Retina

State of the Art Retina Facilities

Retina is like the film of the camera which sends the image to the brain for processing. A damaged retina can lead to significant visual disturbances many of which may become permanent if not treated in time.

Diabetic retinopathy is one of the leading causes of blindness in adults. It is caused by changes in the blood vessels of the retina, making them leaky, causing visual damage. Early detection can be done by Eye Angiography and OCT. Retina Lasers can retard the progress of disease and prevent permanent visual damage. Eye7 is one of the leading national referral centers for advanced retinal diagnostics and surgeries.

Diabetic Retinopathy

Diabetic Retinopathy is one of the leading cause of blindness in adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina.

What are the stages of diabetic retinopathy?

Diabetic retinopathy has four stages:

  • Mild Nonproliferative Retinopathy
  • Moderate Nonproliferative Retinopathy
  • Severe Nonproliferative Retinopathy
  • Proliferative Retinopathy

How does diabetic retinopathy cause vision loss?

Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

  • Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.
  • Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.

Who is at risk for diabetic retinopathy?

All people with diabetes–both type 1 and type 2–are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.

Does diabetic retinopathy have any symptoms?

Often there are no symptoms in the early stages of the disease, nor is there any pain. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year. Blurred vision may occur when the macula—the part of the retina that provides sharp central vision—swells from leaking fluid. This condition is called macular edema. If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision.

How are diabetic retinopathy and macular edema detected?

Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes:

  • Visual acuity test
  • Dilated eye exam Your doctor checks your retina for early signs of the disease, including:
  • Leaking blood vessels.
  • Retinal swelling (macular edema).
  • Pale, fatty deposits on the retina–signs of leaking blood vessels.
  • Damaged nerve tissue.
  • Any changes to the blood vessels.

If your doctor believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. The test allows your doctor to identify any leaking blood vessels and recommend treatment.

Treatment

How is diabetic retinopathy treated?

During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.

Proliferative retinopathy is treated with laser surgery. This procedure is called Pan Retinal Photocoagulation which helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, Laser Photocoagulation can save the rest of your sight.

Laser Photocoagulation works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, laser treatment may still be possible, depending on the amount of bleeding.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.

How is a macular edema treated?

Macular edema is treated with laser surgery. This procedure is called focal laser photocoagulation. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.

A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.

Focal laser photocoagulation stabilizes vision. In fact, it reduces the risk of vision loss by 50 percent.

What happens during laser treatment?

Both focal and Pan Retinal Laser photocoagulation are. Before the treatment, your doctor will dilate your pupil and apply drops to numb the eye. As you sit facing the laser machine, your doctor will hold a special lens in front of your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurred. Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

Retinopathy Of Prematurity

Retinopathy of Prematurity (ROP) is a disease of the retina affecting prematurely born babies. In neonates in whom retinal vascularization is incomplete, abnormal proliferation of immature retinal blood vessels develops due to relative lack of oxygen following the withdrawal of therapeutic oxygen. The abnormal new blood vessels that grow are fragile and prone to leakage. This can result in significant damage to the retina including the formation of scar tissue and retinal detachment.

What Are the Different Types of Retinopathy of Prematurity?

Retinopathy of Prematurity is graded according to its severity: Stage I through “Plus” disease (+).

Stage 1: Demarcation line

Stage 2: Ridge

Stage 3: Ridge with extraretinal fibrovascular proliferation

Stage 4: Retinal detachment “Plus” disease (+)

Symptoms

  • Depending on severity, visual acuity varies from 20/20 to total blindness.
  • Variable visual field defects, usually in the central field of vision (observed during an ophthalmological examination)

Diagnosis

  • Diagnosis is made during an ophthalmological examination either before the infant leaves the hospital or within five to seven weeks of birth. Screening is recommended for all premature and low-birthweight babies, especially those receiving supplemental oxygen.

Risk Factors

  • The main risk factor is premature birth. The condition is most common in infants with a birth weight of less than 1250 grams (~2.75 lbs) and a gestational age of less than 28 weeks.
    ROP is commonly seen in low-birthweight infants, premature infants, and those who received oxygen therapy. It is occasionally seen in full-term neonates.

