AGE-RELATED MACULAR DEGENERATION
WHAT IS AGE-RELATED MACULAR DEGENERATION (AMD)?
Age-Related Macular Degeneration is an eye condition resulting in the loss of central vision.
The Macula is the part of the eye where incoming rays of light are focused and is essential for
seeing straight ahead, details and colour. The cells in the Macula can become damaged for many
different reasons. When it happens in people who are older it is referred to as age-related Macular
degeneration. It normally affects both eyes, although not necessarily at the same time.
Macular degeneration is not painful and does not lead to complete blindness as it is only the
central vision which is affected. People normally have enough side vision to lead independent
lives.
There are two different types of AMD. They are referred to as Wet and Dry because of their
appearance to the ophthalmologist. The most common type is Dry AMD. Wet AMD is rarer and
accounts for only 10% of cases.
DRY AMD
Dry AMD happens when visual cells stop functioning. It occurs gradually resulting in central vision
loss.
WET AMD
Wet AMD happens when new blood vessels begin to grow in or around the Macula. This happens
when there is a lack of oxygen in the cells in the eye. The body tries to deliver more oxygen to
these cells by growing extra blood vessels. The new blood vessels are fragile and can leak fluid
and blood, causing scarring in the macula, which consequently leads to sight loss.
WHAT ARE THE SYMPTOMS OF AGE-RELATED MACULAR
DEGENERATION?
The most common symptom is a loss of central vision. There should not be any pain and
symptoms may develop quickly or over several months.
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Main symptoms to be aware of are:
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Blurred or distorted central vision – objects look an unusual size or shape.
Blank patch or dark spot in central vision.
Difficulty seeing details or identifying people’s faces.
Sensitivity to light.
Seeing lights which are not there.
WHAT ARE THE CAUSES OF AGE-RELATED MACULAR
DEGENERATION?
The exact cause for AMD is not yet known. There are thought to be a number of factors which
might increase the chance of someone developing AMD:
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Age - older people are more likely to suffer from AMD.
Family history – AMD seems to run in families. Specific genes are present in most people
who have AMD.
Smoking – a major risk factor and can increase chances of getting AMD. Stopping smoking
can reduce the chance of developing AMD.
Sunlight - intense exposure to sunlight can cause damage to the Retina. It is advisable to
wear sunglasses in strong sunshine.
Nutrition – research has shown that some vitamins and minerals can protect against AMD.
Eating a well-balanced diet, not smoking and protecting eyes from strong sunlight may help to
delay the development of AMD.
WHAT SHOULD I DO?
If you think you have any of the symptoms for AMD you should make an appointment to see your
optician or doctor.
If you have a rapid change in vision you should either see your doctor or go to an Accident and
Emergency department at a hospital.
If you already have AMD in one eye and start to show signs of AMD in the other eye seek medical
advice urgently to ensure you begin immediate treatment.
CAN IT BE TREATED?
Treatment is available for some cases of Wet AMD. There are many visual aids available to help
cope with sight loss.
PHOTODYNAMIC THERAPY
If Wet AMD is affecting the middle of the macula, photodynamic therapy can be used. A light
sensitive drug is used to identify new blood vessels which are growing in the wrong area behind
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the Retina. A laser is then used to activate the drug, which stops the new blood cells from growing
and prevents the AMD from progressing any further.
ANTI VASCULAR ENDOTHELIAL GROWTH FACTOR
TREATMENT (ANTI-VEGF)
Anti-VEGF treatment can be used for Wet AMD. The treatment involves an injection into the
vitreous jelly in the eye preventing new blood vessels from growing. Anti-VEGF treatment is most
effective when used in the early stages of the condition, as it can stop sight loss from progressing
and on occasion can improve sight already lost.
TREATMENT FOR DRY AMD
There is no known medical treatment for Dry AMD. Research has suggested that vitamin
supplements can slow down the development or even prevent Dry AMD.
NUTRITION
There are reported benefits of high levels of antioxidants and zinc for slowing Macular
degeneration and helping eye health.
A supplement containing the following may help:
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Nutrients – zinc, lutein, zeaxanthin.
Vitamins – A, C and E.
Please contact your doctor before taking any supplements.
IS THERE A CURE?
Unfortunately there is no cure at present for age-related Macular degeneration.
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CATARACTS
WHAT ARE CATARACTS?
