Jai Eye Centre is proud to offer state-of-the-art retina services. We provide cutting edge care for diabetic retinopathy, macular degeneration, retinal vascular disease and other retinal problems. We have qualified and experienced retina specialist who provide treatment in a caring and compassionate atmosphere. The retina is a layer at the back of the eyeball containing cells that are sensitive to light and that trigger nerve impulses that pass via the optic nerve to the brain, where a visual image is formed. With the care of a Retina Specialist it is possible to save vision and restore sight to those suffering from retinal conditions.

Diabetic Retinopathy

Diabetic Retinopathy (DR) is the most common diabetic eye disease. It is the major cause of blindness among adults.

What is Diabetic Retinopathy?
Diabetic Retinopathy is a complication of Diabetes Mellitus. It occurs when tiny blood vessels (capillaries) in the retina change and become damaged or new abnormal blood vessels grow on the surface of the retina due to high blood sugar levels.

What are the symptoms?
People with diabetic retinopathy usually do not notice changes in their vision until the disease progresses.As the disease progresses, symptoms may include the loss of central vision when reading or driving, loss of the ability to see colour, and mild blurring vision.
Small spots or floaters may also indicate blood vessel leaks and may clear up in days, weeks, or even months. In the most severe form, with proliferative diabetic retinopathy, there may be sudden severe vision loss from vitreous bleeding or tractional retinal detachment.
 It is very important for people with diabetic retinopathy to see a trained ophthalmologist/retina specialist every year for dilated retina examination.Early diagnosis of diabetic retinopathy helps delay progression of the disease and allows effective treatment sooner. If left untreated, the disease can cause irreparable vision loss.

Who is at risk of developing diabetic retinopathy?
 All diabetics both type 1 and type 2 are at risk for developing diabetic retinopathy. This is especially so if the diabetes is long-standing. After 20 years, most diabetics will develop this complication of some degree. Those who have poorly controlled diabetes as well as  those with comorbidities (hypertension,hyperlipidemia,renal disease etc) are at higher risk of developing diabetic retinopathy earlier and with more severity.

What are the types of diabetic retinopathy?

DR can be grossly divided into following types:
Non proliferative diabetic retinopathy (NPDR)
Retina shows evidence of tiny blood spots (microaneurysms and haemorrhages) or fatty spots and cotton wool spots (retinal infarcts) etc.. Most patients at this stage do not have any loss of vision unless blood vessels begin to leak at the macula (the part of the retina responsible for central vision). So detection is possible only through routine dilated fundus examination every 6 months by an ophthalmologist.
Proliferative diabetic retinopathy (PDR)
New blood vessels along fibrous tissue grow on the surface of the retina, posterior hyaloid phase and optic disc leading to vitreous haemorrhage and tractional retinal detachment and sudden loss of vision. New vessels may also grow on iris, leading to glaucoma (Neovascular glaucoma) that is very difficult to treat and may lead to rapid blindness.
Diabetic macular edema (DME) 
can coexist with NPDR as well as the PDR.It causes blurring of vision due to leakage of fluid and/or fatty exudates at the macula

How is Diabetic Retinopathy diagnosed ?

Diabetic Retinopathy is diagnosed by
  • Indirect Ophthalmoscopy and Slit lamp biomicroscopy
  • Fundus photography
  • Fundus Fluorescein Angiography (FFA) - A dye is injected into a vein in hand and its flow in the retinal vasculature visualized and captured in images. It helps in determining the stage of diabetic retinopathy and for decision regarding treatment
  • Optical Coherence tomography (OCT) is cross sectional imaging of the retina that helps in the diagnosis and quantification of macular edema.
  • How is diabetic retinopathy treated?

    Control of blood sugar, blood pressure, serum lipids, maintenance of optimal kidney function and serum hemoglobin levels will help to limit DR and aid in regression of macular edema.Treatment of DR is effective when these systemic parameters are well controlled.
    Laser photocoagulation 
    Laser treatment (Pan retinal photocoagulation)shrinks the abnormal blood vessels and reduce new vessel growth. It is an OPD procedure, relatively painless and is done in 3-4 sittings. It is not intended to improve vision, but is successful at preventing further vision loss.Focal laser is sometimes done to treat macular edema.
    Intravitreal injections
    Intravitreal injections are injected into the posterior segment of eye in the operating room under local anaesthesia. It is a quick procedure and doesn't require hospitalization.
     -Anti VEGF agents like Bevacizumab, Ranibizumab its help in regression of new blood vessels as well as resolution of macular edema. It is repeated after one month if required
    -Steroids (Ozurdex) are used in the treatment of diabetic macular edema.
    Its effect lasts for 3-4 months
    Vitreoretinal microsurgery is done for vitreous haemorrhage and tractional retinal detachment. visual prognosis is good in most patients who are good candidates for this procedure.

    Age Related Macular Degeneration

    Age-related macular degeneration or AMD as it is often known, is the leading cause of blindness in adults age 60 and older. AMD is a chronic condition that causes the macula, the portion of the retina responsible for seeing fine detail, to become damaged.

