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PROBLEMS & DISEASES SYMPTOMS CAUSES DIAGNOSTIC TEST DIABETIC RETINOPATHY
 
SYMPTOMS OF PROLIFERATIVE RETINOPATHY MACULAR DEGENERATION    
 
OTHER RETINAL PROBLEMS  
   
 

The rear side of the eye behind the lens, the posterior segment, coprises of a vitreous body and retina.
Inner beck portion of the eyeball includes retina, macula and optic disc. It is called fundus, which is seen during an eye examination, by looking through the pupil.

“Macula is the central portion of the Retina, where light sensitive cells are concentrated. This ensure fine focusing of vision. Vitreous is gel – like substance that fills the inside of the eye, behind the lens between the lens & retina.

Optic nerve is the main nerve of the eye which carries electric signals from the retina to the brain.




The retina & vitreous body may develop problems and diseases of retina, macula , optic disc, optic nerve, or vitreous.

   
   
 
PROBLEMS & DISEASES
  Some of the common diseases are:

  1. Diabetic Retinopathy (DR)
  2. Hypertensive Retinoapthy (HR)
  3. Retinopathy of Prematurity (ROP)
  4. Retinal Detachment (RD)
  5. Hole in Retina
  6. Age Related Macular Degeneration
  7. Macular Oedema
  8. Vitreous Haemaharrage
  9. Retinitis Pigmentosa (RP)
  10. Retinal Tumours
    etc
HR GRADE 4
HR Grade 2
DR

Description of the above diseases is given under common eye problems.
Please refer to the disease “common eye problem”.

Some salient aspects are described here.

 
 
 
   
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SYMPTOMS
  The most common & obvious symptoms a patient will have are :
Blurred Vision
Sudden loss of Near or Far Vision
Complete loss of vision on one side
Flashes & Floaters
Distorted Images
Heaviness of Eyes and/or Head
Some pain or allied feeding
 
 
 
   
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CAUSES
  There could be several causes of Retina or Vitreous problems such as:

Diabetes Mellitus
Hypertension
Ocular Trauma (accidents & injuries)
Congenital
High Refractive Error (Myopia or Hypermetropia)
ROP (Retinopathy of prematurity) due to Incubation of children in oxygen chamber after birth for some reasons.

 
 
 
   
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DIAGNOSTIC TEST
  Following are some of the common and desirable tests recommended for diagnosis of state of disease:
Dialated Fuduscopy
Fundus Photography
Fundus Flurosceine Angiogrphy (FFA)
Ocular Coherence Tomography (OCT)
Heildelberg Retinal Tomography (HRT)

 
 
 
   
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DIABETIC RETINOPATHY
  Diabetes may affect vision by causing cataract, glaucoma or diabetic retinopathy due to damage to retinal blood vessels. The longer one has diabetes, the greater is the likelihood that complications from the disease will affect the eyes.

Hypertension, stress and pregnancy may aggravate diabetic retinopathy, Naturally, following the advice of your doctor and controlling blood sugar is the most important thing that can be done to prevent the complications of diabetes.


The key to saving vision is early diagnosis and treatment. In diabetic eye disease, warning signs and symptoms may not be apparent. That is why it is crucial that any individual with diabetes be examined by an ophthalmologist at least once a year or more frequently if any evidence of retinopathy is present on examination. The ophthalmologist will then decide if treatment is required and how often to be re examined.


How does diabetic retinopathy causes Vision Loss ??

As you recall, the retina is the thin film of tissue and blood vessels in the back of the eye that is responsible for recording the fine details of vision within it’s center, the macula, or it’s side vision, the periphery. The retinal is fed with millions of tiny vessels that provide oxygen carrying blood and nutrients and remove wastes.

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


  1. 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.
  2. 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.

What are the stages of diabetic retinopathy?

Diabetic retinopathy has four stages:


  1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.
  2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
  3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
  4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. (See diagram below.)



