Eagleview Eye Clinic

Category Eye Health Education

DISCIFORM SCAR

Disciform scar is the final scar stage of wet AMD or other causes of choroidal neovascularization (CNV). It’s basically the eye’s “healing” response after a bleed under the macula, but the scar damages central vision.

What it is

  • Definition: A gray-white, disc-shaped fibrous scar under the retina in the macular area
  • Size: Usually 1-5 mm wide, right where you need sharp vision
  • Tissue: Made of fibrous tissue, blood vessels, and pigment after a CNV membrane closes off

How it forms

  1. CNV develops: Abnormal blood vessels from the choroid break through Bruch’s membrane into the subretinal space
  2. Leakage and bleeding: Those vessels are fragile. They leak fluid and blood under the macula
  3. Inflammation + scarring: Your body tries to heal the bleed. Fibroblasts lay down collagen and the CNV becomes fibrotic
  4. RPE disruption: Retinal pigment epithelium clumps or dies, leaving pigment changes around the scar
  5. End stage: Active leakage stops, but the scar remains. This whole process takes weeks to months

Main causes

  • Wet age-related macular degeneration: Most common cause. Seen in patients 60+
  • Pathologic myopia: Can also end in a disciform scar, but in younger myopes it’s often called a Fuchs spot
  • Ocular histoplasmosis: POHS can cause CNV and scarring
  • Trauma or inflammation: Any CNV that bleeds can end this way if untreated

Appearance on exam

  • Color: Gray-white to yellow-white central lesion
  • Shape: Round or oval, “disc” like
  • Surrounding changes: Pigment clumps, atrophy, or lipid deposits at the edges
  • Size: Correlates with how bad vision loss is. Larger = worse

Symptoms

  • Central vision loss: Permanent blur or blank spot in the middle of vision
  • Distortion first: Before scar forms, patients report wavy lines from fluid. After scarring, it’s replaced by a fixed blind spot
  • Peripheral vision stays: You won’t go completely blind. Side vision is normal
  • Contrast loss: Reading and faces are hard even if acuity isn’t terrible

Diagnosis

  • Dilated fundus exam: Doctor sees the pale elevated scar
  • OCT scan: Shows hyperreflective subretinal material, loss of outer retinal layers, RPE disruption
  • Fluorescein angiography: Early CNV leaks. Late disciform scar stains but doesn’t leak because vessels are closed
  • History: Patient usually describes sudden vision drop months earlier from a bleed

Treatment

  • No reversing the scar: Once formed, the tissue is fibrotic and vision doesn’t return
  • Goal is prevention: Anti-VEGF injections like Avastin, Eylea, Vabysmo treat active wet AMD before it scars
  • Too late if scarred: Injections don’t help a mature disciform scar
  • Low vision rehab: Magnifiers, better lighting, eccentric viewing training to use peripheral retina

Disciform scar vs Fuchs spot
Feature Disciform scar Fuchs spot
Main cause Wet AMD Myopic CNV
Age 60+ usually 30s-50s
Color Gray-white fibrous Dark pigmented
Eye shape Normal axial length Long, >26.5 mm
Bilaterality Second eye at risk in 4-7 years Second eye at risk in 30-35%
Prognosis

  • Vision: Usually 6/60 or worse if the scar is subfoveal. If it’s off center, vision may be 6/12 to 6/24
  • Stability: Scar doesn’t grow, but geographic atrophy can develop around it
  • Other eye: High risk of wet AMD in fellow eye. Regular monitoring with Amsler grid and OCT is key

Bottom line: A disciform scar is the “tombstone” of wet AMD. Modern anti-VEGF therapy has made them much less common because we can shut down CNV before it bleeds and scars. That’s why sudden distortion or vision drop needs an urgent retina check.

FUCH’S SPOT

Fuchs spot = Fuchs’ spot. It’s a pigmented scar in the macula caused by bleeding from choroidal neovascularization (CNV). Almost always seen in people with pathologic myopia.

