Age Related Macular Degeneration

1) What is Age related macular degeneration?

AMD is a common eye condition and a leading cause of vision loss among people age 60 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision.

2) What are the types of AMD?

Dry AMD: Accumulation of yellow deposits called drusen. AMD advances so slowly that vision loss does not occur for a long time.
Wet AMD: Accumulation of fluid and/or blood beneath the retina and formation of angiogenesis by VEGF. The disease progresses faster and may lead to a loss of vision in one or both eyes.

3) What are the symptoms of AMD?

  • Decreased visual acuity, insidious or sudden-onset
  • Dry ARMD constitutes 85-90% cases of ARMD, and usually does not cause severe vision loss.
  • Wer AMD constiutes 10-15% of ARMD cases and is the major cause of severe vision loss
  • Blurred vision
  • Distorted near vision
  • Scotoma
  • Visual distortion, metamorphopsia, micropsia
  • Vague visual complaint

4) What are the risk factors for AMD?

Age—the strongest risk factor • Family history of AMD • Caucasian race • Cigarette smoking.

Possible risk factors: Female gender • High blood pressure • Higher level of education • High cholesterol • Light iris color • Sunlight exposure • Far-sightedness • Low dietary fish intake • Cardiovascular (heart) disease.

5) How AMD can be diagnosed?

  • Visual acuity test: Eye chart to measure near and distance vision
  • Dilated eye exam: Instil drops in eyes to widen or dilate the pupils to view back of eye.
  • Amsler grid: A square of straight vertical and horizontal lines chart used to measure central vision.Changes in central vision cause the lines in the grid to disappear or appear wavy
  • Fluorescein angiogram: Helps to identify areas of leakage,Injection of dye through patient’s peripheral veins(arm or hand)
  • Optical coherence tomography: Newer, non-invasive technique similar to ultrasound – except that instead of sound waves light rays are used.Provides a detailed, highly magnified, cross-section view of a patient’s macula

6) What are the non pharmacological options for AMD?

  • Avoid smoking
  • Exercise regularly
  • Maintain normal blood pressure and cholesterol levels
  • Eat a healthy diet rich in green, leafy vegetables and fish

7) What are treatment options available for AMD?

Anti-VEGF: Anti VEGF injections, reduces new blood vessel growth, slows down any leakage or swelling these new blood vessels.

Anti-VEGF drugs have been developed to help stop neovascularization and preserve vision for AMD patients. There are currently 3 anti-VEGF drugs:

  • Avastin® (bevacizumab®)
  • Lucentis® (ranibizumab®)
  • Eylea® (aflibercept®)

Photodynamic therapy: This technique involves laser treatment of select areas of the retina. First, a drug called verteporfin will be injected into a vein in your arm. The drug travels through the blood vessels in your body, and is absorbed by new, growing blood vessels.

Laser surgery: Neovascular AMD with laser surgery, though this is less common than other treatments. It involves aiming an intense “hot” laser at the abnormal blood vessels in your eyes to destroy them.

Diabetic Retinopathy

1) What is Diabetic Retinopathy ?

Diabetic retinopathy is a diabetes complication that affects eyes. It’s caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).Diabetic retinopathy occurs in more than half of the people who develop diabetes.The condition can develop in anyone who has type 1 or type 2 diabetes.

2) What are the types of DR?

  1. Mild nonproliferative retinopathy: Small areas of balloonlike swelling in the retina’s tiny blood vessels, called microaneurysms, occur at this earliest stage of the disease.
  2. Moderate nonproliferative retinopathy: blood vessels that nourish the retina may swell and distort. They may also lose their ability to transport blood.
  3. Severe nonproliferative retinopathy: Many more blood vessels are blocked, depriving blood supply to areas of the retina.
  4. Proliferative diabetic retinopathy (PDR): Growth factors secreted by the retina trigger the proliferation of new blood vessels, which grow along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye.

3) What is Diabetic Macular Edema?

DME is the build-up of fluid (edema) in a region of the retina called the macula. The macula is important for reading, recognizing faces, and driving. DME is the most common cause of vision loss among people with diabetic retinopathy. About half of all people with diabetic retinopathy will develop DME.

4) What are the symptoms of DR?

