Retina Treatment

COMMON RETINAL DISEASES

 

RETINAL DETACHMENT


The retina is a thin, light-sensitive layer at the back of the eye. The lens of the eye focuses light on the retina like the light focused on the film or sensor in the camera. The retina then converts this light into signals that are carried to the brain.
The retina has 10 microscopic layers.

What is Retinal Detachment (RD)?
It is a disorder in which retina peels away from underlying layers which may lead to vision loss or blindness. It is a medical emergency.
There are 3 types of RD:-

  • Rhegmatogenous RD
  • Tractional RD
  • Exudative RD



Rhegmatogenous Retinal Detachment
It is the most common type of retinal detachment. ‘Rhegma’ means ‘break’, hence in this type of retinal detachment the cause is a hole or break somewhere in the retina. Any break (tear or hole) in the retina allows the fluid (vitreous) within the eye to pass through the tear and get behind the retina. This fluid pushes the retina forwards, causing it to get detached.

  • Tear or hole in retina
  • Fluid enters through it
  • Fluid separates the retina from the layer providing nutrition and oxygen to retina
  • Retina detaches



Risk Factors

  • Posterior Vitreous Detachment (PVD)
    • Common age-related condition , in which the jelly within the eye (vitreous) gets separated from the retina, pulls on it, and tears it.
  • Pre-existing weak spots in the retina – lattice degeneration, retinal holes, etc.
  • Injury
  • Myopia (short-sightedness, needing minus-power glasses)
  • Complicated cataract surgery



What does a patient experience?
Sudden, painless loss of vision of one eye Feeling a ‘shadow’ or ‘curtain’ coming down in front of the eye Problems in the vitreous jelly can produce ‘floaters’ – cobweb or thread-like shadows which move around within the eye ‘Flashes’ or ‘sparks’ of light due to the vitreous jelly pulling on the retina

 

 

What is the treatment for retinal detachment?
There is no medical treatment for retinal detachment, like injections, tablets or eye drops. This problem can only be treated with surgery, and the sooner the better.

In its earliest stages, external laser can be done to seal the retinal tears or holes, or prevent a small detachment from extending.

Scleral Buckling surgery is an external surgery in which the doctor sews a silicone band to the outer layers of eyeball, which pushes the eye-wall inward against the hole and closes it. This reduces the fluid flow through it allowing the retina to reattach.

Vitrectomy surgery is an internal surgery which involves removal of vitreous jelly, attaching the retina, doing laser to seal the holes, and replacing the vitreous with silicone oil or gas.

Important Pearls
Detection and treatment of RD is best done by a specialist vitreo-retinal surgeon.

After surgery, the patient have to keep his/her head in a particular position for a few days, if gas or silicone oil has been injected.

Retinal detachment is a medical emergency, as the earlier it is treated, the better is the outcome.

 

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DIABETIC RETINOPATHY


Diabetes affects the blood vessels of the entire body, but damage is mostly seen in the blood vessels of the eye (retina), kidneys, heart, and brain.

Diabetic retinopathy is a condition in which blood vessel damage leads to their blockage, bleeding, leakage of blood proteins and water, and formation of new blood vessels.

Diabetic Retinopathy (DR) is an important cause of permanent vision loss, and can even lead to blindness.

Who is at risk of developing diabetic retinopathy?
Patients who are diabetics with fluctuating blood sugar levels, long-term diabetes, and diabetic who also have high blood pressure (hypertension), high cholesterol, kidney disease (nephropathy), and who smoke, are at a higher risk of developing retinopathy.

Can diabetic retinopathy be prevented?
Yes, it can be prevented by keeping the blood sugar levels under tight control. Adequate control of other parameters like blood pressure, cholesterol levels, nephropathy is also essential to prevent and or delay progression of diabetic retinopathy.

What are the signs and symptoms of Diabetic Retinopathy?
In the early stages diabetic retinopathy may not have any symptoms at all and serious retinal changes may co-exist with normal vision.

In advanced stages, the patient may experience:

  • Sudden drop in vision, due to internal bleeding or retinal detachment
  • Gradual decrease in vision or blurring, due to retinal swelling (edema)
  • ‘Floaters’ or black or red-coloured spots, due to internal bleeding

 



What are the types of Diabetic Retinopathy?
DR proceeds through various stages. In the early stages of the disease, the patient most often does not have any vision-related complaints. If such a stage is reached, treatment can be initiated to preserve vision for the rest of one's life.

Two main retinal problems are seen in DR

  1. New blood vessel formation (Proliferative Diabetic Retinopathy, PDR) – which can lead to internal bleeding and retinal detachment
  2. Leakage in the central retina (Macular Edema) – which causes retinal swelling and drop in vision


Both these problems need to be tackled simultaneously.

How does one diagnose DR?
The best method is by dilated fundus examination by a qualified retina specialist. Eye drops are used to dilate the pupils of the eyes, which allow the retina to be seen in full detail.

Your retina specialist may advise certain tests:

  1. Fundus Photography: This test serves as a record of the present status, which is useful for comparing any changes that may occur with time.
  2. OCT (Retinal scanning): This test can confirm retinal swelling (macular edema) and also measure the actual retinal thickness
  3. FFA (Angiography): In this test, a dye is injected in the hand veins and photographs of the retina are taken. Specific areas of leakage, abnormal blood vessels, and blockages can be visualized.




