Vitreo-Retinal & Uveitis Services

Fundus examination is a diagnostic procedure that employs the use of mydriatic eye drops e.g. tropicamide to dilate the pupil in order to obtain a better view of the fundus of the eye. Once the pupil is dilated, examiners use ophthalmoscope to visualise retina,optic nerve,blood vessels and other features.

Diabetic Retinopathy is one of the most predominant complications of diabetes and it generally affects both eyes. The condition develops slowly throughout many years; therefore, it is essential to undergo regular eye tests when you have Diabetes. Prevention of retinopathy or slowing down of the progression can be established with keeping excellent control of blood sugar levels. Early detection of the disease is vital; therefore, it is recommended that diabetic patients should undergo an annual retinal exam with an ophthalmologist

Diabetes can cause macular oedema. It is the build-up of fluid in the macula which is an area located in the retina, leading to swelling and contributes to high percentage of vision loss. The macula is an area found in the retina that produces sharp central vision. Apart from blurry vision, other symptoms of this condition include colour changes.

Diabetes can also lead to proliferative diabetic retinopathy where blood vessels are leaking into the centre of the eye. The patient may also experience trouble with night vision, seeing spots or floaters.Diabetic retinopathy can be detected by undergoing a comprehensive eye examination that emphasises on the evaluation of specifically the retina and macula. Such a test may include: visual acuity measurements, intraocular pressure measurement, dilated fundus examination.

Treatment of diabetic retinopathy may vary according to the extent of the disease.

• It includes laser treatment which is done to repair leaking blood vessels or to prevent other blood vessels from leaking.In laser photocoagulation, a few to hundreds of tiny laser burns are made to the leaking blood vessels in spaces near the centre of the macula. This procedure can successfully slow down the leakage of fluid, therefore reducing swelling in the retina. The procedure is usually completed with just one session, but in some cases, a patient may require more than one session. It can be done in the form of focal/grid laser or pan retinal photocoagulation in which 3 sittings are required.
• Injection of medicines (anti VEGFs) into the eye is done to reduce inflammation or to avoid the formation of new blood vessels Available anti-VEGF drugs include: Avastin (Bevacizumab)Eylea (Aflibercept)Lucentis/Accentrix (Ranibizumab). Eylea and Lucentis are FDA approved for treating DME. Avastin is FDA approved for treating cancer but is generally used to treat various eye conditions including DME. Corticosteroids are either implanted or injected into the eye and can be used in conjunction with laser surgery or other drugs for the treatment of DME. e.g. Ozurdex (Dexamethasone)
• Surgical Procedures(Vitrectomy) is done in severe cases of diabetic retinopathy to remove and replace the vitreous (gel-like fluid) in the back of the eye.This procedure is generally done under general or local anaesthesia. Temporary water-tight openings (ports) are made in the eye, allowing the surgeon to insert and remove instruments, for example, a small vacuum (vitrector) or a tiny light. A clear salt solution is then gently injected into the eye through one of the openings (ports) to retain eye pressure during surgery and to replace the removed vitreous.

Yes, high blood pressure can cause damage to the blood vessels in the retina. This eye disease is known as hypertensive retinopathy. The damage can be serious if hypertension is not treated. It can lead to symptoms including diminution of vision, loss of vision and headaches. Individuals with hypertensive retinopathy are at risk of various complications, including:

Retinal vein occlusion occurs when a vein in the retina becomes blocked due to clots.

• Retinal artery occlusion occurs when an artery in the retina becomes blocked due to clots, resulting in possible loss of vision.
• Ischemic optic neuropathy involves the obstruction of normal blood flow to the eye, resulting in damage to the optic nerve
• Malignant hypertension causes blood pressure to increase rapidly, causing possible loss of vision. This is a rare complication, which is potentially life-threatening.

Diagnosing hypertensive retinopathy typically involves an examination by an ophthalmologist based on the symptoms present. The only way to treat hypertensive retinopathy is by controlling high blood pressure.

This can be done through lifestyle changes such as:Giving up smoking, losing weight,taking regular exercise,dietary changes,reducing alcohol intake etc.

Retinal detachment is a disorder of the eye in which the retina separates from the underlying layers.

Symptoms include an increase in the number of floaters, flashes of light, and loss of some part of the visual field. This may be described as a curtain over part of the field of vision. In about 7% of cases both eyes are affected. Without treatment permanent loss of vision may occur.

The mechanism most commonly involves a break in the retina that then allows the fluid in the eye to get behind the retina. A break in the retina can occur due to posterior vitreous detachment, injury to the eye, or inflammation of the eye. Other risk factors include being short sighted and previous cataract surgery. Retinal detachments also rarely occur due to a choroidal tumor. Diagnosis is by either looking at the back of the eye with an ophthalmoscope or by ultrasound.

In those with a retinal tear, efforts to prevent it becoming a detachment include cryotherapy using a cold probe or photocoagulation using a laser.Treatment of retinal detachment should be carried out in a timely manner. This may include scleral buckling where silicone buckle is sutured to the outside of the eye, pneumatic retinopexy where gas is injected into the eye, or vitrectomy where the vitreous is partly removed and replaced with either gas or oil.

Age-related macular degeneration (AMD), is a condition which may result in blurred vision in the centre of the visual field. Early,there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Distorted vision in the form of metamorphopsia may occur, in which a grid of straight lines appears wavy and parts of the grid may appear blank. There may also be central scotomas, shadows or missing areas of vision.

Macular degeneration typically occurs in older people. Genetic factors and smoking also play a role. It is due to damage to the macula. Diagnosis is by a complete eye exam.

It is of 2 typesà Dry andWet with the dry form making up 90% of cases.

• Dry AMD (also called nonexudative AMD) is a broad designation, encompassing all forms of AMD that are not neovascular (wet AMD). This includes early and intermediate forms of AMD, as well as the advanced form of dry AMD known as geographic atrophy. Dry AMD patients tend to have minimal symptoms in the earlier stages; visual function loss occurs more often if the condition advances to geographic atrophy. Dry AMD accounts for 80–90% of cases and tends to progress slowly. In 10–20% of people, dry AMD progresses to the wet type.
• Geographic Atrophy(also called atrophic AMD) is an advanced form of AMD in which progressive and irreversible loss of retinal cells leads to a loss of visual function.

Neovascular or exudative AMD, the “wet” form of advanced AMD, causes vision loss due to abnormal blood vessel growth (choroidal neovascularization) in the choriocapillaris, through Bruch’s membrane. It is usually, but not always, preceded by the dry form of AMD. The proliferation of abnormal blood vessels in the retina is stimulated by vascular endothelial growth factor (VEGF). Because these blood vessels are abnormal, these are also more fragile than typical blood vessels, which ultimately leads to blood and protein leakage below the macula. Bleeding, leaking, and scarring from these blood vessels eventually cause irreversible damage to the photoreceptors and rapid vision loss if left untreated.

Preventive efforts include exercising, eating well, and not smoking. There is no cure or treatment that returns vision already lost. In the wet form, anti-VEGF drugs are injected into the eye or less commonly laser coagulation or photodynamic therapy may slow worsening. Antioxidant vitamins and minerals do not appear to be useful for prevention. However, supplements may slow the progression in those who already have the disease

Photodynamic therapy has also been used to treat wet AMD. The drug verteporfin is administered intravenously; light of a certain wavelength is then applied to the abnormal blood vessels. This activates the verteporfin destroying the vessels.

Because peripheral vision is not affected, people with macular degeneration can learn to use their remaining vision to partially compensate.Adaptive devices can help people read. These include magnifying glasses, special eyeglass lenses etc.