What You Can Do to Reduce Risk?

  • The best way to reduce the risk of ROP is to prevent premature birth through prenatal care and educating expecting mothers about factors that can influence a baby’s health in utero. If a child is born prematurely, close monitoring of oxygen levels and appearance of the retinal blood vessels is essential. To prevent ROP, pediatricians attempt to balance the amount of supplemental oxygen the infant is receiving with the appearance of the blood vessels. Oxygen is necessary, but too much can be damaging.

Treatment

  • Currently, treatment relies on the destruction of the areas of the retina that are without blood vessels. This becomes necessary only if the disease has reached a certain, well defined stage, as the milder forms often regress spontaneously. By destroying the retina, the stimulus for the growth of the abnormal blood vessels is removed. The destruction is achieved by cryotherapy (literally freezing the retina, using a small pulse) or photocoagulation with laser energy. Rarely, surgery is undertaken in an attempt to remove the scar tissue.

Age-Related Macular Degeneration

What is Macula?

The retina is a paper-thin tissue that lines the back of the eye and sends visual signals to the brain. In the middle of the retina is a tiny area called the macula. The macula is made up of millions of light-sensing cells that help to produce central vision. The macula allows us to appreciate detail and perform tasks that require central vision such as reading, sewing, driving and colour vision.

What is Age-related Macular Degeneration (AMD)?

AMD is a common eye disease mostly seen in people over the age of 50 years that gradually destroys sharp, central vision. In some cases, AMD advances so slowly that people notice little change in their vision. At this stage, it may be detected on routine retina check-up. But in others, the disease progresses faster and may lead to a loss of vision in one or both eyes. AMD usually involves both eyes, although one may be affected long before the other. AMD causes no pain and almost never leads to total blindness.

How does AMD lead to vision loss?

AMD is of two types:

  1. Dry AMD: More common type. 90 percent of all people with AMD have this type. There is a slow atrophy of macula, leading to a gradual loss of central vision.
  2. Wet AMD: Although only 10 percent of all people with AMD have this type, it accounts for 90 percent of all blindness from the disease.

As dry AMD worsens, formation of abnormal fragile blood vessels cause “wet” AMD. These new blood vessels often leak blood and fluid under the macula. This causes rapid damage to the macula that can lead to the loss of central vision in a short period of time.

Who is at risk of developing it?

At the moment the exact cause for AMD is not known. However there are a number of risk factors, which have been identified.

  • Age: AMD is an age related condition so growing older makes the condition more likely.
  • Gender: Women are more affected than men
  • Genetics: There appear to be a number of genes, which can be passed through families which may have an impact on whether someone develops AMD, or not.
  • Smoking : A definite risk factor. Stopping smoking can reduce the risk of macular degeneration developing.
  • Sunlight: Blue rays of sunlight may accelerate macular degeneration. It is a good idea to wear sunglasses with UV filters to protect the eyes during outdoor activities
  • Nutrition: Research suggests that supplementation with antioxidants like Vitamin C and E, and minerals like zinc and selenium can help protect against macular degeneration.

The symptoms may not be noticeable in early Dry AMD if only one eye is affected to begin with. In the early stages your central vision may be blurred or distorted, with objects looking an unusual size or shape and straight lines appearing wavy or fuzzy (Metamorphopsia). This may happen quickly or develop over several months. People with advanced stage will often notice a black patch or dark spot in the centre of their sight. This makes reading, writing and recognizing small objects or faces very difficult.
There may be a sudden painless loss of central vision when wet AMD develops.

Can AMD be detected in time?

AMD being a slowly progressing disease is detected mostly on a routine ophthalmological evaluation. The comprehensive eye exam includes:

  • Visual acuity test
  • Dilated eye exam to examine your retina and optic nerve for signs of AMD and other eye problems
  • Amsler grid: The pattern of the grid resembles a checkerboard. You will cover one eye and stare at a black dot in the center of the grid. While staring at the dot, you may notice that the straight lines in the pattern appear wavy. You may notice that some of the lines are missing. These may be signs of AMD.
  • Fluorescein angiogram: In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.
  • Optical coherence Tomography: This gives the cross sectional image of macula identifying the exact location of the choroidal neovascular membrane beneath the macula.

How can AMD be prevented?

AMD cannot be prevented. Early diction is important to prevent severe visual loss. Protecting your eyes from the sun, eating a well balanced diet with plenty of fresh fruits and vegetables and stopping smoking may all help to delay the progress of AMD

What are the treatment options?

Dry AMD: Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, treatment can delay and possibly prevent early dry AMD from progressing to the advanced stage, in which vision loss occurs. Nutrition and antioxidants- The role of antioxidants is not clear but supplementation with Lutein ,zeaxanthin ,Vitamin C and E and other minereals has shown a beneficial effect in slowing the progression of disease. Quit smoking.

Wet AMD: Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these treatments is a cure for wet AMD. Each treatment may slow the rate of vision decline or stop further vision loss, but the disease and loss of vision may progress despite treatment

Laser Phtocoagulation: This procedure uses a laser to destroy the fragile, leaky blood vessels. A high energy beam of light is aimed directly onto the new blood vessels and destroys them, preventing further loss of vision. However, laser treatment also may destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula

Photodynamic therapy: A drug caled verteporfin is injected into your arm. Next, a light is shined into your eye for about 90 seconds. The light activates the drug. The activated drug destroys the new blood vessels and leads to a slower rate of vision decline. Treatment results often are temporary. You may need to be treated again.

Transpupillary Thermotherapy: A special type of laser is used to heat up the membrane without destroying the overlying retina.

Injections(Anti VEGF therapy): Wet AMD can now be treated with a new drug that is injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with Wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor. You will need multiple injections, usually given about six weeks apart. The eye is numbed before each injection. After the injection, you will remain in the doctor’s office for a while and your eye will be monitored. As with photodynamic therapy, the main benefit for patients treated with the drug is to slow vision loss from AMD.

Retinal Detachment

What is Retinal Detachment?

A retinal detachment occurs when the retina is pulled away from its normal position in the back of the eye. The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. Retinal detachment can cause permanent vision loss if not treated in time.

What are the types of retinal detachment?

There are 3 types of RD:

  1. Rhegmatogenous retinal detachment- A rhegmatogenous retinal detachment occurs due to a hole or break in the retina that allows fluid to pass into the space between the retina and other layers of the eye.
  2. Exudative or secondary retinal detachment- An exudative retinal detachment occurs due to inflammation that results in fluid accumulating underneath the retina without the presence of a hole or break.
  3. Tractional retinal detachment- A traction retinal detachment occurs when fibro vascular tissue on surface of retina pulls the retina from the underlying tissues as seen in diabetic retinopathy cases.

What are its symptoms?

  • Flashes of light (photopsia) – mostly experienced in the temporal (outside away from the nose) part of vision
  • Floaters- black cobweb like spots moving in front of eye
  • A curtain like shadow coming in field of vision
  • Sudden Vision Loss when macula is detached

What are the treatment options?

  • Retinal hole or breaks are treated with laser photocoagulation or cryopexy (a freeze treatment) as outdoor procedure. During laser treatment, dot like burns are placed around the hole to “weld” the retina. In Cryopexy the area around the hole is frozen and it helps reattach the retina.Retinal detachments are treated with surgery viz sceral buckling and complex vitreoretinal surgery involving use of Silicon oil or gases.In scleral bucking, a silicon band, is placed anchored with stitches around the eyeball to gently push the wall of the eye against the detached retina.In vitrectomy, the surgeon makes tiny incisions in the sclera (white portion of the eye). Vitrectomy instruments are placed inside the eye to take out the vitreous gel and it is replaced with silicon oil or gases to push the retina in place .Laser or cryopexy is done around the breaks to seal it.With modern vitreoretinal instrumentation, around 90 percent of cases with a retinal detachment can be successfully treated, Visual results are good if the retinal detachment is repaired before the macula (the centre region of the retina responsible for fine, detailed vision) detaches. This is important to contact your retina surgeon in time when you notice any flashes or floaters or a curtain in field of vision.

