Dr. Om Prakash Eye Institute

Vitreo Retina Services

VITREORETINAL SERVICES

While it is common knowledge that cataract is by far the single most-important cause of Severe Visual Impairment, it is important to note that several researches point out to Retinal diseases as an emerging threat in Asia, and more specifically North India, which is the  operational area of Sai Retina Foundation.

Retina, as a super specialty, is not available to all as it requires extremely high professional standards. There are only around 12,000 ophthalmologists practicing ophthalmology in our country for a population of 1.1 billion. Of these only about 450 can undertake advanced V-R surgery.

PATIENT EDUCATION:

COMMON RETINAL DISORDERS:


·         Retinal Tear – Tears are due to a flap of retina being pulled off the choroids as the vitreous shrinks

·         Retinal Hole – Holes are circular defects in the retina

 

·         Retinal Detachment (RD) – Separation of retina from the back wall of the eye

 

 

RETINAL DETACHMENT

·        Diabetic Retinopathy (DR) – caused by longstanding diabetes

·         Hypertensive retinopathy 

BRANCH RETINAL VEIN OCCLUSION) BRVO
CENTRAL RETINAL VEIN OCCLUSION (CRVO)

·         Age Related Macular Degeneration (ARMD) – 

WET AGE RELATED RETINAL DETACHMENT (ARMD)

WHAT CAUSES RETINAL DETACHMENT:

  • Lattice degeneration
  • Retinal hole or tear
  • Injury
  • Long term diabetes mellitus
  • Myopia
  • Spontaneous i.e. without any obvious cause

Surgery is the only possibility for treating retinal detachment

 
DIABETES & THE EYE


Diabetes is caused by increased sugar level in the blood


The long term effects are on eyes, kidneys, nerve, skin & heart


WHAT IS DIABETIC RETINOPATHY?

  • Longstanding Diabetes Mellitus damages the small blood vessels of the retina, which normally supply

 oxygen to the retina and thus keep it alive

  • These damaged vessels either leak or close down
  • If the leakages occur in the central part of the retina called macula, it leads to loss of central vision
  • Closure leads to oxygen starvation of the retina, which finally leads to formation of abnormal new vessels to try and improve oxygen supply
  • However these new blood vessels are fragile and not well formed. Thus these are of little help, rather they pose a constant threat of bleeding at any time leading to severe sight threatening complications

 

STAGES OF DIABETIC RETINOPATHY:

·         Background Diabetic Retinopathy

Initial stage of Diabetic Retinopathy

·         Pre-proliferative Diabetic Retinopathy

Develops in some eyes which initially show only simple background diabetic retinopathy. Patients at this stage should be watched closely.

·         Proliferative Diabetic Retinopathy

New abnormal blood vessels spread over the inner surface of retina and may even grow into the vitreous. These blood vessels frequently bleed into the vitreous blocking the light from reaching the retina. Hence clouding of vision.

Diabetic Retinopathy is positively correlated with the duration of diabetes. There are other things which along with diabetes make retinopathy worse:

·         High Blood Pressure

·         Pregnancy

·         Smoking



INVESTIGATIONS FOR DIABETIC RETINOPATHY:


If diabetic retinopathy is noted, colour photographs of the retina may be taken and FLUORESCEIN ANGIOGRAPHY performed. This involves dilating the pupils and injection of a fluorescent dye into a vein in the arm. Photographs of the retina are taken rapidly as the dye passes through the retinal blood vessels. This test helps in determining if laser photocoagulation treatment is necessary. If treatment is to be done, it helps in identifying what structures and areas need treatment with laser.

OPTICAL COHERENCE TOMOGRAPHY (OCT), which is newer non-invasive diagnostic modality provides a cross-sectional view of the retina and helps in quantifying the amount and type of swelling and guides the treatment.




TREATMENT OF DIABETIC RETINOPATHY:


PHOTOCOAGULATION involves the use of a LASER beam to seal leaking blood vessels and prevent growth of abnormal blood vessels. This procedure does not require hospitalization. In background retinopathy, if blood vessels are leaking fluid into the macula, laser treatment stops the leakage and may improve or stabilize vision. In proliferative retinopathy, laser treatment may involve one or more sessions depending on the type or severity of retinopathy. Laser treatment significantly reduces the chances of severe visual loss by destroying the abnormal blood vessels and preventing growth of more such vessels. Vision may improve or stabilize within several weeks to a year. It is important to remember that laser treatment is not a one-time procedure. Regular follow-up is extremely important. Your doctor will tell you when to return for a check-up. 
              


 

 


INTRAVITREAL INJECTIONS – Recently, along with laser treatment, certain medication when injected into the eye or just outside the eye has shown encouraging results. These include anti-VEGF agents such as Avastin, Lucentis and Macugen. They act by reducing macular edema i.e. the swelling in the retina as well as inhibiting growth of abnormal new vessels, or by reducing bleeding from new vessels which may be refractory to conventional laser treatment.


Another agent used is the steroid Triamcinolone Acetonide. This can be either injected into the eye (intravitreally) or into the side of the eye (Sub-Tenons). This agent works well for diabetic macular edema (swelling). However, increase in eye pressure and increased incidence of cataract, are potential side effects. These medicines should therefore be used cautiously and judiciously.


VITRECTOMY (VITREOUS SURGERY) – If the vitreous is too clouded with blood or there is traction retinal detachment, laser treatment will not work. In this situation, a surgical procedure called VITRECTOMY needs to be performed. In this operation, opaque vitreous gel is removed from within the eye by a special instrument that simultaneously sucks and cuts the vitreous. Membranes on the retina which are responsible for traction and recurrent bleeding are dissected. More complete photocoagulation can then be carried out. In case of retinal detachment due to traction in severe cases, gas or silicone oil tamponade is paced at the end of the procedure.



REMEMBER

·           Diabetes is a common cause of blindness

  • In case you are a diabetic for more than 5 years, there is a fair chance that you might have developed diabetic retinopathy
  • You might have developed Diabetic Retinopathy, in spite of having good vision

    ·         For the early detection and to begin the treatment, you should see your retina specialist at regular intervals

    ·         Diabetic retinopathy is largely treatable condition. Early detection and treatment saves eyes.

    ·         You should keep your blood sugar level, hypertension, increased blood lipids & cholesterol and (kidney) disease well under control.
  • Quit smoking
  • Regular exercise and balanced diet.

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