Retina Clinic

Diseases and conditions of the Retina

• Age Related Macular Degeneration
• Diabetic Retinopathy
• Retinal Tear
• Retinal Detachment

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Age-Related Macular Degeneration

What causes AMD?

As part of the normal ageing process, yellowish deposits known as drusen form under the retina, the light-sensitive layer at the back of the eye responsible for clear, sharp images. When drusen increases in size and number, they can disrupt the retina's function, damaging or destroying the light-sensitive cells of the macula.

The macula's cells are essential for sharp, detailed vision. Consequently, their damage can lead to blurred central vision, significantly affecting daily activities like reading, driving, and recognizing faces of friends and family members.

This form of age-related macular degeneration is called dry AMD. Dry AMD can be a precursor to wet AMD.

Wet Age-related Macular Degeneration (AMD) occurs when abnormal blood vessels develop behind the retina and grow under the macula. These vessels frequently leak blood and fluid, damaging or destroying the light-sensitive cells, leading to rapid vision loss.

Although about 80 percent of AMD patients have the dry form, wet AMD accounts for 80 to 90 percent of severe vision loss associated with this disease.

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Life with AMD : what you should know but don't

While AMD can be challenging, it is not as devastating as many fear upon diagnosis and rarely leads to complete blindness. Millions of people live healthy, independent lives despite having AMD.

Learning about the disease and working with a retina specialist is crucial. These specialists are trained and experienced in treating all medical and surgical aspects of AMD and other retinal conditions. They can develop a personalized treatment plan and suggest rehabilitation options, such as low vision aids, which provide tools and resources to help make daily living with AMD easier

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Symptoms

A retina specialist can detect the earliest signs of AMD in the retina before any vision loss occurs. However, individuals who have had the disease for some time may begin to notice vision changes symptomatic of either dry or wet AMD.

Dry AMD symptoms

• Need for brighter light when reading
• Difficulty adapting to low light levels
• Increased blurriness of printed words
• Decrease in brightness of colors
• Blurred spot in the center of the field of vision
• Blank or black spot in the field of vision (spot will start small and grow over time, possibly leading to blindness
  
  

Wet AMD

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Wet AMD Symptoms

• Sudden painless decline in central vision
• Visual distortions, such as straight lines appearing wavy, or objects appearing larger or smaller than they are
• Well-defined blind spot in the center of vision

It is important to pay close attention to any decline in central vision—both near and distant. If you notice any of these signs or symptoms, schedule an examination with a retina specialist.

Risk factors

Many people wonder if AMD can be prevented. Unfortunately, there is no straightforward answer. 

The primary risk factor for AMD is age—the risk increases as you get older. Additionally, individuals with a family history of AMD, women, and people of European descent are at higher risk.

Some lifestyle factors are also known to increase your risk for AMD:

• Cigarette smoking
• Obesity
• Hypertension (high blood pressure)
• Excessive sun exposure
• Diet deficient in fruits and vegetables

Diagnostic tests

The best way to detect AMD is an examination by a retina specialist. The following are some typical methods he/she will use to check for AMD.

Dilated eye exam

During a dilated eye exam, a physician uses eye drops to widen the pupil, allowing for a thorough examination of the retina. Regular dilated eye exams are crucial, especially for those at higher risk for developing AMD. 

If you are over the age of 50, scheduling periodic eye examinations can help detect the earliest signs of AMD before any vision loss occurs.

Ocular coherence tomography

The physician may suggest an optical coherence tomography (OCT) exam. This test provides cross-sectional images of the retina that show its thickness, helping determine whether fluid has leaked into retinal tissue and other changes that happen with AMD.

Amsler grid

Another method to detect AMD is the Amsler grid test. In this test, the patient covers one eye at a time and focuses on the black dot in the centre of the grid. If the straight lines appear broken, crooked, wavy, bent, or distorted, it may indicate AMD.

However, it's important to note that the Amsler grid test alone is not sufficient to rule out AMD, as many individuals with the disease may not see any abnormalities on the grid. Regular comprehensive eye exams are essential for accurate diagnosis and monitoring.

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Visual acuity test

Because AMD affects visual acuity, an eye chart can also be an indicator of the development of AMD.

Treatment and drugs

There is no known cure for AMD, but early detection and proper treatment can protect vision from further deterioration.