A cataract is an eye condition where the Lens part of the eye becomes clouded.
If you have Cataracts, vision is likely to become blurred or dim because light cannot pass through
the clouded Lens to the back of the eye.
Cataracts are very common in people over the age of 60. Treatment is available for the majority of
cataract conditions.
WHAT ARE THE SYMPTOMS?
There are a number of symptoms which might mean someone has developed Cataracts.
BLURRED VISION – especially around the edges. If you wear glasses, it may seem like the
Lenses are dirty or scratched.
SEEING DOUBLE – cloudiness in the Lens may occur in more than one place which means light
reaching the Retina is split causing a double image.
POOR VISION IN BRIGHT LIGHT – artificial bright light or when it is very sunny can make it more
difficult to see.
COLOUR VISION CHANGES – the centre of the cataract becomes more yellow as it develops so
there may be a yellow tint.
WHAT ARE THE CAUSES?
Scientists are not certain about the cause of Cataracts, and there may be several reasons.
Research has linked smoking, exposure to strong sunlight and a diet lacking the right nutrients to
the development of Cataracts.
Cataracts can form at any age but most develop as people get older. They can also result from an
injury, certain drugs, long-term inflammation or from Diabetes.
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Cataracts which are present from birth are known as congenital Cataracts.
WHAT SHOULD I DO?
If you have any of these symptoms please see your optician or optometrist. These symptoms
might be a sign of another eye condition and it is important to have an eye test to ensure you have
the correct diagnosis.
CAN IT BE TREATED?
Cataracts can be treated with a small operation which will remove the cloudy Lens. The Lens will
usually be replaced with a plastic Lens so that the eye can focus properly. Occasionally a Lens
implant is not suitable so contact Lenses or special glasses will be prescribed.
IS THERE A CURE?
After an operation sight should improve within a few days, although it is likely that it will take
several months for the eye to completely heal.
HOW WILL I LIVE WITH IT?
Early Cataracts can increase short sightedness; this can be helped by altering a glasses
prescription. Tinted Lenses and shielding eyes from the sun can also help. As Cataracts develop,
your optician is likely to advise having a simple operation. Cataract surgery is one of the most
common surgical procedures and in most cases can be carried out in a day. You can discuss the
procedure with an eye specialist.
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DIABETIC RETINOPATHY
Diabetic Retinopathy is a common complication with eye sight which is due to the condition
Diabetes.
WHAT IS DIABETES?
Diabetes is a long term condition, where the body does not produce enough insulin or cannot use
insulin properly. Insulin is a hormone produced by the body to break down glucose (sugar) in so it
can be used properly by the body as fuel.
Diabetes can cause problems with different parts of the body, including the eye. People with
Diabetes will not necessarily have complications with their sight. If Diabetes is well controlled there
is a lower risk of any problem and it might be less serious.
It is very important that people with Diabetes have their eyes examined regularly.
There are two types of Diabetes.
TYPE 1 DIABETES
The body does not produce any insulin. People suffering from type 1 will need to use insulin for
the rest of their life. Type 1 normally develops in people under the age of 40.
TYPE 2 DIABETES
The body still produces insulin but not enough to function properly. Sometimes they can manage
their condition by controlling their diet or exercising but in some cases they will need injections of
insulin. The condition normally develops in people over the age of 45 and lifestyle can affect
chances of developing the illness. It is the most common form - 95% of people with Diabetes have
type 2.
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WHAT ARE THE SYMPTOMS AND CAUSES OF DIABETIC
RETINOPATHY?
Diabetes can cause a number of problems with the eye. Diabetic Retinopathy is the most serious
complication as it involves the Retina and blood vessels in the eye.
There are three main stages in the development of diabetic retinopathy.
BACKGROUND DIABETIC RETINOPATHY
People who have had Diabetic Retinopathy for a long time are likely to have this condition. The
blood vessels in the Retina are only mildly affected; when they swell they sometimes leak blood or
fluid. The Macula remains undamaged and vision will be normal.
MACULOPATHY
People who have had background Diabetic Retinopathy are likely to develop Maculopathy. When
the blood vessels in the Retina begin to leak, the Macula becomes affected and central vision will
become gradually worse. It is very rare for someone with maculopathy to lose all of their sight as
peripheral vision will be preserved. It may become difficult to recognise people’s faces from a
distance or see detail. The loss of central vision varies between people.