What it is

  • Location: Center of the macula, the part of your retina used for sharp central vision
  • Appearance: Round or oval dark spot. Color ranges from gray-black to reddish-brown depending on how old it is
  • Cause: End result of a subretinal bleed that healed. The blood gets replaced by scar tissue + pigment

How it forms

  1. High myopia stretches the eye: Eyeball gets too long, >26.5 mm
  2. Bruch’s membrane cracks: Lacquer cracks develop from the stretching
  3. CNV grows: New, fragile blood vessels from the choroid grow through the cracks
  4. Bleeding occurs: Those vessels leak or burst, causing subretinal hemorrhage under the macula
  5. Scar formation: As blood clears over weeks to months, fibrovascular tissue + RPE hyperpigmentation forms. That’s the Fuchs spot

Who gets it

  • Pathologic myopia: Main group. Usually -6.00D or worse
  • Age: Typically 30s to 50s, younger than regular AMD
  • Other names: Sometimes called Forster-Fuchs’ spot. Not related to Fuchs’ endothelial dystrophy of the cornea

Symptoms

  • Central vision loss: Blur or a dark/empty spot right in the middle of vision
  • Distortion: Straight lines look bent or wavy before the scar fully forms
  • Scotoma: Once scarred, you’ll have a permanent blind spot in the center
  • Often unilateral first: Can happen in the other eye later if myopia is severe in both

Diagnosis

  • Dilated fundus exam: Doctor sees a pigmented macular lesion
  • OCT scan: Shows subretinal scar tissue and disrupted retinal layers
  • Fluorescein/ICG angiography: Used early to find active CNV before it scars. Once it’s a Fuchs spot, the vessels are usually inactive
  • History: Patient usually reports a prior episode of sudden central vision drop from the bleed

Treatment

  • No reversal: A true Fuchs spot is a scar. Vision in that exact spot doesn’t come back
  • Goal is prevention: Treat the CNV before it bleeds and scars
    • Anti-VEGF injections: Avastin, Lucentis, Eylea injected into the eye if active CNV is caught
    • Photodynamic therapy: Rarely used now, but was an option before anti-VEGF
  • Low vision aids: If central vision is lost, magnifiers and rehab help with daily tasks

Prognosis

  • Vision impact: Depends on size and location. A small spot off-center may leave 6/12 vision. One dead center can drop to 6/60 or worse
  • Other eye risk: 30-35% chance of CNV in the second eye within 8 years if you have high myopia
  • Stability: Once scarred, it usually doesn’t grow. But new CNV can form at the edge

Fuchs spot vs other macular scars
Condition Cause Age group
Fuchs spot Myopic CNV bleed 30s-50s, high myopes
Disciform scar AMD CNV 60+, non-myopes
Toxoplasmosis scar Infection Any age, often kids/young adults
Bottom line: Fuchs spot is the “tombstone” left after a myopic CNV bleed. The key is catching CNV early with regular OCT scans if you’re a high myope, because once the spot forms, central vision loss is permanent.

ICG ANGIOGRAPHY

ICG angiography = Indocyanine Green Angiography. It’s an imaging test that maps blood flow in the choroid, the blood-vessel layer under your retina.

What it is

  • Dye test: A green dye called indocyanine green is injected into your arm vein
  • Infrared camera: Special camera uses near-infrared light at 790-805 nm to see the dye through the retinal pigment
  • Shows choroid: Unlike fluorescein angiography which shows retinal vessels, ICG goes deeper and highlights choroidal circulation

Why doctors order it

  • See through blood/pigment: ICG light penetrates melanin, fluid, and thin blood. Useful when fluorescein images are blocked
  • Diagnose specific conditions:
    • Choroidal neovascularization (CNV): Especially “occult” CNV hidden under the retina in AMD
    • Polypoidal choroidal vasculopathy (PCV): Branching vessels with polyp-like aneurysms, common in African/Asian patients
    • Central serous chorioretinopathy (CSCR): Shows choroidal hyperpermeability areas
    • Lacquer cracks: Checks if CNV is growing through the cracks
    • Inflammatory diseases: Vogt-Koyanagi-Harada, choroiditis, to see active lesions
    • Tumors: Choroidal melanoma vs nevus

How the test works

  • Prep: Pupils dilated. You’ll sign consent and get an IV line
  • Injection: 25 mg ICG dye injected into arm. It binds to plasma proteins and stays inside blood vessels
  • Imaging phases:
    • Early 0-1 min: Choroidal arteries and choriocapillaris fill
    • Mid 5-15 min: Venous phase and leakage patterns show
    • Late 20-30 min: Staining or “washout” patterns. Polyps stay bright late
  • Time: Takes 20-30 minutes total

