There are many neurons and energy sources in life that we often overlook. The retina is one of the powerhouses of our eyes, which often has a powerful impact on visual sensation and transmission to our brain.
This is such a time now, where we can discuss stories on the retina, its layers, role, functions, and treatment as today's demand. Many scientists identify it as a sensory membrane, composed of cellular layers.
Before learning the layers of the retina, clear the confusion, with simple questions like, “What is outside and What is inside?”
As we all know, a vitreous cavity is on the innermost portion of the eyeball. Then we have coats of the eye. The retina falls outside the vitreous cavity but is the innermost coat of eyeball beneath, the sclera and the choroids.
The retina houses some of the important cells like photoreceptor cells, bipolar, ganglion, and Müller cells. Out of which cones and rods are two photoreceptors) with colors, and night vision respectively.
Cones which are the primary color vision cells relay next with the bipolar cells, which relay with the ganglion cells. Similar is the process of rods, which relay with bipolar cells and ganglion cells simultaneously. This primary arrangement of cells within the retina is extremely important for us to have a normal condition.
In the broader spectrum, the retina is classified into 3 layers, pigmented epithelium, photoreceptor layer, and the inner part of the neurosensory retina.
1) The pigmented epithelium, which is adjacent to the choroid, absorbs light to reduce back reflection of light onto the retina,
2) the photoreceptor layer contains photosensitive outer segments of rods and cones,
3) the nuclear layer contains cell bodies that transmit visual signals
But today we also subclassified the nuclear layer in 8 parts, to learn each one based on their functions and roles.
The retinal pigment epithelium is a single layer covering the retina, with other roles to be discussed. This layer has a role in absorbing excess light and maintaining the health of photoreceptor cells. It also has functions relating to waste removal which prevents age-related macular degeneration (AMD) and Stargardt disease.
Light absorption: They are pigmented and melanosomes consist of melanin absorption of extra light
Protection from Damage: RPE protects the eye from phototoxicity and damage from extreme light exposure.
Visual function: It helps in maintaining visual function with the daily turnover of photoreceptor outer segments.
Nutrient Transport: RPE nourishes the neurons through transport like glucose, fatty acids, and retinol.
Development and health of the retina: The RPE secretes various growth factors like Vascular Endothelial Growth Factor (VEGF), Pigment Epithelium-Derived Factor (PEDF), Transforming Growth Factor Beta (TGF-β), Insulin-like Growth Factor 2 (IGF-2), and Platelet-Derived Growth Factor (PDGF). It has roles in the regulation of retinal health, support for photoreceptors, and pathological reasons.
Waste removal: RPE cells remove waste through phagocytosis, autophagy, lysosomal degradation, proteasomal degradation, and exosomal release.
The photoreceptor layer is where the maximum rods and cone cells are located. Rods are highly sensitive to low light levels and responsible for scotopic vision (night vision). Cones help for proper photopic vision (daylight vision).
A thin barrier separates the outer nuclear layer from the photoreceptor layer, providing structural support. This is named so because it is present towards the outer layer of the retina which is towards the RPE.
It is bicepting at the areas of rods and cones at the level of their nucleus.
It consists of the nuclei of the rods and the nucleus of the cones. This layer contains the cell bodies of photoreceptors, where rods and cones convert light into electrical signals.
Captures light and initiates vision by converting photons into electrical signals.
The photoreceptor rods and cones are synapsing with bipolar neurons, consisting of axons and dendrites that look like plexus. No nucleus is present here crucial for initial light signal processing.
Houses the cell bodies of bipolar cells, horizontal cells, and amacrine cells, contributing to visual signal integration. Only the nuclei of the bipolar cells are present in this layer.
Relay signals from photoreceptors to ganglion cells, integrating input from multiple sources to enhance visual acuity.
These cells are primarily found in the inner nuclear layer and play a crucial role in modulating the input from multiple photoreceptors. They are involved in enhancing contrast through lateral inhibition and help the retina adapt to varying light conditions134.
Similarly, amacrine cells are also located in the inner nuclear layer. They lack axons and are essential for processing visual information by interacting with bipolar cells and retinal ganglion cells at the inner plexiform layer (IPL). Amacrine cells contribute to various functions, including edge detection and temporal processing of visual signals
A synaptic layer where bipolar cells connect with ganglion cells, facilitating complex interactions necessary for visual signal processing. There are no nuclei present, only p
The ganglion cell layer comes 8th in the order that stores the nucleus of retinal ganglion cells (RGCs). It processes information relating to the contrasting color and shape of the image and relays it to the brain with the help of other cells.
The Optic Nerve Fiber layer is one of the important layers, in fac,t it is the one that primarily transmits visual signals from the retina to the brain via the optic nerve. It is made up of unmyelinated axons which bundle up to form the optic nerve head.
