itube apk
Retina
Cataract
Glaucoma
Squint
Retina
9AM to 4PM (Monday to Saturday)
5.30PM to 7PM (Monday to Saturday)
All Sundays are Holiday!!!
 

   
 

Diabetes and the Retina

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
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

Old age and the Retina:

Age Related Macular Degeneration (AMD)


Age Related Retinal Detachment (ARD)

Age-related macular degeneration destroys the clear, “straight ahead” central vision necessary for reading, driving, identifying faces, watching television, doing fine detailed work, safely navigating stairs and performing other daily tasks we take for granted. Itcan make it more difficult to see contrast and can change the way color is seen. Peripheral vision may not be affected, and it is possible to see “out of the corner of your eye”. Vision rehabilitation and assistive devices can help people use their remaining vision effectively. The impact of developing AMD can be devastating to those who were independent and active prior to the onset of this impairment. Their visual world gradually diminishes into a vague blur, making ordinary daily activities challenging. The macula is made up of millions of light-sensing cells that provide sharp, detailed central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina quickly turns light into electrical signals and then sends these electrical signals to the brain through the optic nerve. Next, the brain translates the electrical signals into images we see. If the macula is damaged, fine points in these images are not clear. The picture is there but the fine points are lost.

There are two types of AMD – “wet” or neovascular and “dry” or atrophic. There is no cure for AMD, but new treatments are available for the wet form of the disease. There is no treatment for the dry form, but training and special devices can promote independence and a return to favorite activities.

DRY AMD

Dry AMD is most common type of macular degeneration and affects 90% of the people who have the condition. In the dry form, there is a breakdown or thinning of the layer of retinal pigment epithelial cells (RPE) in the macula. These RPE cells support the light sensitive photoreceptor cells that are so critical to vision. When we look at something, the photoreceptors (rods and cones) gather the images and send them to the brain, where vision takes place. The death or degeneration of these cells is called atrophy. Hence, dry AMD is often referred to as atrophic AMD. It is characterized by the presence of drusen (dots of yellow crystalline deposits that develop within the macula) and thinning of the macula. Dry or atrophic MD reduces one’s central vision and can effect color perception. Generally, the damage caused by the “dry” form is not as severe or rapid as that of the “wet” form. However, over time, it can cause profound vision loss.

RISK FACTORS

CAN CONTROL

Smoking
Diet
High Blood Pressure and Cholesterol
Exposure to Harmful Sunlight

CANNOT CONTROL

Age – AMD signs are present in about 14% of people 55 – 64, 20% of age 65 – 75 year olds and up to 37% of people over age 75.
Gender – AMD is more common in women than in men. This partially may be explained by the fact that women live longer than men.
Race – AMD is more common in Caucasians than other races. This partially may be due to the pigment in the eye or eye color. It may also have to do with differing diets and sun exposure.
Eye Color – AMD is more common in people with blue eyes. This may be related to damage associated with exposure to ultraviolet light. Blue eyed people may have less protective pigment in their eyes.
AMD in One Eye – If you already have AMD in one eye, your chance of developing it in the other eye is higher. Dry AMD in one eye may predispose you to wet AMD in the other eye.
Genetics – If others in your family have macular degeneration, you have a greater risk of developing it. Because of some research in the last two years, we now have a better understanding of which genes and sections of genes increase your risk. If you have one of these genes or complement factors and you smoke, you are increasing your risk as much as 200 fold!

TREATMENT

There are no medical treatments for dry macular degeneration at this time, which is why controlling your risk factors is so important for you.

Research shows that people with AMD who take charge of their lives, use support groups and seek vision rehabilitation, deal with vision problems much better. The Age-Related Eye Disease Study(AREDS) has resulted in many eye vitamins that can help. The good news is the amount of research underway to find treatments is increasing.

WET AMD

Wet macular degeneration is the more severe type of AMD. Although it affects only 10 percent of those who have the condition, it accounts for 90 percent of the severe vision loss caused by macular degeneration.

With this type, the membrane underlying the retina thickens, then breaks. The oxygen supply to the macula is disrupted and the body responds by growing new, abnormal blood vessels. These begin to grow through the breaks of the membrane behind the retina towards the macula, often raising the retina.

To visualize this, imagine the roots of a tree growing and spreading until they actually uproot a sidewalk. Then imagine rainwater seeping up throughout the cracks. These abnormal blood vessels (the “roots) tend to be very fragile. They often grow, leak or bleed, causing scarring of the macula. This fluid is called exudate and wet AMD is sometimes called exudative macular degeneration.

This damage to the macula results in rapid central vision loss. Once this vision is destroyed, it cannot be restored. There are several treatment options for wet AMD which can be very effective if applied early.