  • Spots or dark strings floating in your vision (floaters)
  • Blurred vision
  • Fluctuating vision
  • Impaired color vision
  • Dark or empty areas in your vision
  • Vision loss
  • Diabetic retinopathy usually affects both eyes

5) What are the risk factors for DR?

All types of diabetes patients (type 1, type 2, and gestational) are at risk for diabetic retinopathy. Risk increases the longer a person has diabetes.

6) How DR can be Diagnosed?

Visual acuity testing: Eye chart to measure near and distance vision

Tonometry: This test measures pressure inside the eye.

Pupil dilation: Instil drops in eyes to widen or dilate the pupils to view back of eye

Optical coherence tomography (OCT): capture images of tissues inside the body. OCT provides detailed images of tissues that can be penetrated by light, such as the eye.

Fluorescein angiogram: may be used to look for damaged or leaky blood vessels.

7) How DR can be prevented ?

  • Early treatment can reduce risk of blindness by 95%.Its is recommended that people with diabetes should get dilated eye exam once in year
  • Optimal glucose control reduce the risk of DR.

8) How is DME or PDR can be managed ?

  • Anti-VEGF Injection: Anti-VEGF drugs are injected into the vitreous gel to block a protein called vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessels to grow and leak fluid.

Available anti-VEGF drugs include:

  • Avastin® (bevacizumab®)
  • Lucentis® (ranibizumab®)
  • Eylea® (aflibercept®)
  • Focal/grid macular laser: few to hundreds of small laser burns are made to leaking blood vessels in areas of edema near the center of the macula. Laser burns for DME slow the leakage of fluid, reducing swelling in the retina.
  • Corticosteroids: may be used alone or in combination with other drugs or laser surgery to treat DME.Corticosteroid use in the eye increases the risk of cataract and glaucoma.

Available anti-VEGF drugs include:

  1. Ozurdex (dexamethasone)
  2. Iluvien (fluocinoloneacetonide)
  • Panretinal Photocoagulation: Treatment involves making 1,000 to 2,000 tiny laser burns in areas of the retina away from the macula. These laser burns are intended to cause abnormal blood vessels to shrink.
  • Vitrectomy: A vitrectomy is the surgical removal of the vitreous gel in the center of the eye.

Retinal Vein Occlusion

1) What is Retinal Vein Occlusion ?

RVO is a retinal vascular disorder that results in visual impairment or blindness if left untreated.

When the flow of blood from the retina is blocked, it is often because a blot clot is blocking the retinal vein. When a retinal vein is blocked, it cannot drain blood from the retina. This leads to hemorrhages (bleeding) and leakage of fluid from the blocked blood vessels.

2) What are types of RVO?

  • Central retinal vein occlusion (CRVO) is the blockage of the main retinal vein.The occlusion results in acute lossof vision
  • Branch retinal vein occlusion (BRVO) is the blockage of one of the smaller branch veins.It leads to acute (but often temporary) onset of blurred vision.

3) What are the symptoms of RVO?

  • Sudden, unilateral, painless, acute vision loss
  • Some patients report only a peripheral visual-field defect
  • Wedge-shaped area with retinal vascular signs: Hemorrhages,Cotton-wool spots, Edema,Venousdilation,Tortuosity
  • Macular edema

4) What are the risk factors for RVO?

  • Age, Diabetes, Smoking, Hypertension, Cardiovascular disease, Dyslipidemia.

5) How RVO can be diagnosed?

  • Visual acuity testing: Eye chart to measure near and distance vision
  • Tonometry: This test measures pressure inside the eye.
  • Pupil dilation: Instil drops in eyes to widen or dilate the pupils to view back of eye
  • Optical coherence tomography (OCT): This is a high definition image of the retina taken by a scanning ophthalmoscope with a resolution of 5 microns..OCT provides detailed images of tissues that can be penetrated by light, such as the eye.
  • Fluorescein angiogram: may be used to look for damaged or leaky blood vessels.

6) How RVO can be prevented?

  • Avoid smoking
  • Exercise regularly
  • Maintain normal blood pressure and cholesterol levels
  • Eat a healthy diet rich in green, leafy vegetables and fish

7) How RVO can be treated?

  • Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs: These drugs target VEGF, which is an important growth factor that causes macular edema.

Available anti-VEGF drugs include:

  • Avastin® (bevacizumab®)
  • Lucentis® (ranibizumab®)
  • Eylea® (aflibercept®)
  • Intravitreal injection of corticosteroid drugs: may be used alone or in combination with other drugs or laser surgery to treat DME. Corticosteroid use in the eye increases the risk of cataract and glaucoma.

Available drugs include:

  • Ozurdex (dexamethasone)
  • Iluvien (fluocinoloneacetonide)
  • Focal laser therapy:This treatment provides lasers to areas of swelling to cause a reduction in edema. Laser burns slow the leakage of fluid, reducing swelling in the retina
  • Pan-retinal photocoagulation therapy: This treatment is used when patients have new blood vessel formation following the retinal vein occlusion.Treatment involves making 1,000 to 2,000 tiny laser burns in areas of the retina away from the macula. These laser burns are intended to cause abnormal blood vessels to shrink.

Retinopathy of Prematurity

1) What is Retinopathy of Prematurity?

  • Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 2¾ pounds (1250 grams) or less that are born before 31 weeks of gestation (A full-term pregnancy has a gestation of 38–42 weeks).
  • It occurs when the development of normal retinal blood vessels, which typically requires a full-term pregnancy for completion, is interrupted by the premature birth. If the disease progresses, scar tissue can grow; this can lead to retinal detachment and vision loss.

2) What are the stages of ROP?

    Stage I — Mildly abnormal blood vessel growth. Many children who develop stage I improve with no treatment and eventually develop normal vision.

    Stage II — Moderately abnormal blood vessel growth. Many children who develop stage II improve with no treatment and eventually develop normal vision.

    Stage III — Severely abnormal blood vessel growth. The abnormal blood vessels grow toward the center of the eye instead of following their normal growth pattern along the surface of the retina, when infants have a certain degree of Stage III and “plus disease” develops, treatment is considered. “Plus disease” means that the blood vessels of the retina have become enlarged and twisted, indicating a worsening of the disease.

    Stage IV — Partially detached retina. Traction from the scar produced by bleeding, abnormal vessels pulls the retina away from the wall of the eye.

    Stage V — Completely detached retina and the end stage of the disease. If the eye is left alone at this stage, the baby can have severe visual impairment and even blindness.

3) What are symptoms of ROP?

In 85% to 90% of cases, ROP of milder severity resolves on its own, with no meaningful impact on vision. If ROP progresses to an advanced stage, an infant may:

  • Not respond appropriately to light
  • Have white scar tissue visible in the pupils
  • Progress to blindness

4) What are the risk factor for ROP?

Premature birth and low birthweight are the primary risk factors. Other risk factors for the development of ROP include:

  • Multiple births
  • Other health problems involving the lungs and intestines
  • Infection

5) How to diagnose ROP?

Pupillary dilation using eye drops, the retina is examined using an indirect ophthalmoscope.

6) How ROP can be prevented?

  • Eye Screening of premature infant for ROP
  • Treat early to further reduce the disease severity
  • Regular follow up with ophthalmologist

7) How to treat ROP?

Laser therapy: burns away” the periphery of the retina, destroy the peripheral areas of the retina, slowing or reversing the abnormal growth of blood vessels.

Cryotherapy: instrument that generates freezing temperatures to briefly touch spots on the surface of the eye that overlie the periphery of the retina. destroy the peripheral areas of the retina, slowing or reversing the abnormal growth of blood vessels. Both laser treatments and cryotherapy are performed only on infants with advanced ROP, particularly stage III with “plus disease.

Vitrectomy: Vitrectomy involves removing the vitreous and replacing it with a saline solution. After the vitreous has been removed, the scar tissue on the retina can be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall.

Anti-VEGF: suppress growth of the abnormal blood vessels.

Polypoidal Choroidal Vasculopathy (PCV)

1) What is Polypoidal Choroidal Vasculopathy ?

Polypoidal choroidal vasculopathy (PCV) is a disease primarily affecting the vascular layer of blood vessels in the choroid, resulting in damage to the overlying retina where the photoreceptor cells responsible for vision reside.

2) What are symptoms of PCV?

  • blurred vision.
  • central or paracentral scotoma
  • im vision in the affected eye

3) What are the risk factors for PCV?

  • Age, male gender, smoking, hypertension, coronary artery disease, and hyperlipidemia,high BMI.

4) How to diagnose PCV?

  • Fluoresceinangiogram (FA): Dye is injected through vein. Help to identify the leakage.
  • Indocyanine green angiography (ICG): Indocyanine is injected.This allows visualization of choroidal pathology through overlying serosanguineous fluid, pigment, or a thin layer of hemorrhage that usually blocks visualization during FA.
  • Optical coherence tomography (OCT):Newer, non-invasive technique similar to ultrasound – except that instead of sound waves light rays are used.Provides a detailed, highly magnified, cross-section view of a patient’s macula.

5) How PCV can be managed?

Anti-VEGF: Vascular endothelial growth factor (VEGF) is a molecule generated by the body that causes the abnormal vessels in PCV to leak fluid and to bleed into and under the retina. Injections of anti-VEGF drugs into the eye block the activity of VEGF and often result in a decrease in the fluid or blood caused by the abnormal vessels.

Available anti-VEGF drugs include:

  • Avastin® (bevacizumab®)
  • Lucentis® (ranibizumab®)
  • Eylea® (aflibercept®)

Photodynamic Therapy: In photodynamic therapy (PDT), an intravenous infusion of a special photosensitizing medication (verteporfin) is injected over 10 minutes; this makes the eye more sensitive to light. Then a cold laser is applied to the retina and choroid to damage or destroy the abnormal blood vessels found in PCV.

Photocoagulation: uses light to create a thermal burn in retinal tissue, but doesn’t does not prevent recurrence.

Myopic Chorodial Neovascularization

1) What is Myopic Choroidal Neovascularization?

Myopia is short-sightedness that results if the eyeball is too long, or if the lens or the cornea is too convex.

Myopic Chorodial Neovascularization is characterized by progressive elongation of the globe and abnormal choroidal vasculature, which often leads to a sudden onset but progressive decline in central vision and is associated with a poor prognosis unless treated.

2) What are the symptoms of Myopic Choroidal Neovascularization?

  • Blurred vision
  • Image distortion
  • Blind spot
  • Other symptoms may include: Decreased colour vision, Sensation of sparkling or flashing lights (photopsia),Yellowish discolouration of vision (xanthochromia)

3) What are the risk factors of Myopic Choroidal Neovascularization?

  • Age (increasing risk with age)
  • Gender (more common in women)
  • Presence of other clinical / pathological features of PM
  • Choroidal thinning
  • Lacquer cracks
  • Patchy atrophy
  • Myopic CNV in the fellow eye

4) How to diagnose Myopic Choroidal Neovascularization?

  • Fluorescein angiogram: Helps to identify areas of leakage,Injection of dye through patient’s peripheral veins(arm or hand)
  • Optical coherence tomography: Newer, non-invasive technique similar to ultrasound - except that instead of sound waves light rays are used.Provides a detailed, highly magnified, cross-section view of a patient’s macula

5) How Choroidal Neovascularization managed?

Anti-VEGF: Intravitreal anti-VEGF are considered as mainstay of therapy in myopic CNV. They lead to resolution of the retinal fluid and regression of the subretinal fuzzy lesion. Injections of anti-VEGF drugs into the eye block the activity of VEGF and often result in a decrease in the fluid or blood caused by the abnormal vessels.

Available anti-VEGF drugs include:

  • Avastin® (bevacizumab®)
  • Lucentis® (ranibizumab®)
  • Eylea® (aflibercept®)

Photodynamic Therapy: In photodynamic therapy (PDT), an intravenous infusion of a special photosensitizing medication (verteporfin) is injected over 10 minutes; this makes the eye more sensitive to light. Then a cold laser is applied to the retina and choroid to damage or destroy the abnormal blood vessels.

Laser surgery: It involves aiming an intense “hot” laser at the abnormal blood vessels in your eyes to destroy them.

Source: www.asrs.org/patients/what-is-a-retina-specialist

Get more clarity on your eye health.

Find an eye specialist near you.

?

Once you submit , you will be redirected to a third party website