ICG vs Fluorescein angiography
Feature ICG Fluorescein
Light used Near-infrared 790-805 nm Blue light 490 nm
What it shows Choroidal vessels Retinal vessels
Dye leakage Minimal. Stays in vessels Leaks easily from damaged vessels
See through blood Yes No
Best for PCV, CSCR, occult CNV, choroidal tumors Diabetic retinopathy, vein occlusion, macular edema
Safety & side effects

  • Very safe: Severe reaction rate is about 0.05%, much lower than fluorescein
  • Common effects: Temporary green discoloration of skin, green urine for 1 day
  • Mild reactions: Nausea in 1-2%, sneezing, itching
  • Contraindications: Iodine allergy because ICG contains iodine. Also avoid in liver disease and pregnancy unless essential
  • No kidney issues: Unlike CT contrast, ICG isn’t nephrotoxic

What to expect after

  • Vision: Not blurred by the dye itself, but dilation makes you light sensitive for 4-6 hours
  • Drive: Bring someone. You can’t drive until dilation wears off
  • Results: Retina specialist reads images same day and decides on treatment like anti-VEGF or photodynamic therapy

Bottom line: If fluorescein angiography shows the retinal circulation, ICG shows the “basement” blood supply under it. It’s the go-to test when doctors suspect PCV, CSCR, or hidden CNV, especially in highly pigmented eyes.

ICG ANGIOGRAPHY

ICG angiography = Indocyanine Green Angiography. It’s an imaging test that maps blood flow in the choroid, the blood-vessel layer under your retina.

What it is

  • Dye test: A green dye called indocyanine green is injected into your arm vein
  • Infrared camera: Special camera uses near-infrared light at 790-805 nm to see the dye through the retinal pigment
  • Shows choroid: Unlike fluorescein angiography which shows retinal vessels, ICG goes deeper and highlights choroidal circulation

Why doctors order it

  • See through blood/pigment: ICG light penetrates melanin, fluid, and thin blood. Useful when fluorescein images are blocked
  • Diagnose specific conditions:
    • Choroidal neovascularization (CNV): Especially “occult” CNV hidden under the retina in AMD
    • Polypoidal choroidal vasculopathy (PCV): Branching vessels with polyp-like aneurysms, common in African/Asian patients
    • Central serous chorioretinopathy (CSCR): Shows choroidal hyperpermeability areas
    • Lacquer cracks: Checks if CNV is growing through the cracks
    • Inflammatory diseases: Vogt-Koyanagi-Harada, choroiditis, to see active lesions
    • Tumors: Choroidal melanoma vs nevus

How the test works

  • Prep: Pupils dilated. You’ll sign consent and get an IV line
  • Injection: 25 mg ICG dye injected into arm. It binds to plasma proteins and stays inside blood vessels
  • Imaging phases:
    • Early 0-1 min: Choroidal arteries and choriocapillaris fill
    • Mid 5-15 min: Venous phase and leakage patterns show
    • Late 20-30 min: Staining or “washout” patterns. Polyps stay bright late
  • Time: Takes 20-30 minutes total

ICG vs Fluorescein angiography
Feature ICG Fluorescein
Light used Near-infrared 790-805 nm Blue light 490 nm
What it shows Choroidal vessels Retinal vessels
Dye leakage Minimal. Stays in vessels Leaks easily from damaged vessels
See through blood Yes No
Best for PCV, CSCR, occult CNV, choroidal tumors Diabetic retinopathy, vein occlusion, macular edema
Safety & side effects

  • Very safe: Severe reaction rate is about 0.05%, much lower than fluorescein
  • Common effects: Temporary green discoloration of skin, green urine for 1 day
  • Mild reactions: Nausea in 1-2%, sneezing, itching
  • Contraindications: Iodine allergy because ICG contains iodine. Also avoid in liver disease and pregnancy unless essential
  • No kidney issues: Unlike CT contrast, ICG isn’t nephrotoxic

What to expect after

  • Vision: Not blurred by the dye itself, but dilation makes you light sensitive for 4-6 hours
  • Drive: Bring someone. You can’t drive until dilation wears off
  • Results: Retina specialist reads images same day and decides on treatment like anti-VEGF or photodynamic therapy

Bottom line: If fluorescein angiography shows the retinal circulation, ICG shows the “basement” blood supply under it. It’s the go-to test when doctors suspect PCV, CSCR, or hidden CNV, especially in highly pigmented eyes.