    What causes AMD

    There are two forms of AMD: dry and wet. Dry AMD usually develops slowly over time.About 80% (8 out of 10) of people who have AMD have the dry form. Dry AMD is when parts of the macula get thinner with age and tiny clumps of protein called drusen grow. You slowly lose central vision. There is no way to treat dry AMD yet.
    Wet AMD symptoms can occur suddenly.This form is less common but much more serious. Wet AMD is when new, abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring of the macula. You lose vision faster with wet AMD than with dry AMD. Early detection and treatment for either form is very important and is the only way to avoid vision loss. 

    What are the symptoms?

    Symptoms of AMD include 

    • Blurring of central vision(may be gradual or rapid in onset) 
    • Shadows or missing areas of vision
    • Distorted vision (e.g. straight lines appear wavy)
    • Problems discerning colours, especially differentiating between similar colours
    • Slow recovery of visual function after exposure to bright light
    • Loss of contrast sensitivity (ability to tell different levels of brightness apart)

    Who Is at Risk for AMD?

    You are more likely to develop AMD if you:
    • eat a diet high in saturated fat (found in foods like meat, butter, and cheese)
    • are overweight
    • smoking
    • are over 50 years old
    • hypertension (high blood pressure)
    • have a family history of AMD
    Having heart disease is another risk factor for AMD, as is having high cholesterol levels. Caucasians (white people) also have an elevated risk of getting AMD.

    How is AMD diagnosed and monitored?

    Age-related macular degeneration is typically detected during routine eye (retina) exams. A common early warning sign of macular degeneration is the presence of drusen (tiny yellow deposits under the retina). Drusens are easily identified by doctors during dilated retinal examinations.
    An Amsler grid is a pattern of straight lines that resemble a chess or checkerboard. The grid can help identify those at risk of developing AMD. If some of the straight lines appear wavy or some of the lines are missing entirely; chances are the patient will be diagnosed with AMD.
    Fluorescein or Indocyanine green angiography is done to show the exact location and type of any new vessels or vessels that may be leaking fluid or blood in the macula.
    Optical coherence Tomography is another way to look closely at the retina. A machine scans the retina and provides very detailed images of the retina and macula.

    Treatments for Macular Degeneration

    While there is currently no cure for Dry AMD there are several treatment options that can prevent severe vision loss or slow the progression of the disease or stabilise the vision considerably in Wet AMD. Treatment is usually necessary as the condition may worsen over the next few weeks and may lead to irreversible vision loss. 
    These include:
    • Anti-Angiogenesis Drugs: Medications that block the development of new blood vessels and leakage from the abnormal vessels within the eye that cause wet macular degeneration. Many patients report to have regained vision that was lost. However, the treatment may need to be repeated during follow-up visits. Avastin (Bevacizumab), Lucentis (Ranibizumab)and Eylea (Aflibercept) are examples of drugs used to treat wet AMD . The injection can be performed safely after the eye has been anaesthetised with eye drops. You will experience some mild discomfort after the injection.
    • Vitamins: Age related eye disease study showed that for certain individuals, vitamins C, E, beta carotene, zinc and copper can decrease the risk of vision loss in patients with intermediate to advanced dry macular degeneration. 
    • Laser Therapy: High-energy laser light can be used to eliminate actively growing abnormal blood vessels that occur in macular degeneration.
    • Photodynamic Laser Therapy: A two-step treatment in which a light sensitive drug is used to damage the abnormal blood vessels. A doctor will then inject the drug into the bloodstream to be absorbed by the abnormal blood vessels in the eye. A cold laser is shown in the eye to activate the drug, damaging the abnormal blood vessels.
    • Low Vision Aids: There is a ton of devices on the market today that have special lenses or electronic systems that produce enlarged images of nearby objects. They help people who have vision loss from macular degeneration make the most of their remaining vision. 

    Flashes and Floaters

    Those tiny specks or clouds we see moving in our field of vision are called floaters. Floaters are actually small clumps of material and/or cells inside the gel-like fluid, called the vitreous, in your eye. Floaters can appear in many forms and sizes. Flashes are the sensation of flashing lights or lightning streaks caused by the pulling of the vitreous gel on your retina. Both of these occurrences become more common as we age due to the vitreous gel pulling away from the back wall of the eye. In some cases, these occurrences are due to a retinal tear or detachment and need to be treated quickly to avoid vision loss. Delayed treatment can result in the retina detaching from the back of the eye.If you experience the following, please contact an ophthalmologist right away:
    • A sudden increase in floaters
    • A sudden appearance of flashes
    • An appearance of a shadow or curtain on the side of your field of vision
    • A gray curtain moving across your field of vision
    • A sudden decrease in your vision

    Retinal Tears and Detachment

    Retinal detachment is a very serious condition that occurs when the retina separates from the tissue surrounding it. Without immediate treatment, a retinal detachment can cause permanent vision loss. People who are severely nearsighted, have had an eye injury or have a family history of retinal detachments are more likely to get a detached retina. There are several ways to treat a detached retina, including with lasers and surgery. Retinal tears often occur before a retinal detachment and is usually caused by the tugging of the vitreous. When the vitreous shrinks over time, a piece of the retina may stay adhered to the vitreous causing a tear. When a retina tear occurs and is not treated quickly, fluid can enter the tear and lift the retina off the surrounding tissue, creating a retinal detachment.

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