PROLIFERATIVE DIABETIC RETINOPATHY
People who have been dependent on insulin for a long period of time are more likely to develop
Proliferative Diabetic Retinopathy. Diabetes can cause blood vessels in the Retina to become
blocked. As a consequence new blood vessels will form in the eye, which is nature’s way of trying
to correct the problem as the Retina needs a new blood supply. These new blood vessels are
weak and grow on the surface of the Retina and the vitreous gel. They can scar very easily and
cause scar tissue to form in the eye. The scarring pulls and distorts the Retina out of position.
Eyesight may become blurred or patchy as Retinal bleeding obscures vision. Retinal bleeding or
detachment can cause sudden and severe sight loss. If proliferative retinopathy is not treated, total
loss of vision might occur.
WHAT SHOULD I DO?
If you have Diabetes make sure you have an eye examination every year. Do not wait until your
eyesight deteriorates as early diagnosis is vital in preventing diabetic retinopathy. Sight tests are
free for people with Diabetes. Your doctor, dialectologist or optometrist can examine for diabetic
retinopathy. Photographs of the back of your eye are used to detect abnormalities.
Complications with Diabetic Retinopathy can be reduced by having good control of Diabetes. It is
important to monitor your Diabetes, and treat high blood pressure to prevent sight loss from
Diabetes. You can discuss with your doctor what is best for you.
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Smoking can raise blood pressure and blood sugar levels and can increase chances of nerve
damage, kidney and cardiovascular disease in people with Diabetes.
You can help reduce the risk of Diabetic Retinopathy by having your eyes checked regularly, not
smoking, and controlling sugar levels, blood pressure and your cholesterol.
CAN IT BE TREATED?
Treatment can prevent sight threatening diabetic retinopathy, if it is diagnosed early enough. It is
crucial to have an eye examination once a year if you have Diabetes.
Laser treatment can be used to manage most sight threatening problems with Diabetes. The laser
treatment can prevent further sight loss by sealing the blood vessels which might be leaking. This
treatment can also be used to stop 80% of new blood vessels growing.
IS THERE A CURE?
Laser treatment can save remaining sight, but it cannot make it better or repair damage. Once
you have had laser treatment, the problem is mostly controlled. You should have regular eye
checks to make sure you do not need more laser surgery.
HOW WILL I LIVE WITH IT?
Action for Blind People can help you to learn how to use your remaining vision as fully as possible.
Your eye specialist can offer you advice on low vision aids.
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RETINITIS PIGMENTOSA
WHAT IS RETINITIS PIGMENTOSA?
Retinitis Pigmentosa (RP) refers to a group of hereditary eye disorders which affect the Retina.
The Retina is the light sensitive tissue lining the back of the eye. Retinitis means disease or
inflammation of the Retina. Pigmentosa refers to how the Retina appears in this condition, as the
Retina can have dark spots of pigment. The parts of the Retina affected can be the rod or cone
receptors, these sometimes are affected from birth or slowly stop over time. Sight loss is gradual
but progressive. It is unusual for people with RP to become completely blind.
WHAT ARE THE SYMPTOMS OF RETINITIS PIGMENTOSA?
There might be some difficulty seeing in low light such as outdoors at dusk or in a dimly lit room.
The visual field is also reduced and sight loss can be from above and below. This is often referred
to as tunnel vision it means that the rod cells and some of the outer cone cells have been affected
first. In some RP related conditions central vision is lost first and the person affected can have
difficulty reading print or doing detailed work. In many types of RP the glare from bright lights can
cause a problem although some people do not suffer from this until the condition has developed.
YOUNG CHILDREN
Parents may notice the following signs in their children and that their vision has reduced.
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Eyes moving to and fro - this is known as Nystagmus
Touching their eyes
Roving eye movement
An optician can check how their eyes react to bright light. Some children may have other
symptoms of RP which do not relate to their vision it may only be later that vision is affected. Other
symptoms of RP are conditions such as low hearing, learning difficulties and reduced growth.
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WHAT ARE THE CAUSES OF RETINITIS PIGMENTOSA?
Retinitis pigmentosa is caused by genetics. A person with RP has often inherited a gene from one
or both of their parents, although the condition can often skip generations.
RP occurs because the Retina can not respond to light properly. The problem can be in many
parts of the Retina such as the rod or cone cells or in the connections between the cells of the
Retina. In most cases the early symptoms of RP develop between the ages of 10 and 30.