Who is at risk for retinal detachment?

  • A retinal detachment can occur at any age, but it is more common in people over age of 40.Common risk factors for developing RD are:
    • High Myopia –Especially more than 5 Dioptre. After cataract surgery
    • Retinal detachment in the other eye
    • Family history of retinal detachment
    • Presence of other eye diseases such as retinoschisis, degenerative myopia, or lattice degeneration
    • Following an eye injury

Flourescein Angiography

What is Flourescein Angiography?

It is an extremely valuable test in which a series of photographs of the retina are taken with the help of a special camera to analyze the blood circulation of choroids and retina.

How this test is performed?

You need to be fasting for 2 hours only before the test. The pupil is dilated with dilating eye drops. A special dye, called Flourescein, is injected into a vein in the arm. The dye reaches to the blood vessels inside the eye in few seconds, A camera equipped with special filters takes the photographs of the back part of the eye as the dye circulates though the blood vessels .

Why is this test necessary?

This test is done to evaluate, diagnose and guide treatment for certain diseases of retina like Diabetic retinopathy, Age related macular degeneration and Retinal vascular blockage etc.

What are its side effects?

Few patients may experience nausea and vomiting or transient giddiness or itching. All the side effects are temporary and pass of within few minutes. Very rarely seriously allergic reaction may occur.

Your urine will be dark coloured for 24 to 48 hours as the dye passes through urine.

When do I get my report?

We have the digital imaging system, which allows us to interpret the results immediately, and you can get the report of your test within 15 minutes.

Can I drive after the test?

It is advisable not to drive for 5 hours after the test because your pupils are dilated and your vision remains blurred.

Injection, Avastin / Lucentis

What is Anti-VEGF treatment?

Anti-VEGF treatment is a way to slow vision loss in people with conditions like wet form of AMD (Age related Macular Degeneration), CNVM (Choroidal Neo Vascular Membrane), Severe Diabetic Retinopathy, Macular Edema (swelling), Vascular Blocks, Neovascular Glaucoma (NVG), Vitreous Hemorrhage, etc. These retinal diseases, which were earlier considered incurable, or had very poor results with existing treatments are now being tackled with good results with these anti-VEGF agents.

How does Anti- VEGF help slow vision loss?

A certain chemical in your body is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor, or VEGF. Recently,scientists have developed several new drugs (anti-VEGF) that can block the trouble-causing VEGF. Blocking VEGF reduces the growth of abnormal blood vessels, slows their leakage, and helps to slow vision loss.

What happens during an Anti- VEGF treatment?

The anti-VEGF drug must be injected into your eye with a very fine needle. Your ophthalmologist will clean your eye to prevent infection and will administer an anaesthetic to your eye to reduce pain. Usually, patients receive multiple anti-VEGF injections over the course of many months. As with any medical procedure, there is a small risk of complications following anti-VEGF treatment. Any complications that might occur usually result from the injection itself, which in rare circumstances can injure the eye’s lens or retina or lead to an infection. For most people, though, the benefit of the treatment outweighs the small risk of injection injury.

How will I know if I require Anti-VEGF therapy or not?

Your ophthalmologist will determine if the treatment is appropriate for you. In some cases, your ophthalmologist may recommend combining anti-VEGF treatment with other therapies. For instance, some patients also receive photodynamic laser therapy. With this treatment, a special drug is injected into the veins in your arm, where it flows to your macula. Your ophthalmologist uses a special laser to activate this drug in order to close abnormal blood vessels in the macula. The treatment that’s right for you will depend on the specific condition of your retina.

As of now, there are three injections available with us for treatment. These are Lucentis, Avastin and Macugen. These injections are given inside the eye. The procedure is a very small one, but is performed inside the operation theatre to maintain the strict asepsis. The patient is discharged within 10-15 minutes of the procedure, and can resume his/her normal activities immediately.

Photo Dynamic Therapy

What is Photo Dynamic Therapy (PDT) Treatment?

