Pigment Epithelial Detachment: Symptoms, Causes, and Alternative Treatments
Pigment epithelial detachment (PED) is a condition that happens when a specific layer of cells called retinal pigment epithelium (RPE) gets detached. It is a pathological process in which the RPE separates from the underlying Bruch’s membrane due to the presence of drusen, serous exudate, blood, a neovascular membrane, fibrovascular tissue or a combination.
Retinal pigment epithelial detachment can arise from an unknown cause or in association with other diseases. PED eye disease may or may not be associated with choroid neovascularization, creation of new blood vessels in the choroid layer of the eye. PED often contributes to loss of central vision, whether or not it is related to the presence of choroid neovascularization. It is a sight-threatening condition, and you should contact your health care provider as soon as you notice the first symptoms.
This article will inform you of the PED symptoms, diagnosis, types, and best alternative treatments like acupuncture, micro acupuncture 48, neuro-vision acupuncture, and custom herbal medicine.
Pigment Epithelial Detachment Management at Makari Wellness
PED symptoms can be successfully treated at Makari Wellness. We offer custom-tailored treatments for every individual because we do not treat the disease but the person. With over 15 years of experience, we provide a powerful combination of ancient wisdom and modern methods for treating PED. Call us at (888) 871-8889 and try the best alternative pigment epithelial detachment treatment in San Diego and Oceanside.
We are proud to present amazing results in treating PED symptoms in a patient who underwent our initial vision program, including micro acupuncture 48 and custom herbal therapy. With the pictures below, we are able to prove that we treat the untreatable – there is solid evidence that we get the measurable results in the patient whose condition visibly changed and the PED level reduced from 6.5 to 5 after the first course of treatment.
What is Pigment Epithelial Detachment?
It is a condition characterized by a separation between the RPE and the innermost aspect of Bruch’s membrane. The space created by this separation may be fulfilled by blood, serous exudate, drusen, fibrovascular tissue, or a combination. Various ocular and systemic diseases may be associated with PED.
Ocular diseases associated with PED include idiopathic central serous chorioretinopathy (CSC), polypoidal choroidal vasculopathy (PCV), dry/wet age-related macular degeneration (AMD), Vogt Koyanagi Harada syndrome (VKH), and retinal angiomatous proliferation.
Some systemic conditions associated with PED include:
- Renal: tubulointerstitial nephritis, uveitis syndrome, membranoproliferative glomerulonephritis type 2.
- Inflammatory: inflammatory bowel disease, systemic lupus erythematosus, sarcoidosis.
- Infectious: neurosyphilis, post-streptococcal syndrome, Blastocystis hominis.
- Neoplastic: IgA or IgM gammopathies, paraproteinemias (including cryoglobulinemia), Waldenström macroglobulinemia, large cell non–Hodgkin lymphoma, choroidal nevi, acute myeloid leukemia.
Some other reasons may include side effects of certain drugs (like Pamidronate), procedures like organ transplantation or hemodialysis, and in some cases, even head trauma.
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Types of Pigment Epithelial Detachment
Based on the type of depositions that may accumulate under the RPE space, we have three types of PED:
- Drusenoid pigment epithelial detachment – Appear as yellow or yellow-white deposits that result in elevations of the RPE. They usually have scalloped borders and a slightly irregular surface, with a speckled or stellate pattern of brown or gray pigmentation on their surface.
- Serous pigment epithelial detachment – Appear as distinct oval or circular detachment of the RPE. These deposits have a sharply demarcated border. Typically associated with central serous chorioretinopathy, the deposits are clear or yellowish in color.
- Fibrovascular/Hemorrhagic pigment epithelial detachment – Indicates a presence of the choroid neovascularization, with new blood vessels proliferating between the RPE and Bruch’s membrane. They develop an organized vascular network; however, these abnormal blood vessels tend to leak and bleed, causing this type of PED.
Pigment Epithelial Detachment Symptoms
The symptoms of PED do not differ from other eye diseases. Some patients describe them as blurry vision, partial vision loss, metamorphopsia (when straight lines become curved), and micropsia (objects are perceived to be smaller than they actually are). Others describe a dark shadow over their eyes or like they look through a curtain.
