The retina is the innermost layer of the eye. It receives images through the lens, and contains the receptors for vision, the rods and cones. Retinopathy is a disease of the retina, especially one that is non-inflammatory and associated with damage to the blood vessels. Maculopathy is any disease condition of the macula, the small spot in the retina where vision is keenest.

Retinopathy can be caused by various other disease processes that lead to damage to the blood vessels of the retina such as:

• Retinal vein occlusion

• Sickle cell anemia

• Arterial hypertension (high blood pressure) – hypertensive retinopathy

• Direct sunlight exposure- solar retinopathy

• Pheochromocytoma

• Exposure to toxic compounds

The signs and symptoms vary according to which type of retinopathy:

Retinopathy: At first, retinopathy may cause no symptoms or only mild vision problems. Symptoms may not be noticed until the late stages of the illness and can include:

• Blurred vision

• Sudden loss of vision in one or both eyes

• Black spots

• Flashing lights

• Difficulty reading or seeing detailed work

Eventually, however, retinopathy can result in blindness.

Hypertensive retinopathy: There are often no symptoms, though some people complain of blurred vision. hypertensive retinopathy that is associated with essential or malignant hypertension, changes may include irregular narrowing of the retinal arterioles, hemorrhages in the nerve fiber layers, arteriosclerotic changes.

Central serous retinopathy symptoms include:

• Blurred or dim vision, sometimes coming on suddenly

• Blind spots

• Distorted shapes

• Reduced visual sharpness

Retinopathy is diagnosed by an optometrist or an ophthalmologist during ophthalmoscopy. Different types of retinopathy may require different test for diagnosis.

Hypertensive retinopathy: A physician examines the eye with an ophthalmoscope and looks for tiny areas of the retina that look pale or white compared to the rest because these areas are not getting enough blood. The doctor also may see areas of bleeding from ruptured blood vessels. Occasionally, the retina may show areas of swelling, particularly at the area that controls fine vision (macula), or swelling of the optic nerve.

Central serous retinopathy: A doctor or ophthalmologist uses an ophthalmoscope to detect clear fluid that has seeped between one layer of the retina and another. Fluid between these layers can resemble bubbles on the retina, visible with an ophthalmoscope.

Treatment depends on the cause of the disease.

• Hypertensive retinopathy: Lowering blood pressure often can stop ongoing damage to the retina, although some damage that is established can persist. Medications can lower blood pressure and improve changes in the retina. People with very high blood pressure and swelling of the optic nerve require emergency treatment in a hospital.

• Central serous retinopathy: This condition usually goes away on its own, but an ophthalmologist should monitor you closely for three to six months to make sure the condition improves. If it does not, laser treatment may be used to speed healing. Full vision can return within six months.

Many types of retinopathy are progressive and may result in complications from retinopathy may produce irreversible loss of vision, particularly if the macula becomes affected.

• Prior to the rating schedule change for eyes on May 13, 2018, diabetic retinopathy that was compensable was evaluated analogous to this diagnostic code.

• Consider entitlement to Auto and auto adaptive equipment under 38 CFR 3.308 if there is permanent impairment of vision in both eyes consisting of central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20° in the better eye.

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• Review for potential entitlement to special monthly compensation under 38 CFR 3.350 when there is loss/loss of use of one or both eyes, light perception only; visual acuity 5/200 or less; the vision field is reduced to 5 degree concentric contraction in both eyes; or blindness with no light perception in one or both eye.

• Evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation.

• For the purposes of evaluation under 38 CFR 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes.

• Examples of treatment may include but are not limited to: Systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions.

• For the purposes of evaluating visual impairment due to the particular condition, refer to 38 CFR 4.75, 38 CFR 4.76, 38 CFR 4.77, 38 CFR 4.78,  and  38 CFR 4.79, diagnostic codes 6061-6091.