WHAT SHOULD I DO?
RP is best detected by an examination of the inside of the eye using a ophthalmoscope by a
doctor.
A normal eye test may not detect peripheral and side vision loss. There are other tests which
measure the area of visual field and the ability to adapt to low lights.
CAN IT BE TREATED?
There is no treatment available to cure or prevent the progression of RP.
LIVING WITH/HOW WILL I COPE?
There are low vision devices which can help magnify, reduce glare and illuminate objects at home
and in work. Children can wear spectacles to help the vision parts of the brain develop correctly.
There are many practical changes that can be made to help.
IS THERE A CURE?
Scientists are researching treatments such as Retinal implants and drug treatments.
OTHER RELATED CONDITIONS
People with RP often develop Cataracts. These can be operated on once they reach a certain
stage. The Lens can be replaced or glasses prescribed. Depending on the condition of the Retina
a certain amount of vision might be restored after the operation.
USHER SYNDROME
People with RP can also inherit another condition called Usher Syndrome, which is when people
develop hearing loss. For more information on Usher Syndrome please contact SENSE.
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GLAUCOMA
WHAT IS GLAUCOMA?
Glaucoma is an eye condition where the Optic Nerve is damaged leading to sight loss. In the UK,
Glaucoma affects two in 100 people over the age of 40.
Glaucoma refers to a number of eye conditions where the Optic Nerve is damaged. Glaucoma can
be caused by changes to eye pressure; the eye needs pressure to keep the eyeball in shape. In
other cases Glaucoma can be caused by a weakness in the Optic Nerve.
Eye pressure rises if the fluid produced in the eye can not drain or if too much is produced.
Damage can occur when pressure within the eye increases and presses on the Optic Nerve. A
sudden high pressure can damage the Optic Nerve immediately. It is more common for there to be
a lower level of pressure which causes damage more slowly and sight will gradually be lost.
This change in pressure leads to a reduction in the field of vision and in the ability to see clearly.
Glaucoma sufferers are often unaware until significant damage has occurred.
There are four main types of Glaucoma:
ACUTE GLAUCOMA
Acute Glaucoma happens quickly. This can occur when there is a sudden blockage to the flow of
aqueous fluid in the eye. It can be painful and cause permanent damage to your sight if not treated
properly.
CHRONIC GLAUCOMA
Chronic Glaucoma is the more common type of Glaucoma and can develop over many years. Eye
pressure rises very slowly and there is no pain but the field of vision gradually becomes impaired.
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DEVELOPMENTAL GLAUCOMA
Developmental or congenital Glaucoma is a rare condition which babies have and is caused by
defects in the drainage system in the eye. The majority of cases are diagnosed by the age of one.
If parents notice their child has either a cloudy, white, enlarged or protruding eye they should
consult a doctor.
SECONDARY GLAUCOMA
Another eye condition can cause a rise in eye pressure. There may be symptoms of Secondary
Glaucoma following an eye injury, an infection, inflammation, a tumour or an enlarged cataract.
WHAT ARE THE SYMPTOMS OF CHRONIC GLAUCOMA?
Chronic Glaucoma can be hard to detect as eyesight may seem normal and there is no associated
pain. There may be an early loss of field of vision in the shape of an arc above or below the centre
when looking straight. This can spread outwards and inwards. The centre of vision is last affected
so this eventually becomes like looking through a long tube, this is referred to as tunnel vision.
Eventually even this sight would be lost.
WHAT ARE THE CAUSES OF CHRONIC GLAUCOMA?
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Age - Glaucoma is more common in older people. It is rare to have Glaucoma below the
age of 40. Glaucoma affects 1% of people over the age of 40 and 5% of people older than
65.
Family history - people with close relatives who have chronic Glaucoma are more likely to
develop Glaucoma. You should have a regular eye test and one every year once you are
older than 40.
Race - chronic Glaucoma is more common in people of African origin, it may develop
earlier than average and be more severe.
Short sight - people with a high degree of myopia (short sightedness) are more likely to
develop chronic Glaucoma.
Diabetes - having Diabetes increases the risk of developing Glaucoma.
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WHAT SHOULD I DO?
Glaucoma is more common over the age of 40 and it is advised that you have an eye test at least
every two years and ask for three very simple Glaucoma tests from your optician.