Pigment Epithelial Detachment Vs. Central Serous Retinopathy
Central serous retinopathy is a condition when fluids build up under the retina. The fluid leakage usually comes from a layer of cells under the retina, called the choroid. Another layer of cells between the retina and the choroid is called the retinal pigment epithelium (RPE). When the cells in RPE do not work properly, fluid builds up under the retina resulting in a small detachment and visual distortion. Pigment epithelium detachment is a prominent feature or a sign of CSC.
PED Retina Diagnosis
There are several different diagnostic imaging procedures available:
- Fluorescein angiography (FA) – a technique used for examining the circulation of the retina and choroid using a fluorescent dye and specialized camera.
- Fundus autofluorescence imaging (FAF) – it is a non-invasive imaging modality that utilizes the fluorescent properties of lipofuscin within the retinal pigment epithelium to create an image.
- Indocyanine green angiography (ICG) – it is a diagnostic procedure using dye to examine the blood flow in the choroid – a blood flow that lies underneath the retina. Indocyanine Green dye is injected into a vein in the arm or hand. As the dye passes through the blood vessels of your eye, photographs are taken to record the blood flow. The most common application is the detection of choroidal neovascularization.
- Optical coherence tomography (OCT)– another non-invasive imaging technology used to obtain high-resolution cross-sectional images of the retina. OCT uses rays of near-infrared light to measure retinal thickness. These two- and three-dimensional, micrometer-resolution images allow your doctor to see inside your eye without touching it.
How is Pigment Epithelial Detachment Treated?
Unfortunately, there is no cure for PED that is proven effective. However, there are several strategies that are being used to treat vascularized PEDs mostly:
- Laser photocoagulation is an eye surgery using a laser to create a microscopic burn in the target tissue (to destroy leaking, an abnormal ocular blood vessel in the retina).
- Photodynamic therapy is an office-based procedure where a special light-activated dye (Verteporfin) is used to seal abnormal blood vessels. A non-thermal laser is then directed at the abnormal vessel for approximately 90 seconds. The laser activates the dye, which destroys the leaking vessel.
- Intravitreal steroids are steroids in the form of injections in the eyeball. These drugs have an anti-inflammatory effect and suppress vascular endothelial growth factor expression.
- Anti-VEGF therapy, including drugs ranibizumab and bevacizumab, are injected into the eyeball. PED flattening has been reported, which suggests a certain level of control over neovascularization.
PED Natural Treatment
Traditional Chinese Medicine (TCM) has been used for millennia to treat various eye diseases.
Acupuncture as the primary modality of the TCM is based on the ancient Chinese tradition. It is a procedure of inserting small needles into the specific points in the body – acupuncture points. These points are located along the meridians, which present energy pathways along the body. The acupuncturist selects the points based on imbalances that are recognized during the intake process.
Micro Acupuncture 48
Micro acupuncture 48 is a relatively new acupuncture system based on the stimulation of the 48 acupoints located only on hands, feet, and forehead. This system is highly successful in treating all the modalities of the AMD, including PED. It strengthens nerve fibers and nerve conduction to improve the vision to normal or near normal.
Chinese herbal therapy also has a long tradition of treating eye diseases. Your certified Chinese herbalist will use herbs or herbal mixtures for their flavor, scent, and therapeutic properties. The herbal therapy focuses on treating not only the core problem but also on strengthening the overall immune system. They can be used as teas, liquid extracts, lotions, powders, capsules, tablets, fresh or dried herbs. Some of them are:
- Herbs that activate the blood and improve circulation open blood vessels and promote circulation. Common herbs include motherwort fruit angelica root, safflower, dan shen root, peach seed, red peony root, and many more.
- Tonifying herbshave immunity-boosting and antioxidant effects. These include rehmannia root astragalus root, codonopsis root, poria, privet fruit, paper mulberry fruit, herba cistance, wolfberry and many others.
- Vision clarifying herbs improve vision and control PED progression. These are cassia seed, buerger pipewort flower, pale butterflybush flower, common scouring rush herb, and many others.