Dry AMD treatments

• Currently, no medical treatments exist for dry AMD, but the retina specialist will suggest strategies to slow its progression—taking vitamin or mineral supplements, for example.
• If you have Dry AMD, it is extremely important to follow your retina specialist’s eye examination schedule.
• Biweekly Amsler’s grid self examination
• Also, if you experience new symptoms or your notice any deterioration in vision, see your retina specialist right away.

Wet AMD treatments

There is a variety of medical treatments that can help stop further vision loss caused by wet AMD:

• Laser surgery – These procedures can eliminate abnormal blood vessels and prevent additional leakage, bleeding, or growth.
• Photodynamic therapy – In this treatment, the patient is injected in the arm with a medicine that is triggered by a laser to destroy abnormal blood vessels.
• Eye injections – These medicines destroy abnormal blood vessels in the eye and prevent them from leaking.

Intravitreal Injections

• Pegaptanib (Macugen)
• Bevacizumab (Avastin)
• Ranibizumab (Lucentis): Is the newest and most effective anti-VEGF agent approved by the FDA for the treatment of wet age-related macular degeneration (AMD).

Retinal Tear / Detachment

Tears or detachment results from ageing, an eye-injury, or another eye problem.

A retinal detachment occurs when fluid leaks through the tear and separates the retina from the back of the eye.

Symptoms of Retinal Tear:

• Floaters (specks or threads in your vision).
• Flashes (lights, stars or streaks in your vision).
• Sudden blurry vision.

Treatment of Retinal Tear is mainly surgical this involves :

Pneumatic retinopexy- Sealing a tear:

This procedure can treat retinal detachment if the tear is small and easy to close. A small gas bubble is injected into the eye, specifically into the clear, gel-like substance between the lens and the retina. The bubble rises and presses against the retina, closing the tear. Then, a laser or cryopexy is used to seal the tear.

Both treatments work by sealing the retina to the back of the eye, preventing further deterioration of the tear.

Symptoms of Retinal Detachment:

Flashes of light

Seeing “floaters” (small flecks or threads)

Darkening of your peripheral (side) vision

Treatment for Retinal Detachment :

• Laser Treatment of the Retina: Laser is usually performed to decrease leakage in the retina, treat abnormal blood vessel growth, or create a beneficial scarring effect that can help prevent a retinal detachment. It is a non-invasive procedure .
• Scleral Buckle: This treatment for retinal detachment involves surgically sewing a silicone band (buckle) around the white of the eye (called the sclera) to push the sclera toward the tear until the tear heals. This band is not visible and remains permanently attached. Laser or cryo treatment may then be necessary to seal the tear.
• Vitrectomy: A sophisticated microsurgical technique in which the vitreous gel is removed from inside the eye with a small, specialised cutting device, an operating microscope to look into the eye, and microsurgical instruments.
• Depending on the complexity of the retinal detachment, various combinations of vitrectomy, buckle, laser and gas bubble may be used to repair the retina.

Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that affects the eyes, caused by damage to the blood vessels in the retina, the light-sensitive tissue at the back of the eye. In individuals with diabetes mellitus, cells struggle to properly use and store sugar. High blood sugar levels can damage the blood vessels in the eyes, potentially leading to diabetic retinopathy, which can result in vision loss or blindness. If you have diabetes or are at risk for diabetic retinopathy, you can take steps to reduce your risk of vision loss from this condition.

Symptoms

• Spots or dark strings floating in your vision (floaters)
• Blurred vision
• Fluctuating vision
• Impaired color vision
• Dark or empty areas in your vision
• Vision loss

Risk factors Causes

Diabetes, characterised by high levels of glucose (sugar) in the blood, is the primary cause of diabetic retinopathy. Elevated sugar levels can damage the small blood vessels that supply nutrients to the retina, potentially blocking them entirely. Consequently, the retina may experience a reduced blood supply, impacting vision.

In response to this reduced blood flow, the eye may produce growth factors that contribute to two serious complications: diabetic macular edema, which can cause decreased vision, and proliferative diabetic retinopathy, which can lead to retinal detachment and vision loss.

Risk of developing diabetic retinopathy can increase as a result of:

• Duration of diabetes — the longer you have diabetes, the greater your risk of developing diabetic retinopathy
• Poor control of your blood sugar level
• High blood pressure
• High cholesterol
• Pregnancy
• Tobacco use
• Being black, Hispanic or Native American

Complications

Complications can lead to serious vision problems:

1. Vitreous haemorrhage: The new blood vessels may bleed into the clear, jelly-like substance that fills the centre of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision.

Vitreous haemorrhage by itself usually doesn’t cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision may return to its previous clarity.

2. Retinal detachment: The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss.

3. New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).

4. Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.

Development & Types Of Diabetic Retinopathy

Diabetes can damage the blood vessels of the retina, leading to various complications. 

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In Background Diabetic Retinopathy, these vessels may leak fluid, proteins, or fats, or they may rupture, causing haemorrhage (bleeding), or become blocked.

In more severe cases, blocked blood vessels can result in the loss of nutrition and oxygen to the retina. This deprivation promotes the growth of new, fragile abnormal vessels on the optic disc or elsewhere, which are prone to rupture, leading to large haemorrhages and severe visual loss or blindness. This condition is known as Proliferative Diabetic Retinopathy.

When the central vision, particularly the area of the retina called the Macula, is affected, causing difficulty in near vision, it is termed Diabetic Maculopathy.

Detection & Prevention Of Vision Loss

The problem with diabetic retinopathy is that there are no symptoms in the early stages. During the time when retinopathy is most easily treated, the diabetic will not notice visual changes. In fact, more than 50% of patients with proliferative retinpathy may have good vision for 5 years or more. 

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When visual symptoms start, it is often too late. Therefore, consider the following steps:

• Routine eye examination – Eyes should be checked periodically as advised by your eye doctor
• Diabetes Control
• Control of blood pressure (hypertension) and cholesterol
• Stop smoking & alcohol intake.

Investigations

• Diabetic retinopathy is best diagnosed with a dilated eye exam.
• During the exam, the eye doctor looks for:
• Abnormal blood vessels
• Swelling, blood or fatty deposits in the retina
• Growth of new blood vessels and scar tissue
• Bleeding in the clear, jelly-like substance that fills the centre of the eye (vitreous)
• Retinal detachment
• Abnormalities in optic nerve

In addition to this exam, there are 3 other diagnostic tools eye specialist use to detect and manage diabetic retinopathy:

1. Fundus Photograph: This involves taking images of the retina using a specialised non contact fundus camera.
2. Fundus Fluorescein Angiography (FFA): By injecting dye into one of the peripheral veins, severity of retinopathy can be picked up for treatment depending on the pattern of dye leakage.
3. Optical Coherence Tomography (OCT): is non-invasive as compared to FFA (no needle) & with fundus photography, it provides accurate screening for diabetic retinopathy severity. We have installed the latest 3D OCT at Surya Eye for enhanced imaging quality.

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In addition, the eye doctor may:

• Check vision
• Measure eye pressure to test for glaucoma
• Look for evidence of cataracts

Treatment

• Laser photo-coagulation: Diabetic retinopathy is a treatable condition by laser photocoagulation. The Laser beam energy is absorbed by the ocular tissues/retina where it is directed & it is then changed to heat energy which coagulates the tissue by burning. Thus the Laser is used to spot weld the leaking point in the retina. We can prevent the complications of retinopathy such as haemorrhage, fibrous scar tissue formation & retinal detachment.
• Intravitreal injections: these are the more recent means of treating diabetic retinopathy. Like Lasers they are not particularly painful, and can be more effective than the laser itself in most cases.
• Surgery: with Microincisional  (keyhole) Stitchless Vitrectomy surgery, diabetic retinopathy complications like bleeding & retinal detachment can be easily treated without opening up tissues of the eye or taking stitches.

Are you looking for Retina Treatment in Mumbai, Bandra, Mulund & Airoli?

We at Surya Eye have the Best Retina Specialist in Mumbai for Retina treatment and surgery. At Surya Eye Hospital, one of the best eye hospitals in Mumbai all kinds of Retinal diseases like Diabetic Retinopathy, Age-Related Macular Degeneration, Retinal tear, and Retinal Detachment are treated.

Contact Surya Eye Hospital today for all your Retina Treatment in Mumbai City
Call us at +91 8070504504