Retina Treatment

WORLD CLASS RETINA CARE WITH A LEGACY OF OVER 40 YEARS

Retina and its Diseases

Retina forms the thin layer of tissue that rests in the back of your eye. Framed with numerous light-sensitive cells, it organizes your vision. Your brain receives the information via the optic nerve that relies on your retina - That's how you see! Retinal disorders differ at large, but visual symptoms would be common for all the diseases. Retinal detachment, or a detached retina, is a very serious eye condition where the retina pulls away the tissues supporting it. The symptoms may include sudden changes in vision, darkening side vision, etc.

Retinal Treatment
HOW DO I KNOW IF I HAVE ANY RETINAL DISEASE

Symptoms

If you have retina disease, you may observe

Diabetic Retinopathy

As the name rightly implies, Diabetic Retinopathy deals with the relation between diabetes and its complexities that reflect in your vision directly due to the damage in blood vessels. In the initial stages, it has no symptoms or in some cases very mild symptoms. But if not given importance, will even lead to your blindness.

Diabetes type and type 2 are very common disorders these days. And that’s why it is rightly said that if you are highly prone to diabetes and you care for it the least, then your chances of being prone to diabetic retinopathy is very high! You might experience dark dots floating in your vision, consistently leading to blurred vision and then to no vision.

It is usually caused by the excess blood sugar in the blood that leads to the blockage of tiny blood vessels that nourish the retina. Hence, the eye tries to grow new blood vessels that may not develop properly and may lead to leakage.

Diabetes also effects the central oxygen rich area of the retina responsible for fine vision known [macula] and this condition is called as diabetic maculopathy. This is due to deposition of protein rich fluid into the macula leading to swelling, that reduces the vision.

Diabetic Retinopathy
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Treatment Options

Control of sugars

Needless to be said, this is the most important factor for treatment and control of diabetic retinopathy.

Control of Sugars
Anti-VEGF

Intravitreal Injection of Anti-VEGF

Anti-VEGF compounds are highly specific antibodies which target a particular molecule. These molecules when delivered into the eye, reduce the thickening of the macula [diabetic maculopathy] and improve the vision with regular use. They also cause the fragile leaky blood vessels to regress in cases of proliferative diabetic retinopathy

Retinal LASER photocoagulation

LASERing the retina is only reserved for patients who have later stages of diabetic retinopathy i.e proliferative diabetic retinopathy. LASER is delivered to the entire retina sparing the central retina alone. This reduces the oxygen demand of the retina which causes the regression of the newer blood vessels.

Retinal LASER photocoagulation
Pars Planar Vitrectomy

Pars Planar Vitrectomy

Vitrectomy procedure is only reserved for advanced stage of diabetic retinopathy such as Tractional Retinal Detachment [TRD] or bleeding in the jelly [vitreous haemorrhage] which has not resolved for more than 3 months.

Age Related Macular degeneration [ARMD]

Age-related macular degeneration or ARMD is another leading of permanent visual loss in the elderly population. The disease is due to accumulation of toxic metabolic waste in the Pigment Epithelium layer of the retina [RPE]. These deposits are called as Drusen, and the condition at this stage is known as Dry ARMD. The RPE layer is responsible for keeping the retina water tight. Damage to this layer gradually causes leaky blood vessels to grown into the retina and causes retinal thickening.

This thickening in the early stages leads to distortion of vision, where patients complain of seeing straight lines crooked [metamorphopsia], or larger [macropsia] or smaller [micropsia] than normal. This stage of the disease is known as Wet ARMD. The central vision is affected early on in this disease and patients have difficulty doing fine near work. If the disease is left to progress, it affects the entire central retina and enlarges the area of defective vision. At later stages of the disease, there is extensive scarring of the retina, with permanent loss of vision.

Age Related Macular degeneration

Treatment Options

Observation and lifestyle modifications:

These include cessation of smoking, reducing use of brightly lit screens, addition of nutrition supplements such as lutein and zeaxanthin [grapes, etc]. Patients are also need to monitor their vision with the help of an Amsler’s chart on fortnightly or monthly basis to check for any distortion of vision

Observation of Eye
Intravitreal Injections

Intravitreal Injections

Intravitreal injection of Anti-VEGF is the mainstay of therapy for Wet ARMD. This causes the leaky blood vessels to regress, thereby reducing the swelling of the retina leading to dramatic visual recovery. However, repeated injections are usually required along with regular follow-ups.