When circulation to the retina is impaired by progression of this process then these vessels can close and permanently impede the flow of nutrients and oxygen. The retina responds by creating new vessels (neovascularisation) in a process known as Proliferative Diabetic Retinopathy.
 
 
 
   
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Symptoms of Proliferative Retinopathy (PR)
 

At first, you will see a few specks of blood, or spots, "floating" in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.

Normal vision
Same scene viewed by a
person with diabetic
retinopathy

 
Never Wait for Symptoms
 
Be sure to have a comprehensive dilated eye exam at least once a year.
Your eye care professional 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 Diabetic retinopathy is noted then color photos of retina are taken by Fundus Photography(FP).

Treatment of Proliferative Retinopathy

It is important to have regular comprehensive dilated eye exam. PR is treated with Laser Surgery,
‘ Scatter Laser Treatment’. Laser shrinks the abnormal blood vessels.

Scatter laser treatment & vitrectomy are normally used for treating retinopathy. Both treatment are effective in reducing vision loss. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have high success rates, they do not cure diabetic retinopathy.Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.


 
 
 
   
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MACULAR DEGENERATION
 

Age-related macular degeneration (ARMD) is a chronic degenerative disease of the retina that results in a deterioration of central vision and is the number one cause of blindness in individuals 65 years of age and older. ARMD is a disease that can affect the sharp central vision needed for straight ahead activities like reading , driving telling time and recognizing faces. It progresses so slowly that you notice little change in vision for a long time. Dozens of studies have been undertaken over the past 15 years to better understand this frustrating disorder.

Enthusiasm for new treatments for this disease has diminished as research studies show little progress in a medical or surgical “cure.” Many approaches to treatment such as interferon, radiation therapy, surgery to relocate the diseased area of the retina, blood plasma filtration treatments and photodynamic therapy have not yielded an improvement in vision.


Symptoms of ARMD

  1. AMD is the leading cause of blindness in people over 65 years of age.
  2. AMD causes black or blind spot in the centralvision
  3. Seeing objects as wavy or curved
  4. Colors seem washed out and dull

Risk Factors Of ARMD

  1. The incidence of AMD is greater in family members of people who have the disease.
  2. Women are at greater risk for AMD than men.
  3. People with blue eyes are at greater risk than people with brown eyes.
  4. Smoking increases the risk of AMD.
  5. Alcohol use may also increase the risk of AMD.
  6. Sun exposure increases the risk of AMD.
  7. Increased fat in the diet increases the risk of AMD.
  8. A diet low in anti-oxidants is associated with increased risk of AMD.
  9. Having AMD in one eye: of those having AMD in one eye about 40% will get AMD in other eye within 5 years .

Treatment of ARMD

PDT Photodynamic therapy .In this procedure a light activated drug is injected into the blood stream which travels to the eye. It is then activated in the eye with a non heat laser to help reduce risk of further vision loss.
Laser: A high energy laser beam of light is used to destroy leaking blood vessels to prevent further loss of vision.

How to Reduce Rate Risk Of ARMD

  • Stop smoking.
  • Exercise regularly
  • Control Blood pressure
  • Use ultra-violet protecting sunglasses and wear a hat when out of doors to reduce the amount of ultraviolet light entering the eye.
  • Eat generous daily helpings of spinach, kale and vegetables high in lutein and zeaxanthin. Take an anti-oxidant vitamin supplement speciaaly formulated for eye health.

How to Maximise Vision with ARMD

  1. Spectacle correction Get a good pair of eyeglasses with proper correction which has a large reading bifocal with increased power.
  2. Use a hand magnifier and a very bright reading light to magnify the image.
  3. Use a stand magnifier when reading.
  4. Low vision aids are available through low vision services that can magnify distance and intermediate vision, such as telescopes.
  5. Closed-circuit television cameras and monitors can magnify imaging for reading and can be purchased from several sources.
 
 
 
   
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OTHER RETINAL PROBLEMS
 

There are several other problems like Macular Edema, Tumours, Retinal Hole, Retinitis Pgmentosa etc.

You may refer to the section COMMON EYE PROBLEMS.

   
   
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