t.r.

August 19, 2015 . An injection of Lucentis was given. The procedure takes 15 minutes, I admit that it was a little scary, I watched enough videos of how they do it, I thought it was very painful procedure... I was wrong, we can say that pain no, there is only one slightly unpleasant moment, but even then it lasts a couple of seconds and then, by and large, you can not perceive it. So if they do it to someone and he doesn’t yet know how it happens, don’t worry about sometimes it hurts more to stab you in the ass!

At the appointment, Dr. Anton Albertovich, who gave the injection, told me to come to him in a week.

September 21, 2015 I had a follow-up consultation. The date of the next injection is October 14. The dynamics are very slight positive, there are indications for the next injection, as the laser surgeon said. I don’t understand why, if the dynamics are even small, but there are positive ones, and during this time my vision with this eye has become noticeably worse. I see more curvatures and it feels like more fields of vision are missing.. Examination results: