June 2022 - ASG Eye Hospital | Best Eye Hospital in India

Blog

Read our latest news from the ASG ophthalmology news. Feel free to ask questions in comments for any news you find interesting.
asgeye.png

Eye Retinal Detachment is an emergency that occurs when the retina, a light-sensitive membrane situated at the back of the eye, separates from its normal position.
The lens of the eye focuses an image on the retina when light passes through it. The retina is a thin layer of tissue that receives images and sends them as electric signals through the optic nerve to the brain.
So, when the retina separates from its normal position it renders deprived of oxygen and nourishment. This may lead to Retinal Detachment surgery for treatment. As the retinal cells are cut off from the blood vessels that provide oxygen, the risk of partial or permanent vision loss increases. If it is not treated immediately, it may lead to severe consequences.

Symptoms of Retinal Detachment

Though there is no significant pain associated with this situation, various symptoms occur before or in the advanced stages:

 

  • Blurred vision
  • The sudden appearance of floaters or tiny specks or strings drifting through the field of vision
  • Partial vision loss that occurs as a curtain has pulled across your field of vision, with a shadowing effect
  • Photopsia: Sudden flashes of light in the eyes
  • Gradual reduction of side or peripheral vision
Symptoms occur rapidly and if not addressed or treated immediately, may lead to eye surgery for retinal detachment. The risk of vision loss also increases with time if the symptoms are overlooked.

Types or Causes of Retinal Detachment

Whether this condition is caused by a tear, scar tissue, or disease, the types differ with the state of the retina.
Majorly, there are three types of Retinal Detachment:
Rhegmatogenous: It is the most common type of retinal detachment caused by a hole or a tear in the retina, making the fluid slip through the opening and collect underneath the retina, consequently pulling the retina away from the underlying tissues. The regions where the retina detaches lose their supply of blood and cease to work, causing loss of vision.
Aging is the most common cause of rhegmatogenous detachment. Vitreous, a gel-like substance that fills the inside of the eye may change in consistency or render more liquid with age. Usually, this gel-like substance separates from the surface of the retina without any complications and this condition is termed posterior vitreous detachment (PVD). The common complication of this separation is a tear.
Vitreous may tug on the retina with sufficient force to create a retinal tear when it separates or peels off the retina. If immediate measures are not taken, the liquid vitreous can pass through the tear and settle behind the space of the retina, causing detachment.
Tractional: This type of retinal detachment is typically observed in people who have poorly controlled diabetes or people suffering from diabetes mellitus (which mainly affects the retinal vascular system).
In tractional retinal detachment, the scar tissue grows or contracts on the retina’s surface, causing the retina to pull away from the back of the eye.
The retinal vascular damage leads to scar tissue accumulation resulting in detachment of the retina.
Exudative: This type of retinal detachment is not caused by any tears or holes in the retina. In this, fluid accumulates beneath the retina. The main causes are:
  • Age-related macular degeneration
  • An inflammatory disorder that leads to the accumulation of fluid behind the retina
  • Injury or wound to the eye
  • Tumors
  • Cancer behind the retina

Are you at risk of retinal detachment?

It is usual for anyone to experience retinal detachment but a few factors can highly increase being at risk:
  • Anybody with a family history of retinal detachment
  • A severe injury or wound in the past
  • If someone has been through eye surgeries such as cataract surgery
  • Diagnosed with eye conditions or diseases
  • Aging (greater risk if the person is above the age of 50)
  • Extreme myopia (Not able to see objects situated farther from the eye)
  • Diagnosed previously with retinal detachment
Some eye-related conditions or diseases also put you at a higher risk:
  • Diabetic Retinopathy (a diabetic complication that affects the blood vessels in the retina)
  • Lattice degeneration (the thinning of the retina)
  • Retinoschisis (the separation of the retina into two layers)
  • Posterior vitreous detachment (gel-like material in the center of the eye pulls or separates away from the retina)

How is Retinal Detachment diagnosed?

This condition is diagnosed through an eye exam. The eye specialist will use dilated eye exam to check the retina. Initially, eye drops are put in the eyes. These drops dilate the pupils or widen them. The doctor will be able to get a close look after a few minutes.

 

The eye specialist or ophthalmologist may prescribe other tests after the dilated eye exam. These tests are non-invasive and painless. They help the doctors provide more detail and information for the further course of treatment. Some of the tests which are mostly recommended are:
Optical coherence tomography (OCT): Firstly, the pupils are dilated for this imaging. Secondly, the patient is required to sit in front of the OCT machine, where your head is placed on a support to stay still. Lastly, the machine scans your eye but does not touch it.
Eye (ocular) ultrasound: This test does not use drops for dilating the eye but the doctor may use drops that numb the eyes to diminish the discomfort. The patient is made to sit on a chair and rest the head on a support, so it stays still. The doctor will gently place the instrument in front of the eye to scan it. Thereafter, the patient is asked to close their eyes. The eye specialist puts gel on the eyelids. To scan the eyes with the instrument, the patient needs to move the eyes keeping them closed.

What is the treatment for retinal detachment?

In minor cases of retinal detachment or tears of the retina, a simple procedure in the eye specialist’s office may suffice. But, in most cases, surgery becomes a necessity to repair the detached retina.
Laser surgery (photocoagulation) and freezing (cryopexy) are the most usual treatment options for the tears in the retina.
Photocoagulation
Photocoagulation is performed with a laser in case there exists a hole or tear in the retina but the retina is still attached. The laser burns around the tear site and results in scarring, which in consequence affixes the retina to the back of the eye.
Cryopexy
Cryopexy is a procedure that means freezing with intense cold. In this treatment, the doctor applies a freezing probe outside of the eye in the region over the retinal tear site and the eventual scarring will hold the retina in the normal place.
 

Eye Surgery for Retinal Detachment

In case, a larger part of the retina is detached, doctors usually recommend Retinal Detachment Surgery to move the retina back in place.
The three most typically prescribed surgeries are retinopexy, scleral buckling, and vitrectomy.

 

Pneumatic retinopexy

This procedure is performed to repair minor detachments. The doctor may perform it in the office itself. Firstly, the doctor uses medicine to numb the eyes to reduce or diminish discomfort. The steps thereafter are:
  • A small amount of fluid is extracted with the help of a tiny needle.
  • Formation of petite bubbles in the eye by injecting a small amount of air.
  • Lastly, the doctor waits for the retina to shift back into place and repairs any holes or tears with laser surgery or freezing.
The air bubble in the eye will cause no issues and disappear over time, but some precautions are suggested after the surgery to make sure the eye heals completely.
Few engagements like intense exercise, heavy lifting, or flying in an airplane should be avoided for minimal exertion of the body. The patient needs to keep following up with the doctor to make sure the eye is healing correctly.

Scleral bulking

Scleral bulking is performed in more severe cases of retinal detachment. The doctor will typically give the patients anesthesia for this surgery so they can sleep and do not feel any discomfort during the entire procedure. Next:
  • The doctor will place a small and flexible band around the sclera (white portion of the eye).
  • The band then pushes the sides of the eye and toward the retina so it will reattach.
  • The band remains permanently after the surgery.
  • Lastly, to repair any holes or tears, laser surgery or freezing might be provided.
The retinal detachment surgery is very simple and not painful, so the doctor may discharge the patient the same day. Although, due to the induced anesthesia, someone might have to drive the patient home.
Some precautions are necessary to make sure the eye heals properly:
  • Wearing an eye patch for at least a day after surgery.
  • Avoidance of heavy lifting or intense exercise.
  • Follow-ups with the eye specialist.

Vitrectomy

It is an eye surgery for retinal detachment used for larger tears and is performed usually in an outpatient surgery center. The patient will be under anesthesia to proceed through the following steps:
  • The doctor will make a small incision in the sclera of the eye.
  • A microscope is inserted to examine the interior of the eye.
  • Then, the doctor will remove abnormalities like scar tissue or vitreous.
  • A gas bubble will be injected simultaneously placing the retina back in its place.
  • Eventually, freezing or laser will be done to repair tears or holes.
The patient might feel some discomfort after the surgery and is suggested to avoid intense exercise.

