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Retina Service

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How do we see?

Human eye is like a camera. When you take a picture with the camera, the lens allows light to pass through and focuses it on the film. When the light hits the film, picture is taken. Our eye works in the same way. The light rays from the object passes through the cornea, and lens which focus the light on the retina. On the retina an inverted image of the object is formed. Once light energy hits the retina, the photosensitive enzymes trigger a chain of impulses that travel through the optic nerve and reach the brain. Brain will read the information from both eyes, convert the electrical impulses into light impulses and fuse both images from the two eyes. That’s how we see!

Anatomy of Eye

What is retina?

Retina is the innermost photosensitive layer of the eye. It is connected to the brain via the optic nerve.

What are the parts of retina?

Macula (central retina) – appreciation of fine details, reading and color vision Peripheral retina – functions for night Vision

What are the symptoms of retinal disease?

  •  Sudden or gradual decrease in
  • Loss of field of vision
  •  Flashes of light
  •  Floaters
  •  Objects appearing distorted(Metamorphopsia) 
  • Night Blindness

When should one consult a retinologist?

Whenever patient has any of the above mentioned symptoms he is advised to have an immediate check up with a retina specialist. Regular eye examinations if the patient is diabetic, hypertensive and over forty years.

What are the diseases that affect the retina?

Common diseases include :
• Diabetes mellitus
• Hypertension
• Age related macular degeneration
• Myopia
• Infectious diseases
• Heriditary degeneration
• Congenital degeneration
• Rarely drugs used for some systemic diseases affect the retina

What are Floaters?

You may sometimes see small specks or clouds moving in your field of vision. They are called floaters. You can often see them when looking at a plain background, like a blank wall or blue sky. While these objects look like they are in front of your eye, they are actually floating inside. What you see are the shadows they cast on the retina. Floaters can have different shapes: little dots, threads, circles, lines, clouds or cobwebs .

What causes floaters?

When people reach middle age, the vitreous gel may start to shrink, forming clumps or strands inside the eye. Posterior vitreous detachment (PVD) : The vitreous gel pulls away from the retina, causing a posterior vitreous detachment. It is a common cause of floaters. PVD is more common for people who :

• Are shortsighted or myopes ;
• Have undergone cataract operations;
• Have had YAG laser of the eye;
• Have had inflammation inside the eye / any trauma
• Infectious diseases
• Heriditary degeneration
• Congenital degeneration
• Rarely drugs used for some systemic diseases affect the retina

Are floaters ever serious?

The retina can tear if the shrinking vitreous gel pulls away from the retina. This sometimes causes a small amount of bleeding in the eye that may appear as new floaters.

A torn retina is always a serious problem, since it can lead to a retinal detachment. You should see your retina specialist as soon as possible if even one new floater appears suddenly or you see sudden flashes of light or if you notice other symptoms like the loss of side vision.

What can I do about Floaters?

Floaters can get in the way of clear vision, which may be quite annoying, especially if you are trying to read. You can try moving your eyes, looking up and then down to move the floaters out of the way.

While some floaters may remain in your vision, many of them will fade over time and become less bothersome. Once your retina is examined and everything is normal, you can ignore the floaters.

What causes flashes of lights?

When the vitreous gel rubs or pulls on the retina, you may see what look like flashing lights or lightning streaks. You may have experienced this same sensation if you have ever been hit in the eye and seen “stars.” The flashes of light can appear off and on for several weeks or months. As we grow older, it is more common to experience flashes. If you notice the sudden appearance of light flashes, you should visit your Retina specialist immediately to see if the retina has any problem.

What is the treatment of a retinal tear / hole ?

If the tear has not caused a retinal detachment(RD) then a laser is done surrounding the hole / tear to seal it. This reduces the risk of RD. However you need to regularly follow up with a retina specialist as new holes / tears can still form.

What is Myopia?

• Myopia is also known as shortsightedness.
• It is a disorder in which a person cannot focus distant things clearly.
• The light rays from an object are focused in front of the retina, making them look blurred.
• It is corrected with minus numbered lenses / Lasik surgery.

How does myopia affect the retina?

  •  Myopia can affect the retina in the following ways 
  •  Myopes have larger eye balls and can develop retinal thinning and degeneration in the peripheral parts of the retina, these occur due to stretching of the globe.
  • These degenerations are prone to progress and later may form holes or tears in the retina.
  • These retinal holes or tears if not treated can lead to retinal detachment, which will cause sudden loss of vision and will require major surgery at the earliest, to prevent further loss of vision.
  • Sometimes the central part of the retina (macula) may be affected by macular degeneration or choraidal neovascular membrane.

How does myopia affect the retina?

Diabetes affects the retina and this condition is called as diabetic retinopathy.

It is a micro angiopathy affecting the retinal blood vessels. The main features of diabetic retinopathy are micro vascular (small blood vessel) occlusion and leakage. As a result of this, there is reduced blood supply to the retina .Due to leaking blood vessels, hemorrhages and fluid accumulation in the retina can occur. This initial stage is also called as Non-Proliferative Diabetic Retinopathy (NPDR).

What happens in late stages of Diabetic Retinopathy?