LACQUER CRACKS

Lacquer cracks are breaks in Bruch’s membrane, a thin layer in the back of your eye. They’re mostly linked to high myopia but can show up in other conditions too.

What exactly breaks?

  • Location: Bruch’s membrane sits between the retinal pigment epithelium (RPE) and the choroid. It’s like the “basement membrane” for the retina
  • The crack: Think of paint on a wall. If the wall stretches too much, the paint develops hairline cracks. Same idea when the eyeball elongates in high myopia
  • Appearance: On eye exams, they look like yellowish, irregular lines in the back of the eye, often near the macula

Main causes

  • Pathologic myopia: Biggest cause. Eyes longer than 26.5 mm or stronger than -6.00D stretch Bruch’s membrane until it tears
  • Trauma: Blunt injury to the eye can cause acute cracks
  • Angioid streaks: Associated with systemic diseases like pseudoxanthoma elasticum, Ehlers-Danlos, Paget’s disease. Angioid streaks can develop lacquer cracks
  • Choroidal neovascularization: Sometimes new blood vessels form around the cracks

Symptoms

  • Often none early: Many people have lacquer cracks with no vision change
  • If macula involved: Blurred vision, distorted vision where straight lines look wavy, or a blind spot
  • Sudden vision drop: Usually means a complication like bleeding or CNV has started

Complications to watch for

  • Choroidal neovascularization (CNV): New, leaky blood vessels grow through the crack. This is the main threat to vision and can cause bleeding/scarring
  • Subretinal hemorrhage: Blood under the retina from CNV, causes sudden central vision loss
  • Fuchs’ spot: Pigmented scar that forms after a bleed heals. Leaves permanent central scotoma

How doctors diagnose

  • Dilated fundus exam: Doctor sees yellow lines
  • OCT scan: Shows the break in Bruch’s membrane and any fluid/blood
  • Fluorescein angiography: Dye test to check for CNV leaking through the crack
  • ICG angiography: Better for seeing deeper choroidal vessels

Treatment

  • No fix for the crack itself: Bruch’s membrane can’t be stitched back. Goal is to manage complications
  • If CNV develops: Anti-VEGF injections like Avastin, Lucentis, or Eylea into the eye to stop new vessels
  • Monitor: Regular OCT scans if you have lacquer cracks, especially with high myopia
  • Lifestyle: No proven way to prevent them, but controlling myopia progression in kids may help reduce future risk

Who’s at risk

  • High myopes: -6.00D or worse, or axial length >26.5 mm
  • Age: Usually appears in 20s-40s in myopic patients
  • Family history: Pathologic myopia runs in families

Bottom line: Lacquer cracks themselves don’t always hurt vision. The danger is when new blood vessels grow through them. If you have high myopia, get yearly dilated eye exams so any CNV gets caught early.

DIETARY REQUIREMENTS FOR THE EYES

Dietary requirements for the eyes — what you eat directly affects your retina, lens, tear film, and optic nerve. Here’s the breakdown:

1. Omega-3 fatty acids: DHA & EPA

  • Why: DHA makes up 50-60% of fatty acids in your retina. Keeps photoreceptor cells flexible. EPA reduces eye surface inflammation
  • Sources: Salmon, mackerel, sardines, anchovies, fish oil supplements
  • Target: 2-3 servings fatty fish per week or 1000-2000 mg combined EPA+DHA daily
  • Benefits: Helps dry eye, meibomian gland function, may lower AMD risk

2. Lutein & Zeaxanthin

  • Why: These carotenoids form the macular pigment. Acts like “internal sunglasses” that filter harmful blue light
  • Sources: Kale, spinach, collard greens, egg yolks, corn, orange bell peppers
  • Target: 6-10 mg lutein + 2 mg zeaxanthin daily. AREDS2 used 10 mg + 2 mg
  • Benefits: Reduces risk of macular degeneration and cataracts

3. Vitamin A + Beta-carotene

  • Why: Vitamin A makes rhodopsin, the pigment your rods need for night vision. Deficiency = night blindness
  • Sources: Liver, dairy, eggs for preformed A. Carrots, sweet potatoes, pumpkin for beta-carotene
  • Target: 700-900 mcg RAE daily. Don’t overdo supplements because high dose vitamin A can be toxic
  • Benefits: Cornea health, night vision, prevents xerophthalmia