Prevention from Retinal Detachment Surgery

There are no known ways to prevent retinal detachment condition or surgery but a person can take a few precautionary measures:
  • Getting eye dilation exams regularly
  • Wearing a protective eye shield while playing sports
  • Controlling levels of blood sugar
These conditions might worsen the normal functioning of the eye and may result in severe consequences. But, don’t worry if you have such conditions. At ASG Eye Hospitals, we take pride in providing the best solutions for eye care to people irrespective of their awareness, knowledge, and financial levels. The most optimal retinal detachment surgery at ASG encompasses state-of-the-art equipment and highly experienced doctors.

asg2.png

Diabetic retinopathy, the leading cause of blindness worldwide, occurs as a change in blood vessels of the retina as a result of diabetes. The retinal damage and impairment of vision lead to Diabetic retinopathy treatment. It is a condition that is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). It is mainly a diabetic complication and affects in two stages:
  • The early stage of the disease in which blood vessels swell and leak is called nonproliferative retinopathy. The macular edema or the swelling of the retina may result in mild vision loss.
  • The advanced stage in which abnormal new blood vessels grow on the surface of the retina is termed proliferative retinopathy. This may result in severe vision loss as these blood vessels may break and bleed into the vitreous (the clear watery gel that fills the eye).
While there are not many known ways to prevent diabetic retinopathy, you can reduce the risk of having it develop or progress. Maintaining the blood sugar levels slows the onset of retinopathy and may prevent it from getting worse. It also decreases the need for Laser Retinopathy treatment or other procedures in the severe stages.

What are the causes of Diabetic Retinopathy?

The leading cause of Diabetic Retinopathy is high levels of sugar in the blood that result in blockage of the tiny blood vessels which nourish the retina. Consequently, the eye attempts to grow new blood vessels but these don’t work properly and easily leak. The new blood vessels behave abnormally and eventually cause Diabetic Retinopathy.

Symptoms of Diabetic Retinopathy

You may not have any symptoms in the early stages of diabetic retinopathy and the vision may not change until the disease gets worse. But as the disease progresses you may observe:

Diabetic Retinopathy Symptoms

  • Floaters, spots, or strings in the visual field which move in the direction you look
  • Blurry vision
  • Fluctuating vision
  • Poor color vision & contrast
  • Difficulty in seeing at night
  • Blind spots in the field of vision
  • A strange dark or empty spot in the center of the vision
  • A sudden or total loss of vision
A person who is suffering from diabetes is at a higher risk of developing this disease. The risk increases with age and with other factors like smoking, high blood pressure, and pregnancy.

Are There Any Complications if Diabetic Retinopathy is Left Untreated?

Without proper treatment, this disease can lead to various complications.
A condition called vitreous hemorrhage might occur when the blood vessels bleed into the main jelly that fills the eye (vitreous). As the blood in the vitreous blocks light from entering the eye, it can result in vision loss. Although in mild cases the symptoms include floaters in the visual field.
If there’s no damage to the retina, bleeding in the vitreous may resolve itself.
In some cases, a severe complication called detached retina might occur. It is caused when the scar tissue pulls the retina from the back of the eye. The person may experience floating spots in the field of vision, flashes of light, and severe vision loss. If not treated, it may lead to total vision loss.

How is Diabetic Retinopathy Diagnosed?

An ophthalmologist can easily detect the signs of this disease. It is recommended that people who suffer from diabetes must have an eye examination at least once a year to prevent themselves from Diabetic Retinopathy Surgery. The ways of diagnosis of diabetic retinopathy are multiple:

Diabetic Retinopathy Diagnosis

Dilated Eye Exam

For the dilated eye exam, an eye doctor puts drops into the person’s eyes. This helps to dilate the pupils and allows the doctor to see the inside of the eye.
They then take photographs of the eye’s interior and look for the presence of:
  • Cataracts
  • Retinal detachment
  • Changes in the eye pressure
  • Abnormalities in the blood vessels or the retina
  • Scar tissue
You may feel minor discomfort due to the eye drops and the bright lights of the photographs.

Visual Acuity Test

It is an eye chart test that measures central vision ability at different distances.

Fluorescein Angiography

This test is conducted initially by dilating the pupils and then by injecting a dye called fluorescein into the vein of the person’s arm.
Further, pictures are taken as the dye circulates the eyes. To determine which blood vessels are leaking fluid or are blocked or broken down the doctor examines the flow of the dye. The dye, fluorescein, may leak through the retina or stain the blood vessels if these vessels are behaving abnormally.
This helps the doctor to go on with the proper course of treatment.
People may notice that they have yellowish skin or dark orange urine due to the existence of dye in the body.

