The Brain and the Eye – How They Work Together

The Brain and the Eye

The eye works like a camera. The iris and the pupil control how much light to let into the back of the eye, much like the shutter of a camera. When it is very dark, our pupils get bigger, letting in more light; when it is very bright our irises constrict, letting in very little light.

The lens of the eye, like the lens of a camera, helps us to focus. But just as a camera uses mirrors and other mechanical devices to focus, we rely on eyeglasses and contact lenses to help us to see more clearly.

The focus light rays are then directed to the back of the eye, on to the retina, which acts like the film in a camera. The cells in the retina absorb and convert the light to electrochemical impulses which are transferred along the optic nerve to the brain. The brain is instrumental in helping us see as it translates the image into something we can understand.

The Brain and the Eye

The eye may be small, but it is one of the most amazing parts of your body. To better understand it, it helps to understand the different parts and what they do.

Choroid
A layer with blood vessels that lines the back of the eye and is between the retina (the inner light-sensitive layer that acts like film) and the sclera (the outer white part of the eyeball).

Ciliary Body
The muscle structure behind the iris, which focuses the lens.

Cornea
The very front of the eye that is clear to help focus light into the eye. Corrective laser surgery reshapes the cornea, changing the focus to increase sharpness and/or clarity.

Fovea
The center of the macula which provides the sharp vision.

Iris
The colored part of the eye used to regulate the amount of light entering the eye. Lens focuses light rays onto the retina at the back of the eye. The lens is transparent, and can deteriorate as we age, resulting in the need for reading glasses. Intraocular lenses are used to replace lenses clouded by cataracts.

Macula
The area in the center of retina that contains special light-sensitive cells, allowing us to see fine details clearly in the center of our visual field. The deterioration of the macula can be common as we age, resulting in age related macular degeneration.

Optic Nerve
A bundle of more than a million nerve fibers carrying visual messages from the retina to the brain. Your brain actually controls what you see, since it combines images. Also the images focused on the retina are upside down, so the brain turns images right side up. This reversal of the images Is a lot like what a mirror does in a camera. Glaucoma can result when increase pressure in the eye restricts the flow of impulses to the brain, causing optic nerve damage and makes it difficult to see.

Pupil
The dark center opening in the middle of the iris changes size to adjust for the amount of light available to focus on the retina.

Retina
The nerve layer lining the back of the eye that senses light and creates electrical impulses that are sent through the optic nerve to the brain.

Sclera
The white outer coating of the eyeball.

Vitreous Humor
The clear, gelatinous substance filling the central cavity of the eye.

3/3/16

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Layers of the Retina

The retina at the back of the eye is essential for all vision. Each layer of cells in this tissue serves a specific purpose. As we prepare for Age-Related Macular Degeneration Awareness Month in February, a closer look at the layers of the retina and their function.

layers of the retina

Layers of the Retina

Choroid – This is made up of a layer of blood vessels that supply oxygen and nutrients to the retina. Defect in the CHM gene can cause choroideremia, leaky blood vessels can expand in the retina causing wet age-related macular degeneration (AMD) and diabetic retinopathy.

Retinal pigment epithelium – This is a single layer of cells that provide essential nutrition and waste removal for the photoreceptor cells. Accumulation of waste can lead to AMD and Stargardt disease.

Photorecptors – This is where the rods and cones are located that convert light into electrical signals. Rods help you with night and peripheral vision. Cones are more concentrated in the macula (the central part of the retina) and proved central and color vision. Death of the rods can cause vision loss called retinitis pigmentosa, while AMD is the loss of central vision.

Horizontal cells – These cells are connect to the photoreceptors that surround the bipolar connected photoreceptor cells and help the help integrate and regulate the input from multiple photoreceptor cells, increasing your visual acuity.

Bipolar cells – The dependence of each layer of the retina on each other is exemplified here. These cells take the electrical information from the photoreceptor cells and pass it along to other retinal cells.

Ganglion cells – These cells extend to form an optic nerve that conveys information to the brain and take the electrical information from the bipolar cells and process it to determine shapes, contrast and color. Glaucoma vision loss results from high intraocular pressure that affects the optic nerve, interrupting the signals to the brain.

 

Uveitis Explained

12/18/14

Uveitis is defined as inflammation of the uveal tissue. The uvea includes the iris, ciliary body, and the choroid of the eye. The iris is located in the anterior compartment of the eye and acts like the aperture of the camera, precisely filtering the amount of light entering the eye. The ciliary body, which is attached posteriorly to the iris, is involved in both the production of the aqueous fluid in the eye as well as the accommodation of the lens apparatus. The choroid is a dense layer of blood vessels that sits underneath the retina on the back wall of the eye, helping to nourish and remove metabolic waste products from the retina. Inflammation of any of these structures will consequently cause disruption of the visual pathway and over the long term can cause permanent visual loss. In fact, uveitis is the third most common cause of preventable blindness in the developed world.
uveitis explained
Symptoms of uveitis include blurry vision, ocular pain, photophobia, redness, and floaters. These can be acute in nature, lasting a few days to weeks, and in some cases can be chronic, lasting weeks or months. Anyone with any of these symptoms should see their eye care provider as soon as possible, as faster treatment of uveitis has shown to result in better long term visual outcomes.

