Lacquer cracks in the retina are lesions that affect the back of the eye, particularly in individuals with certain eye conditions. These cracks represent breaks in a delicate layer of tissue that supports the retina. While they may not always cause immediate symptoms, understanding their nature is important for eye health.
What Are Lacquer Cracks?
Lacquer cracks are fine, linear, yellowish-white lines that appear on the fundus, the interior surface of the eye. These breaks occur in Bruch’s membrane, a thin layer situated between the retina and the choroid. The choroid is a network of blood vessels that supplies nutrients to the outer layers of the retina. Lacquer cracks often appear in the posterior pole of the eye, an area near the center of the retina. They are considered healed mechanical fissures in the Bruch’s membrane complex.
Causes of Lacquer Cracks
The primary cause of lacquer cracks is high myopia, also known as pathological myopia. This severe form of nearsightedness causes the eyeball to elongate excessively, becoming longer than a typical eye. This elongation stretches and thins the various layers of the eye, including the retina, the choroid, and the underlying Bruch’s membrane. This mechanical stress leads to the development of these cracks. Lacquer cracks are considered a complication of pathological myopia, where the abnormal enlargement of the eye exerts passive stretch on Bruch’s membrane.
Recognizing the Symptoms
Lacquer cracks often remain asymptomatic, meaning they do not cause noticeable visual changes on their own. However, they can lead to complications that affect vision. Patients may experience symptoms such as blurred vision, distorted vision (metamorphopsia), or the appearance of blind spots (scotomas). Sudden vision loss can also occur if severe complications develop.
The absence of symptoms in early stages makes regular eye examinations important for individuals at risk. The presence of lacquer cracks indicates a susceptibility to further myopic macular degeneration, which could lead to irreversible visual impairment. These cracks can progress over time, sometimes leading to other changes in the fundus, including patchy atrophy or choroidal hemorrhage.
Diagnosis and Management
Ophthalmologists diagnose lacquer cracks primarily through a comprehensive dilated eye examination, which allows for a detailed view of the retina. Imaging techniques such as Optical Coherence Tomography (OCT) are used to detect discontinuities in the retinal pigment epithelium and can indirectly indicate linear defects in Bruch’s membrane. Fluorescein angiography (FA) is another method that helps identify lacquer cracks by showing linear hyper-fluorescence at the site of the crack. OCT angiography (OCTA) can also be useful for detecting ruptures of the choriocapillaris in the area of lacquer cracks.
There is no direct treatment to repair the lacquer cracks themselves. The main focus of management involves careful monitoring for complications, especially choroidal neovascularization (CNV). CNV is a condition where abnormal new blood vessels grow beneath the retina, which can bleed and lead to scarring, affecting vision. Patients with lacquer cracks have a higher incidence of myopic CNV, with about 29% developing it.
If choroidal neovascularization develops, the standard treatment involves intravitreal anti-VEGF (vascular endothelial growth factor) injections. These medications, such as ranibizumab, aflibercept, and faricimab, are injected directly into the eye to stop the growth of the abnormal blood vessels and help preserve vision. Anti-VEGF therapy is considered the first-line treatment for CNV and can reduce choroidal neovascularization, macular edema, and hemorrhage. Regular follow-up appointments are necessary to monitor the cracks and promptly address any emerging complications.