Tonometry

This test is conducted to check the pressure (intraocular pressure, or IOP) inside the eye.

Optical Coherence Tomography

This test allows the doctors to look for cysts or swelling of the retina. OCT is a non-invasive imaging scan that helps provide high-resolution cross-sectional images of the retina to reveal its thickness.
It also aids in checking the effectiveness of the treatment as doctors perform it before and after treatment.
Though it is similar to ultrasound testing, it uses light rather than sound to produce images. It also helps to provide information about the optic nerve.

Ophthalmoscopy

In this test, the ophthalmologist will look closely at your eye and examine it with the help of a special magnifying glass.

How is Diabetic Retinopathy Treated?

The treatment of this disease depends on several factors that include the severity of the condition and how it has responded to previous treatments.
In the early stages, the doctor will follow watchful waiting in which the person’s eye is monitored closely without intervening.

Diabetic Retinopathy Treatment

Maintaining blood sugar levels and controlling diabetes is very crucial and it can significantly slow down the development of this disease.
But in advanced stages, the person usually requires Diabetic Retinopathy treatment:
There are three ways to treat the disease:

Laser Treatment

Laser for Diabetic Retinopathy is used in a targeted manner to shrink blood vessels in the eye and seal the leaks from abnormal blood vessels. It is also known as scatter laser surgery and is generally used to treat proliferative retinopathy or macular edema.
The treatment may slow down or stop the leakage of blood and the build-up of fluid in the eye.
It is conducted by placing a medicine that numbs the eye and then aiming a strong beam of light (laser) into the eye using a special lens.
The person may feel uncomfortable due to the bright light and may experience blurry vision for the rest of the day. Small spots may also appear in the visual field for a few weeks after the laser treatment.  More than one session may be required for the patient.
This procedure involves certain risks, such as loss of peripheral vision, color vision, and night vision. The person should consult their doctor about the benefits and risks of this treatment.

Laser Treatment

Injections

Certain medicines can be injected into the eye to reduce swelling and minimize leakage from the blood vessels in the eyes.
To perform this treatment the doctor follows certain steps. The eye specialist will place medicine that numbs the eye, then he may clean the eye to help prevent infections and eventually inject the medicine into the eye. The medicine may slow down the growth of the abnormal vessels of the retina and may also treat macular edema.
Depending upon the severity of the condition people may need regular injections but with time they require injections less frequently.

Vitrectomy or Diabetic Retinopathy Surgery

A vitrectomy may benefit the person who has problems with the retina or vitreous. The procedure is conducted for the removal of some of the vitreous from the eye.
The eye surgeon may perform this procedure under general or monitored anesthesia.
It helps the surgeon to find and repair any sources of retinal bleeding by replacing cloudy vitreous or blood to improve vision.
The cloudy or bloody vitreous is replaced by a liquid or gas that is inserted by the surgeon into the eye. Subsequently, the body will absorb the liquid or gas with time and create new vitreous in its place.
The person may need to wear an eye patch for a day or so and use eye drops to reduce swelling and prevent the eyes from infections.
A person should be aware of the fact that Diabetic Retinopathy Surgery is not a cure, but it may slow down or stop the progression of symptoms. Diabetes is a chronic condition, and subsequent retinal damage and vision loss may occur in spite of treatment.

Prevention from Diabetic Retinopathy

The ways to prevent yourself from this harmful disease are not many, but the successful management of blood sugar levels may be very helpful.
Moreover, the early detection of symptoms makes the treatment more effective and optimal.
The blood sugar levels can be maintained in many ways such as eating a healthy and balanced diet, exercising regularly, keeping a moderate body weight, and scheduling regular health check-ups.
These conditions might worsen the normal functioning of the eye and may result in severe consequences. But, don’t worry if you have such conditions. At ASG Eye Hospitals, we take pride in providing the best solutions for eye care to people irrespective of their awareness, knowledge, and financial levels. The most optimal Diabetic Retinopathy Treatment at ASG encompasses state-of-the-art equipment and highly experienced doctors.

=


MEET THE EXPERTS





MEET THE EXPERTS