What are the treatment options for diabetic retinopathy?
Prevention is better than cure. By keeping one’s diabetes under control, sight-threatening problems can be prevented. Damage that has already occurred cannot be reversed, but further damage can be delayed or averted.

  1. Retinal Laser can be used to close the new blood vessels that develop in PDR. Once these blood vessels close, the risk of future bleeding or retinal detachment is minimized
  2. Eye injections (Accentrix™ or Lucentis™, Avastin™, Ozurdex™, triamcinolone) are helpful in reducing the retinal swelling and improving vision.
  3. Vitrectomy surgery may be required to remove blood within the eye that does not dissolve on its own, or to restore the retina to its normal position.



Protect Your Eyes
You can protect your eyes from losing vision due to diabetic retinopathy. Meet your retina specialist every year for a retina check-up. Early diagnosis and treatment can preserve vision for the rest of your life.

 

 


AGE-RELATED MACULAR DEGENERATION


As the name suggests, this is a disease that occurs due to ageing. It is seen in people above the age of 50 years. In this disease, it is the ‘macula’, the central area of the retina, that gets damaged.

AMD is one of the leading causes of irreversible low vision in the world. It is very common in the western world, principally because of a longer life-span, but is now being recognized more and more in India.

Who is at risk of developing AMD?
This disease can occur in anybody after the age of 50 years. Studies have shown a few other risk factors:

  • Hypertension
  • Smoking
  • Family history
  • Specific genetic mutations



What are the signs and symptoms of AMD?
The earliest and sometimes only symptom in painless loss in vision. The patient may experience difficulty in reading, or looking at far-off objects clearly, or recognizing people’s faces. Sometimes this may be noticed suddenly by the patient when they close one eye, as the disease can occasionally affect one eye more than the other.

Another important symptom is ‘waviness’ of objects that should be straight. This distortion is called metamorphopsia.

AMD affects only the central vision. Patients may notice a central black spot wherever they try to focus, but it never causes total blindness.

 



 

What are the types of AMD?

In general there are two types of AMD – Dry and Wet.

Dry AMD is significantly more common than the wet form. However it can slowly progress to the wet stage. This stage is characterized by slowly progressive damage to the photoreceptor and retinal pigment epithelial cells.

Wet AMD is less common, but 90 percent of patients with vision loss due to AMD have this type of disease. In this stage, new blood vessels begin to develop underneath the retina (‘neovascularization’), which lead to bleeding and leakage of water into and below the retina.

How does one diagnose AMD?
The best method is by dilated fundus examination by a qualified retina specialist. Eye drops are used to dilate the pupils of the eyes, which allow the retina to be seen in full detail.

Your retina specialist may then advise certain tests:

  1. Fundus Photography: This test serves as a record of the present status, which is useful for comparing any changes that may occur with time.
  2. Fundus Autofluorescence: A special type of photograph, it can clearly delineate the extent of damage in patients with dry AMD.
  3. OCT (Retinal scanning): This test can detect retinal swelling (macular edema) and also measure the actual retinal thickness for future reference.
  4. FFA (Angiography): In this test, a dye is injected in the hand veins and photographs of the retina are taken. Specific areas of leakage, abnormal blood vessels, and blockages can be visualized.


 

What are the treatment options for AMD?
This disease cannot be entirely cured or reversed.

In the dry stage, treatment is aimed at stabilizing or slowing the speed at which worsening occurs. This is the rationale behind prescribing antioxidant and vitamin supplements.

In the wet stage, treatment tries to halt further damage, and in early cases vision can improve significantly. The medication required is administered directly into the eye in the form of injections. A number of drugs are available – namely Avastin™, Accentrix™ (formerly called Lucentis™), and Eylea™. All of these are regularly administered at Laxmi Eye Institute.

Occasionally, a highly specialized type of ‘cold’ laser called PDT (photodynamic therapy) is useful. In this procedure, a dye Verteporfin™ is injected in the arm, and laser light is applied to the abnormal retina blood vessels.

Remember, early treatment can help to stabilize vision and can even improve vision.

 

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RETINA TREATMENT




LASER
 
Focused light energy is delivered to the retina in an extremely controlled manner, with reproducible clinical results. The entire procedure is done in the OPD and may take between 5 and 15 minutes. It is painless, and there are no restrictions on one’s activities after the procedure.

LASER energy is used to target microscopic areas of the retina in diseases like Diabetic Retinopathy (DR), Age-related Macular Degeneration (AMD), retinal vein blockages (BRVO and CRVO), central serous retinopathy (CSR), and many others.

Intravitreal Injections

Certain drugs can only reach the retina if they are injected directly into the eye, rather than being given as eye drops or tablets. This also minimizes the risk of any side-effects in other parts of the body. Vision can improve dramatically with their use. Commonly used drugs are Accentrix™ (formerly Lucentis™), Avastin™, Ozurdex™, Eylea™, and triamcinolone. At Shobhana Eye Clinic, we administer these injections in the operating theatre, maintaining the strictest hygienic conditions.

These drugs mainly act by reducing retinal leakage and swelling in diseases like Age-related Macular Degeneration (AMD), Diabetic Retinopathy, retinal vein blockages (BRVO and CRVO), and uveitis.

Retinal Surgery
Retinal surgery is the last resort in many retinal diseases. Some diseases like Retinal Detachment (RD) can only be treated by surgery. Surgery can often produce dramatic improvement in vision.