Your optician will:
1. Observe the Optic Nerve by shining the light from a special torch in your eye.
2. Measure the pressure in the eye using a special instrument.
3. Test the field of vision by asking you which lights you can see on a screen.
It is important to have your eyes tested regularly because chronic Glaucoma can go undetected as
it gradually develops and your sight will be at risk.
If you are over the age of 40 and have an immediate family member who has Glaucoma you are
entitled to a free sight test once a year with the NHS.
CAN CHRONIC GLAUCOMA BE TREATED?
Early diagnosis is essential as damage can be kept to a minimum but once it has been done it can
not be repaired.
Eye drops are used to lower the pressure in the eye by reducing the fluid in the eye by opening up
the drainage channels so excess liquid can drain away.
Some treatments also aim to improve blood supply of the Optic Nerve. Laser treatment or an
operation called a trabeculectomy is can be used to improve the drainage of fluids from your eye.
As Glaucoma is painless people can become inconsistent with their use of eye drops which can
result in severe sight loss. Some people stop using them because they find eye drops
uncomfortable. It is important if you have Glaucoma to use your prescribed eye drops to prevent
irreparable sight loss. If you are having problems using eye drops ask you eye doctor for help.
IS THERE A CURE?
It is not possible to cure damage but it can be kept to a minimum with treatment. It is very
important to have an eye test as early diagnosis and treatment can ensure that damage does not
cause complete sight loss.
WHAT ARE THE SYMPTOMS OF ACUTE GLAUCOMA?
Acute Glaucoma can be a series of milder or one sudden attack. It is important that if you have
any of these symptoms to seek medical help immediately.
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SUDDEN ATTACK
The sudden pressure can be very painful in the eye. Vision may deteriorate rapidly; it becomes red
and might black out. The person suffering may have nausea and be vomiting and will need to go
to the emergency department of a hospital immediately.
MILD ATTACK
People can suffer from a series of mild attacks, which often happen in the evening. If there is
discomfort in the eye and vision is misty with coloured rings around white lights you should contact
a doctor immediately. These attacks may last for a few hours but the person might experience
repeat symptoms. Each attack takes part of the field of vision.
WHAT ARE THE CAUSES OF ACUTE GLAUCOMA?
Acute Glaucoma can happen very suddenly when the Iris is pushed or pulled forward which blocks
the angle of the eye where the fluid in the eye is drained.
WHAT SHOULD I DO?
Contact a doctor immediately if you think you are having any attacks. You will need to go to
hospital so that the pain and pressure can be stopped.
CAN ACUTE GLAUCOMA BE TREATED?
Treatment needs to be administered immediately after an attack to relieve pain and pressure in
the eye.
Acute Glaucoma can be treated with medication which will reduce the production of aqueous liquid
in the eye and improve its drainage.
If it is caught early acute Glaucoma can usually be treated within a few hours and the eye will
become more comfortable and vision will begin to return.
The follow up treatment to help prevent further attacks is usually laser treatment. You will have a
small operation which will make a painless, small hole in the outer border of the Iris to relieve the
obstruction which will allow the liquid to drain away. It is common to have the same treatment on
the other eye too as there is a high risk that it will develop in both eyes.
IS THERE A CURE?
If acute Glaucoma is diagnosed and treated immediately there may be a complete recovery of
vision. Unfortunately if this is delayed there can be sight loss in the affected eye. If eye pressure
remains high, the treatment is the same as chronic Glaucoma.
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HOW WILL I LIVE WITH GLAUCOMA?
Early diagnosis can prevent or slow down further damage by Glaucoma. If you suffer from some
sight loss there are resources available for you to help use your remaining vision as fully as
possible.
DRIVING
It might be possible to remain driving if the loss of visual field is not too advanced. A special test
can assess whether you meet the standards of the DVLA.
HOW WILL I COPE?
Adjusting to having Glaucoma may be difficult and overwhelming at first as it may involve some
changes to your life. Action for Blind People is here to support you, to make life easier and to
answer any questions you may have about your sight or day-to-day living.
There are some things which can be done to help
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There are visual aids which can help you use your remaining vision.
Counselling is available if you need any emotional support or to talk about your diagnosis
with someone.