Photodynamic therapy is a special form of Laser treatment for Choroidal Neo Vascular Membrane (CNVM) due to various causes like – Age related Macular Degeneration (AMD), High Myopia, idiopathic and post inflammatory. In photodynamic therapy , the non thermal laser selectively close the abnormal blood vessels, thereby stopping the leakage and bleeding without damaging the normal structures of the retina.

What is Photo Dynamic Therapy (PDT) Treatment?

Photodynamic therapy is a special form of Laser treatment for Choroidal Neo Vascular Membrane (CNVM) due to various causes like – Age related Macular Degeneration (AMD), High Myopia, idiopathic and post inflammatory. In photodynamic therapy , the non thermal laser selectively close the abnormal blood vessels, thereby stopping the leakage and bleeding without damaging the normal structures of the retina.

How this procedure is carried out?

Photodynamic therapy (PDT) is a treatment that uses a photosensitizing drug and red laser light to kill abnormally growing cell. Photodynamic therapy is a two step procedure.

First: The dye called Visudyne (verteporfin ) is injected through a vein in the hand or arm. This dye circulates through the body and sticks to the walls of the abnormal blood vessels beneath the macula.

Second: A beam of red laser light is aimed onto choroidal neovascular membrane. The light activates the dye, causing it to block the abnormal blood vessels, but does not damage the adjacent retina. It often takes more than one treatment to stop the leakage from these vessels

What precautions to be taken after treatment?

Avoid exposure of skin and eyes to direct sunlight or bright light for 5 days.

Retina Faqs

What are the danger symptoms of a detached retina?

Any of the following symptoms are an eye emergency and you must consult a doctor immediately.Light flashes, or curtain obstructing part or all of your vision, a sudden shower of floaters that resemble spots, or spider webs and a sudden decrease of vision.

What should I do if I have the above symptoms?

You need to contact your eye specialist urgently. Receiving immediate treatment increases the chances of you regaining or retaining your vision, and limiting further loss.

What is diabetic retinopathy?

Diabetic retinopathy is a disease of the retina caused by damage to its blood vessels due to elevated blood sugars. It can lead to both temporary, and permanent loss of vision. All diabetics should have their retina examined at regular intervals. The frequency of examination may differ from person to person; an ophthalmologist can advise you on this.

What is macular degeneration?

Macula is the most sensitive part of the retina and its degration results in loss of vision. It may present as a decrease in vision, distortion of objects or impaired colour vision. There are two types of macualr degeneration: wet and dry.Regular eye exams are recommended to detect macular degeneration the early stage.

Retina

Retina is like the film of the camera which sends the image to the brain for processing. A damaged retina can lead to significant visual disturbances many of which may become permanent if not treated in time. Diabetic retinopathy is one of the leading causes of blindness in adults. It is caused by changes in the blood vessels of the retina, making them leaky, causing visual damage. Early detection can be done by Eye Angiography and OCT. Retina Lasers can retard the progress of disease and prevent permanent visual damage. Eye7 is one of the leading national referral centers for advanced retinal diagnostics and surgeries.

Doctors

Dr. Charu Malik

Retina

Dr. Charu Malik is a Retina consultant at Eye7 Darya Ganj

    Dr. S.P. Chaudhary

    Retina

    Dr S.P. Chaudhary is a senior vitreo-retinal surgeon and uveitis specialist at Eye 7 Indirapuram.

      Dr. Anisha Seth

      Retina

      Dr Anisha Seth has done her MBBS and M.S. in Ophthalmology from prestigious Maulana...

        Dr. Tinu Gupta

        Retina

        Dr Tinu Gupta has done her MBBS from Indra Gandhi College,Nagpur, Maharashtra and completed...

          Dr. Pawan Gupta

          Cataract - Glaucoma - Retina

          Dr Pawan Gupta is a senior vitreo-retina specialist at Eye7 Lajpat Nagar.

            Dr. Neeraj Sanduja

            Retina

            Dr Neeraj Sanduja is a senior vitreo-retina specialist at Eye7 Chaudhary Eye Centre, Daryaganj, New Delhi.

              Dr. Ajay Aurora

              Retina

              Dr Ajay Aurora is a senior Vitreo-retina specialist at Eye7, Daryaganj. He underwent Vitreo-retina...


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