The inner Limiting membrane is the innermost layer of the retina. It acts as a barrier between the retina and the vitreous body. It has specialized glial cells that provide structural support to the retina. The ILM is a true basement membrane, measuring approximately 0.5 to 2 micrometers in thickness. It is one of the thickest and smoothest later near the fovea on the vitreal side.
The retinal surface is quite uneven due to the branching process of the Muller cells. The ILM has important functions such as.,
All the cell systems that need to be kept together by support cells are Glial cells (neuroglial cells), which are Muller cells. These cells act as a nutritive function and support framework for the retinal layer.
They are present vertically to limit the horizontally arranged cells. Through the vertical matrix of the neuroglial cells, all our cells are going to pass. At some point, they are going to perforate it at two points.
The outermost ending of the Muller cells where retinal cell layers are perforating are outer limiting membranes and the innermost layer where cells make perforation is an inner limiting membrane. Limiting membranes are nothing but the perforations of the retina on the vertical arrangement of Muller cells through which rods, cones, and nerve fiber layers pass. These are the supporting structures of the retina.
The thickness of the NFL can be indicative of various ocular diseases, particularly glaucoma. OCT is commonly used to measure the thickness of NFL, which allows early detection of retinal disease.
In retinal degenerative diseases, the primary target for pathology is the retinal photoreceptor cells. The pathological processes cause the photoreceptors to be dysfunctional and die.
If you have any conditions like retinitis pigmentosa, you start to see the thinning of the NFL.
RP primarily damages the outer retinal layers, but it can have secondary effects on the inner retina like cell death and thinning of the NFL over time.
The loss of photoreceptors can trigger transneuronal degeneration, decrease in the number of axons in the NFL, resulting in measurable thinning,
There can be age-dependent thinning, but RP patients have a faster rate of thinning than healthy individuals.
Even, glaucoma is primarily detected with NFL thinning, with further, optic disc excavation and progressive loss of retinal ganglion cells. Elevated intraocular pressure (IOP) and subsequent damage to retinal ganglion cells result in the thinning of the NFL layer.
The rise in IOP can also lead to reduced perfusion pressure in the optic nerve head, resulting in ischemic damage.
The thinning of the RNFL is often not uniform; it typically presents as localized defects corresponding to areas of glaucomatous damage
Greater loss in the superotemporal and inferotemporal quadrants, which are critical for visual field sensitivity
In MS patients, NFL thinning can be a biomarker for neuroaxonal damage. There can be an inflammation and subsequent axonal loss that can trigger optic neuritis.
Thinner NFL measurements may indicate systemic circulation issues that could contribute to retinal nerve fiber loss
Conditions such as Alzheimer's disease and other forms of dementia have been linked to NFL thinning, making the retina vulnerable to neurodegeneration.
Instances of RNFL thickening due to inflammatory edema or other factors. It causes fluid build-up within retinal layers, contributing to swelling and RNFL thickening. The underlying reason for inflammatory edema can be ischemia and chronic inflammation. Even the uveal tract inflammation can lead to subsequent RNFL thickening.
Retinal problems need immediate attention. There can be alterations in clarity or quality of vision, such as blurriness, and reduction in side or central vision.
There are 3 primary treatment options for retinal problems discovered to date. Not all the advances have made their way to Nepal, they are still in the early stages and may not assure 100% treatment or recovery as these are still experimental and not accessible to all Nepalese yet.
Anti-VEGF is a therapy for improving growth factor secreted in the retina, which treats conditions like diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD). In Nepal, Bevacizumab is the most commonly used anti-VEGF agent, followed by Ranibizumab and Aflibercept.
Patients undergoing anti-VEGF therapy have recommended a positive response with regular follow-ups. The use of anti-VEGF agents has brought quite a revolution to retinal care. Each injection dose can cost you around NRs 6,000 to 10,000 and you get the treatment directly from Tilganga.
Gene therapy in Nepal is largely experimental. It helps one with inherited retinal diseases such as
For aiding visual function, there is the use of Luxturna (voretigene neparvovec-rzyl). These can be quite expensive but the initial results are promising, though the access is still limited in Nepal.
Stem Cell therapy in Nepal is an effective treatment option for individuals with retinal eye diseases. The treatment facility is offered for over 50 different conditions, including autism, stroke, arthritis, diabetes, and COPD, especially for genetic linkage to disease.
The cost of stem cell treatments in Nepal is relatively lower compared to developed countries. From some sources, it is estimated that the cost of stem cell therapy for retinal diseases in Nepal is under 4 lakhs, but it's more than $4500 in developed countries. However, it is not accessible in Nepal.
Retinal problems can manifest through various symptoms and impact different layers. One must understand the timely intervention and treatment. Inquire us if you have any additional queries. Book your appointment today to get initial; consultation discounts and get the best of eye care clinic services and products at a great deal.
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