EYE ANATOMY
The eye is made up of different parts which are all vital for vision. As light passes into the eye
through the Cornea, the Iris opens the Pupil depending on how much light there is. The light is
then focused by the Lens on the Retina at the back of the eye. This light is transformed into
electrical signals by the cells in the Retina and passed through the Optic Nerve into the brain.
These electrical signals are then processed into an image by different parts of our brain. All parts
of the brain and eye need to be present and working for us to see normally.
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CHOROID
The Choroid is the layer of blood vessels and connective tissue between the Sclera and the
Retina. The Choroid provides oxygen and nutrients to the Retina. The Macula and Optic Nerve are
dependent upon blood supply from the Choroid.
CONE CELLS
Cones are photoreceptor (light sensitive) cells. The Retina has approximately six million Cones, in
the macula, which is the area accounting for central vision. Cones are essential for sharp vision,
working best in bright light and letting the eye see colour, which is why when it is darker we see
colours less accurately.
CORNEA
At the front of the eye is the protective part of the eye, the Cornea, which covers the Iris, Pupil at
the front. The Cornea and the Lens refract light so the eye can focus. The Cornea is transparent
and does not have blood vessels; it needs oxygen directly from the air. If something touches the
Cornea, the eyelid will involuntarily close. Astigmatism, short and long sightedness can be caused
if the shape of the Cornea is not as curved as it should be. Corrective eye surgery uses
techniques to reshape the Cornea to reducing the need for glasses.
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FOVEA
The Fovea is in the centre of the Macula and contains most of the cone cells. The Fovea is
responsible for sharp central vision, necessary in any activity where visual detail is important such
as for reading or watching television.
IRIS
The Iris is the coloured part of the eye, which is blue, brown, green, grey, black, hazel depending
how much Melanin (pigment) they contain. The Iris controls the diameter and size of the Pupil and
the amount of light which reaches the Retina. The Iris can make the Pupil smaller or bigger
depending on how much light is entering the eye, similar to how an aperture on a camera works.
LENS
The Lens is the transparent part of the eye which refracts light so it is focused on the Retina. The
Lens can change shape allowing the eye to focus on objects at different distances. The Lens
becomes thicker with age and can not change shape so easily, which is why as we become older
it may be more difficult to focus on close objects without reading glasses. The Lens might also
become larger and cloudier with age, which is known as Cataracts.
MACULA
The Macula is an oval, highly pigmented spot near the centre of the Retina at the back of the eye
and is responsible for central vision. The Macula is yellow and absorbs excess blue and ultraviolet
(UV) light that enters the eye.The Macula contains a high density of cones and is needed for
accurate and central vision.
MELANIN
Melanin is a dark pigment in the tissue of the Iris, it also determines skin and hair colour. The
Melanin in the eye helps the Choroid limit uncontrolled reflection within the eye. People who are
albino have low levels of Melanin and vision is low.
OPTIC NERVE
The Optic Nerve is a collection of communication wires which convey information from the Retina
in the eye to the brain. Our ‘blind spot’ is due to a lack of Retina where the Optic Nerve leaves the
eye.
PUPIL
The Pupil is an opening in the Iris and appears as a black, round circle in the middle of the eye. It
looks black because most of the light is absorbed by the tissues inside the eye. The Pupil acts as
the eye’s aperture, allowing more or less light into the eye. If bright light is shone into the eye the
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Iris muscles contract and reduce the size of the Pupil, in low light the Pupil grows larger (dilates) to
allow more light in.
RETINA
The Retina lines the inner surface of the back of the eye. There are millions of photoreceptors,
called Rods and cones, in the Retina which capture the rays of light. Light falls on the Retina, the
photoreceptors turn them into electrical impulses which trigger nerves and are sent to visual areas
of the brain through the Optic Nerve.
RODS
Rod cells are photoreceptors in the eye, one of the two types of light sensitive cells in the Retina.
There are approximately 125 million Rods in the outside of the Retina and these work best in dim
light and are used for peripheral and night vision.
SCLERA
The Sclera is the white part of the eye, a thick, tough, protective layer covering the entire eyeball.
It prevents the eyeball from being injured and helps it to hold its shape. There are muscles on
different points of the Sclera enabling the eye to move in different directions
VITREOUS GEL
Vitreous gel is a clear gel which fills most of the inside of the eyeball. The gel ensures the eyeball
holds its spherical shape and maintains the pressure of the eye. The gel holds the Retina in place.
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