CAN CONTROL

Smoking
Diet
High Blood Pressure and Cholesterol
Exposure to Harmful Sunlight

CANNOT CONTROL

Age – AMD signs are present in about 14% of people 55 – 64, 20% of age 65 – 75 year olds and up to 37% of people over age 75.
Gender – AMD is more common in women than in men. This partially may be explained by the fact that women live longer than men.
Race – AMD is more common in Caucasians than other races. This partially may be due to the pigment in the eye or eye color. It may also have to do with differing diets and sun exposure.
Eye Color – AMD is more common in people with blue eyes. This may be related to damage associated with exposure to ultraviolet light. Blue eyed people may have less protective pigment in their eyes.
AMD in One Eye – If you already have AMD in one eye, your chance of developing it in the other eye is higher. Dry AMD in one eye may predispose you to wet AMD in the other eye.
Genetics – If others in your family have macular degeneration, you have a greater risk of developing it. Because of some research in the last two years, we now have a better understanding of which genes and sections of genes increase your risk. If you have one of these genes or complement factors and you smoke, you are increasing your risk as much as 200 fold!

TREATMENT

Fortunately for people with wet macular degeneration, there are several treatment options and more being developed. These are aimed at sealing off the leaking blood vessels (with a laser and light sensitive drug) and/or preventing the blood vessels from growing back (these last are called anti-angiogenic therapies).

Repeated treatments are necessary (intravitreal avastin or lucentis injection), as often as once a month, but doctors are now finding that treatments can be spaced further apart and still be effective. Each eye is different, so your doctor will watch carefully how you respond and will recommend what works best for you.

With multiple treatment options available, your doctor can advise you which therapy will probably be best for your case. Early detection and treatment are key to good results of any therapy for wet macular degeneration. All these treatments work better if applied early in an episode of bleeding. The goal of current treatments is to stop or slow the progression of wet AMD. While it is possible to restore some vision in patients treated early, none of the therapies can restore vision in an eye with scarring.

Trauma and the Retina

RETINAL DETACHMENT

Retinal Detachment (RD) – Retinal detachment is a separation of the light-sensitive membrane in the back of the eye (the retina) from its supporting layers.

The retina is the clear tissue in the back of the eye. It helps you see the images that are focused on it by the cornea and the lens.

The most common type of retinal detachments are often due to a tear or hole in the retina. Eye fluids may leak through this opening. This causes the retina to separate from the underlying tissues, much like a bubble under wallpaper. This is most often caused by a condition called posterior vitreous detachment. However, it may also be caused by trauma and very bad nearsightedness. A family history of retinal detachment also increases your risk.
Another type of retinal detachment is called tractional detachment. This is seen in people who have uncontrolled diabetes, previous retinal surgery, or have chronic inflammation.

When the retina becomes detached, bleeding from area blood vessels may cloud the inside of the eye, which is normally filled with vitreous fluid. Central vision becomes severely affected if the macula, the part of the retina responsible for fine vision, becomes detached.

Symptoms

Bright flashes of light, especially in peripheral vision
Blurred vision
Floaters in the eye
Shadow or blindness in a part of the visual field of one eye

Surgery is the only possibility for treating retinal detachment. Such procedures include:

Scleral buckle to gently push the eye wall up against the retina
Vitrectomy to remove gel or scar tissue pulling on the retina, used for the largest tears and detachments

Tractional retinal detachments may be watched for a while before surgery. If surgery is needed, a vitrectomy is usually done.

INTRAOCULAR FOREIGN BODY

FOREIGN BODY IN THE EYE

Penetrating eye injuries tend to occur when people are hammering or grinding. Under these circumstances small pieces of metal travelling at high speed hit the eye and enter it through the outer coat of the eye.

If you tell your doctor that you have suffered a possible eye injury while carrying out a high-risk activity such as hammering, the eye will be examined in full detail.

Your vision will be assessed, and it is possible that this may be reduced. There may be evidence that the pupil is distorted and there may be blood inside the eye.

If the lens of the eye has been hit by the foreign material, there may be evidence of an early cataract.

X-rays or scans may be required if there is any suspicion there is foreign material inside the eye.

An operation is needed to remove foreign bodies that have penetrated inside the eye. This usually takes the form of a vitrectomy, which involves going into the eye to remove the foreign material with fine surgical forceps or intraocular magnets.

At the same time, any damage to the eye caused by the entry of the foreign material can be repaired. This may involve removal of haemorrhage, removal of the lens, suturing of any defect of the globe or repair of retinal damage.

Complications Of Cataract Surgery

Common complications of cataract surgery are as follows:

Dislocation of the nucleus into the vitreous
Dislocation of the intraocular lens implant into the vitreous
Endophthalmitis (infection)

All the above conditions can be managed effectively by vitreoretinal surgery.