Uveitis can affect virtually any part of the eye, from front to back. Anterior uveitis or iridocyclitis is confined to the iris, ciliary body, anterior chamber, and cornea. Inflammation affecting the vitreous is termed intermediate uveitis, or pars planitis, and any inflammation affecting only the retina or choroid is termed posterior uveitis. The term panuveitis may be used when multiple layers of the eye are affected.

There are many possible causes of uveitis, including infection, inflammatory diseases, autoimmune diseases, and trauma. However, the majority of cases of uveitis, approximately half, are considered idiopathic, where no etiology is ever found. Trauma is the next most common cause of intraocular inflammation, accounting for approximately 20% of all cases. The remaining cases are secondary to a systemic disorder or localized ocular condition. Systemic etiologies can include inflammatory disorders such as sarcoidosis, infections such as tuberculosis and syphilis, as well as autoimmune diseases such as rheumatoid arthritis and lupus.

Treatment of uveitis is aimed at both blunting the intraocular inflammation as well as addressing any underlying systemic etiology. The most common treatment is the use of corticosteroids. These can be taken orally, or used topically as eye drops. In some cases, corticosteroids can be injected in or near the eye as well. If the uveitis is caused by an infection, such as tuberculosis or syphilis, the patient is also given antibiotics. Systemic corticosteroids can have major side effects when taken chronically, such as weight gain, hair loss, osteoporosis, hypertension, secondary diabetes, psychosis, and reduced growth in children. Because of these potential problems, the chronic use of systemic corticosteroids is not recommended. In cases of chronic uveitis that require long term treatment, immunosuppressive agents with less known side effects such as methotrexate, cyclosporine, and mycophenolate mofetil (Cellcept) are more commonly used. However, these biologic agents have their own set of potential side effects and therefore, it is recommended that a rheumatologist should also be involved in the care of the patient when using these agents. Topical and intraocular steroids localized to the eye can cause elevated intraocular pressure as well as cataracts. In most cases, elevated intraocular pressure can be controlled with topical glaucoma drops, but in some cases surgical intervention is required to prevent severe glaucomatous damage.

The most common type of uveitis is acute anterior uveitis or iridocyclitis. Many cases of anterior uveitis are idiopathic though almost half of all cases are associated with the HLA- B27 haplotype. Systemic diseases associated with HLA-B27 include psoriatic arthritis, ankylosing spondylitis, reactive arthritis, and inflammatory bowel syndrome. Signs of anterior uveitis include redness of the eye, sometimes termed ciliary flush. The conjunctiva can become extremely red, and when associated with ocular pain and photophobia, is a strong indicator of anterior uveitis. Inflammatory cells found in the anterior chamber are the hallmark of anterior uveitis, sometimes deposited on the corneal endothelium (keratic precipitates) or iris (Bussaca nodules). Patients with anterior uveitis are typically treated with topical corticosteroid and cycloplegic eye drops. A laboratory workup for systemic etiologies is usually not necessary unless the patient experiences a recurrent episode.

Inflammation affecting primarily the vitreous cavity is known as intermediate uveitis or pars planitis. Inflammatory cells in the vitreous, known as vitritis, are typically bilateral, and when severe, can be found clumped in the vitreous cavity (snowballs) or deposited on the inferior pars plana (snowbanking). Intermediate uveitis is typically idiopathic though sarcoidosis, multiple sclerosis, and Lyme disease are also possible causes. Certain malignancies such as lymphoma can also ‘masquerade’ as intermediate uveitis, and when seen in older patients, should be suspected and ruled out.

Posterior uveitis involves the retina, choroid, and/or the retinal vasculature, and usually is more difficult to treat than anterior uveitis.

Uveitis Explained
This patient with Cat-scratch disease, caused by infection with Bartonella henselae, is an example of posterior uveitis. Note the characteristic star-like pattern of exudate in the macula along with optic nerve swelling.

In many cases, patients with posterior uveitis will exhibit characteristic exam findings that help narrow the differential diagnosis. For instance, an area of active retinitis next to an old pigmented chorioretinal scar is highly suggestive of toxoplasmosis. The most common symptom in patients with posterior uveitis is blurred vision. One of the more typical findings in posterior uveitis is macular edema, which is usually treated with periocular or intraocular corticosteroids.

In summary, uveitis is a visually threatening inflammatory condition that should be diagnosed and treated immediately. It is important to determine as best as possible the etiology of the uveitis and treat appropriately. In general, most patients with uveitis have good visual recovery with the proper management. However, in some cases, severe damage can occur, either due to the inflammation itself (usually chronic) or as a side effect of therapy (corticosteroids).

RichardRoeMD-ThumbnailRichard H. Roe, MD, MHS
Retina-Vitreous Associates Medical Group