Low vision aids

When the ARMD has progressed to a stage of scarring where the central macula is scarred, low vision aids are usually suggested to help restore some basic vision to the patient. Hence it is extremely important to diagnose this entity at the earliest and treat when required without neglecting the disease.

Low vision aids

Retinal detachment

Retinal detachment is the separation of the inner layer of the retina from its basal layer leading to a loss of vision. There are numerous causes of retinal detachment:

Rhegmatogenous detachment [RRD]: This type of detachment occurs due to preexisting holes in the borders of the retina. Once the detachment affects the macula i.e the central retina, the patient experiences a sudden loss of vision. These are commonly seen in patients having myopia [shortsightedness], although there are numerous conditions where these types of detachments are common. The chance of the second eye being involved after the first eye is also commonly seen.

Tractional Retinal Detachment [TRD]:These types of detachments are usually seen in patients with advanced high risk diabetic retinopathy, wherein the abnormally sticky blood vessels and membranes contract and pull the retina along with it leading to loss of vision

Exudative Retinal Detachment:Exudative retinal detachment is due to an inflammatory reaction in the middle layer of the eye [choroid]. This inflammation leads to the accumulation of cells and other proteins leading to a swelling and detachment of the retina.

Retinal Detachment

Treatment Options

Vitrectomy

Vitrectomy is the gold standard for patients having tractional [TRD] as well as rhegmatogenous RD [RRD]. This procedure involves making tiny self-sealing sutureless ports into the back of the eye. After removing the jelly filling the back of the eye [vitreous humor], the retina is positioned back. Laser is then be performed to seal any holes [in case of RRD] or reduce the oxygen demand of the retina [in case of TRD]. A tamponade material, either gas or silicone oil to keep the retina flattened against the back of the eye.

Vitrectomy
Scleral Buckling

Pneumatic retinopexy with scleral buckling

Pneumatic Retinopexy with Scleral Buckling is the conventional eye surgery followed to cure the retinal detachments. Retinal scars occur on the eye’s sclera and if not treated at the right time, there is a chance of permanent vision loss. The tear or scar or break in the retina scleral develops no pain. Partial vision loss, blurred vision and floaters are the most common symptoms of Retina Scleral. Pneumatic Retinopexy method does not require operation theatre setup and it is a non-incisional procedure. The gas is passed through the retinal detachment eye, the bubbles push the scars or tears back for complete coverage of the retinal break. Pneumatic Retinopexy with Scleral Buckling shows great results and complications depending on how the procedure is done. The surgical procedure takes 45 minutes and 3 to 4 weeks is the recovery time post-surgery.

Frequently Asked Questions

What happens after vitreoretinal surgery? Logo

It is very common that you may experience a swollen eye, or red or eye tenderness for a couple of weeks. Also, you may have a blurry vision accompanied with a mild pain. Normal stage will be restored within 3 to 4 weeks of time. You may also need to maintain a face-down position for a prescribed length of time if necessary

Is retinal laser surgery painful? Icon

Conventional Retinal LASER treatment causes mild discomfort to the eye. However at Sri Eye Care we use a pattern scan multispot LASER which uses a shorter LASER exposure time and delivers multiple spots in one shot onto the retina. This reduces the discomfort, as well as reduces treatment time to 1/10 th of conventional LASERs.

How does diabetic retinopathy affect vision? Icon

The abnormal blood vessels associated with diabetic retinopathy boosts the growth of scar tissue that eventually pulls the retina away from the eye. This results in the floating vision, and eventually to being blind. The diabetes also affects the central vision by causing swelling of the central retina [macula]. This is called as diabetic maculopathy/macular edema.

How long will I be dilated? Icon

Once you have received the dilating drops, it may take around 30 minutes for your pupils to fully open. Pupils of diabetic patients take a longer time to dilate, so it may take upto 45minutes. The effect of dilatation may last up to six hours, usually.

How long will my appointment take? Icon

Although routine appointments at Sri Eye Care take around 25-30mins, appointments made for a retina check-up can take upwards of 60-90minutes. This may increase in case additional diagnostic scans are advised. If there a LASER advised, each LASER sitting should take around 15-20minutes AFTER dilatation.

Why would I need to take repeat injections? Icon

Only a small amount of Anti-VEGF [0.1ml] can be injected into the eye at one time. At this dosage, the effect of the drug lasts only for a period of 4-5 weeks. As the disease process is still active in the eye, you would need repeated injections until the leaking vessels regress.