As a result of reduced blood supply to the eye because of diabetes the eye will start forming its own new blood vessels Proliferative Diabetic Retinopathy (PDR), which are fragile hence they can rupture and bleed any time which lead to sudden drop in vision. This is known as Vitreous hemorrhage. Sometimes in more severe forms traction on retina can develop that can lead to retinal detachment.

This requires treatment in the form of laser to the eye or surgery or both. The treatment is to stabilize the patient’s vision and prevent further progression of visual loss.

What is Diabetic maculopathy?

Diabetic Maculopathy

Lasered Ratinopathy

  • Diabetic maculopathy is the commonest cause of visual loss in diabetic patients.
  •  Fluid accumulation leads to swelling in the macula which is the area concerned with vision. It may be focal, diffuse or ischemic.
  • Focal-focal leakage from the microaneurysms which leads to localized swelling.
  • Diffuse-diffuse leakage which leads to swelling throughout the posterior pole.
  • Ischemic-in this type the blood supply to the macula decreases and this leads to poor vision.

What are the different investigations done in Diabetic Retinopathy?

Fundus Fluorescein Angiography (FFA) and Optical Coherence Tomography (OCT) are the two investigative procedures which may be done before the treatment plan for Diabetic Retinopathy.

Fundus Fluorescein Angiography (FFA)

This is a diagnostic procedure where in fluorescein dye is injected into a vein of the hand and then a series of photographs of the patient’s retina are taken. This gives us a picture of the passage of the dye through the microvasculature of the eye. This helps us to know the status of the blood vessels in retina and reveals blockage, excess leakage of the dye in case of abnormal new blood vessels.

It also helps us to know whether the patient needs laser photocoagulation or not.

What is the treatment of the Diabetic Retinopathy?

The treatment is usually in the form of laser or rarely an injection is given in the eye.The laser treatment may be done in 1- 3 sittings

How frequent should a diabetic have eye check up?

Every patient once diagnosed to have diabetes should have regular eye check
ups every 6 months.

 

AGE RELATED MACULAR DEGENERATION (ARMD)

What are the symptoms of ARMD?

Distortion of lines or objects (Alphabets appear distorted or wavy while reading)

Cloudiness or decrease in central vision.Decrease in colour vision

What are the types of Age related Macular Degeneration?

Dry type (drusen)
Most common cause of vision loss in old age, visual loss is usually gradual. This occurs due to accumulation of a specific material in the ageing cells in the macula as a result of this the cells do not work normally and vision becomes blurred.

Treatment:

Some patients benefit with systemic antioxidant or macronutrient vitamins for the retina

.
Wet Type (choroidal Neovascular Membrane)
This occurs in 10-15% of patients with ARMD but the loss of vision is more profound and may also be sudden sometimes.


This occurs due to formation of a membrane or layer of new blood vessels called Choroidal neovascular membrane (CNVM) which occurs beneath the retina. These new blood vessels can leak blood or fluid that leads to loss of vision and distortion. What are the investigations for ARMD ? FFA and OCT

Can Wet AMD be treated?

  • Treatment initiated at the earliest stabilizes the vision.
  • Various modes of treatment include:
  • Laser photocoagulation
  • Photodynamic therapy (PDT)
  • Intravitreal injection of Anti-VEGF drugs( Lucentis or Macugen or Avastin)
  • Combination therapy or mono therapy will be decided by the retinal specialist.
  •  Usually a Combination therapy of any two of the above is done

Wet Macular Degeneration

What is Photodynamic therapy?

Photodynamic therapy is performed by injecting a special dye known as  Verteporfin. Intravenous verteporfin, selectively localizes in new blood vessels and  is activated by laser light on the target area. Non thermal laser energy (diode laser,  operating at a wavelength of 689 nm) is then applied locally to the CNVM to  produce photochemical reactions that lead to closure of new vessel (thrombosis). 

More than one treatment sessions may be required to achieve complete closure.

What are anti VEGF agents?

  • Lucentis ( Ranibizumab)
  • Avastin (Bevacizumab)
  • Macugen (Pegaptanib sodium)

Lucentis /Macugen /Avastin :

These are the latest drugs which have given a ray of hope to improve vision in  patient with wet ARMD.These are drugs which prevent the formation of new blood  vessels and reduce leakage. 

More than one injection may be necessary. 

COMPUTER VISION SYNDROME 

Introduction : 

It wasn’t too many years ago that the primary concerns in thearea of occupational  medicine were to prevent traumatic injuries in our industrial plants. Today,  occupational health and safety concerns are focused on the office worker,  particularly those workers who spend a considerable amount of time at computer  displays. Even though these health problems are subtle compared to the serious  injuries to which many blue collar workers are exposed, they have become a  primary concern in large part because of our shift towards office jobs. 

The vision problems at computers result in inefficiencies and in eye – related  symptoms. The causes for the insufficiencies and the visual symptoms are  individual vision disorders and / or poor visual ergonomics. The symptoms occur  whenever the visual demands of the task exceed the visual abilities of the  individual. For example, many individuals have marginal vision disorders such as  uncorrected refractive errors, accommodative disorders, or binocular vision  disorders which are not observed while performing less demanding visual tasks.  Likewise, there are numerous aspects of the computer and its work environment 

which make it a more demanding visual task than others – therefore, more  individuals are put beyond their threshold for experiencing symptoms.