4. Vitamin C

  • Why: Antioxidant in the aqueous humor of your eye. Helps regenerate vitamin E and supports blood vessels
  • Sources: Oranges, guava, bell peppers, strawberries, broccoli
  • Target: 75-90 mg daily. AREDS used 500 mg for AMD patients
  • Benefits: Slows cataract progression, supports collagen in cornea/sclera

5. Vitamin E

  • Why: Protects eye cell membranes from oxidative damage
  • Sources: Almonds, sunflower seeds, avocado, wheat germ oil
  • Target: 15 mg daily. AREDS used 400 IU
  • Benefits: Works with vitamin C and zinc to slow AMD

6. Zinc

  • Why: Concentrated in retina and choroid. Helps vitamin A move from liver to retina to make melanin, a protective pigment
  • Sources: Oysters, beef, pumpkin seeds, cashews, beans
  • Target: 8-11 mg daily. AREDS2 used 80 mg zinc oxide, but high doses need copper added
  • Benefits: Critical for night vision and AMD risk reduction

7. Water & general hydration

  • Why: Your tear film is 98% water. Dehydration = worse dry eye
  • Target: About 2-3 L fluid daily depending on climate and activity
  • Benefits: Better tear volume, less gritty eyes

8. Other helpful nutrients

  • Vitamin D: May reduce inflammation in dry eye and AMD. Source: Sun, fatty fish, fortified milk
  • B vitamins: B2, B6, B12, folate help lower homocysteine, linked to retinal vein issues
  • Selenium & Copper: Cofactors for antioxidant enzymes in the eye

Sample eye-friendly day

  • Breakfast: Eggs with spinach + orange
  • Lunch: Grilled sardines, kale salad, almonds
  • Snack: Carrot sticks + guava
  • Dinner: Sweet potato, baked salmon, broccoli

Key rule: Eat colorful. Dark green, orange, yellow, and red foods usually pack the carotenoids your eyes need.

STERILE BURR

A sterile burr is a small, drill-like ophthalmic instrument used to remove rust rings or embedded foreign bodies from the cornea. It’s typically single-use, precision-engineered, and comes pre-sterilized to prevent infection.

Here’s the step-by-step usage:

  1. Numb the eye with topical anesthetic drops.
  2. Position the patient comfortably under a slit lamp for magnification.
  3. Stabilize the eye using a lid speculum or gentle pressure.
  4. Activate the burr (usually battery-powered) and gently apply it to the rust ring or foreign body.
  5. Rotate lightly to scrape away the material without pressing too deep.
  6. Irrigate the eye to flush out debris.
  7. Apply antibiotic ointment and possibly a patch for comfort.
  8. Advise on aftercare — typically antibiotic drops, no rubbing, and follow-up if pain or vision changes persist.
CORNEA FOREIGN BODY POST CARE

After a corneal foreign body is removed, you’ll typically use antibiotic eye drops to prevent infection, and maybe lubricating drops for comfort. Avoid rubbing your eye, wear sunglasses if light-sensitive, and don’t wear contacts until it’s healed. Most people feel better in 24–48 hours, but if pain, redness, or blurry vision gets worse, see your eye doctor ASAP.

CORNEA FOREIGN BODY REMOVAL

Corneal foreign body removal is a common eye procedure done when something like dust, metal, or sand gets stuck on the cornea. Here’s how it’s typically done:

  • Assessment: Doctor checks eye with a slit lamp to locate and evaluate the foreign body.
  • Anesthetic drops: Numbing eye drops are applied for comfort.
  • Removal: Using a sterile needle, burr, or cotton swab, the doctor gently lifts out the foreign object.
  • Post-care: Antibiotic eye drops or ointment are prescribed to prevent infection.
  • Follow-up: Healing usually happens within 24-48 hours; pain and redness should improve quickly.

CORNEA FOREIGN BODY

Corneal foreign body: small object (metal, dust, sand) stuck on eye surface. Causes pain, redness, tearing, blurry vision, and gritty feeling. Doctor removes it with slit lamp and tiny needle or swab. After removal, antibiotic drops prevent infection, and eye heals fast—usually 24–48 hrs.