About VITREORETINAL

The vitreoretinal centre in Mehta Eye Clinic is well equipped with state-of-art imaging and diagnostic facilities which deals with the management of diabetic retinopathy, ARMD, retinal detachment, trauma, infections and other retinal disorders.

We aspire to provide highest quality medical and surgical care for our patients with retinal diseases in a compassionate and efficient environment. Retinal related surgery is an extremely specialized and skilled area of practise. At Mehta Eye Clinic we have a dedicated team of specialists handling vitreoretinal disorders. Our doctors are well trained with surgical and diagnostics skills for treating such specific retinal problems.

Common Diagnostic Tests at Mehta Eye Clinic

  • undus Photography: Colour photographs of the Retina at the back of the eye.
  • Fluorescein Angiography (FFA): A diagnostic procedure that photographs the blood circulation of the retina. This involves injection of a dye called fluorescein into a vein in the arm or hand.
  • Indocyanine Green Angiography (ICG): A diagnostic procedure that photographs the blood circulation of the choroid. (Choroid is a layer of blood vessels behind the retina). This procedure is very similar to fluorescein angiography and involves injection of the indocyanine green dye into a vein in the arm or hand.
  • Optical Coherence Tomography (OCT): This is a diagnostic procedure similar to the CT scan of the brain. It uses a beam of light and its reflection to obtain cross-sectional images that provide information about the different layers of the retina.
  • Visual Field Analysis (Perimetry): Measurement of the full extent of the area visible to an eye that is fixating straight ahead.

Lasers

Indirect Ophthalmoscopic Laser Delivery System (LIO): This laser delivery system is mainly used for peripheral retinal lesions:

  • Horse shoe tear (HST)
  • Lattice degeneration
  • Retinal holes
  • Retinopathy of prematurity (ROP)
  • Pan retinal photocoagulation for vascular retinopathy in a hazymedia.
  • Cryotherapy: is a second way of treating retinal tears apart from laser. An extremely cold probe is used to "freeze-burn" a small area on the outside of the eyeball that overlies the retinal tears. The purpose is to seal the tears and create an eventual scar that will "stick" the retina to that spot.
  • Pneumoretinopexy: is a method of treating selected cases of retinal detachments. A gas bubble is injected into the eye after applying cryo spots to the area of retinal tear.

Common Retinal Diseases

1. Diabetes and Eye Problem

Diabetes mellitus is emerging as a major public health problem in India. It is a multisystem disorder which affects the heart, kidneys, peripheral nerves and the eyes. In the eyes, High levels of blood sugar can lead to early onset of Cataract and or can lead to a condition known as Diabetic Retinopathy.

2. Diabetic Retinopathy

Diabetic retinopathy is an eye problem that can be caused by either type 1 or type 2 diabetes mellitus. Retinopathy occurs when diabetes damages the tiny blood vessels in the retina which may leak fluid and blood. It’s a sight threatening condition, however if diagnosed and treated, vision loss can be prevented.

Firstly, examination of the retina of the eye is done using indirect ophthalmoscopy after dilating the pupils. If diabetic retinopathy is found, specialized test:

  • OCT (Optical coherence tomography)
  • Fluorescein angiography (FFA)

These Tests Will Help Us in Deciding the Stage & Treatment of Diabetic Retinopathy.

Laser Treatment: The aim of this treatment is to protect central vision. It does not restore lost vision, but it can prevent further deterioration, which is why early diabetic retinopathy diagnosis through periodic eye examination is imperative.

Intravitreal Injections (Anti VEGF agents): Anti VEGF agents (Lucentis, Avastin, Macugen) are emerging as the new modality of treatment for various stages of diabetic retinopathy. These agents are injected into the eye (intravitreal injection). They are commonly used in diabetic maculopathy and proliferative diabetic retinopathy.

Surgery (VITRECTOMY): A microsurgical procedure where the blood filled vitreous gel is replaced with a clear gas/solution/oil to restore vision.

3. Vitrectomy

In the event of the patient presenting with very advanced diabetic retinopathy, a microsurgical procedure known as vitrectomy is recommended. Blood-filled vitreous gel of the eye is replaced with a clear solution to aid in restoring vision. Sometimes the retina may also be detached. Vitrectomy surgery is then performed to reattach the retina.
Sutureless Vitrectomy
Points to Remember:

  • Control your blood glucose as effectively as possible
  • Keep your regular screening appointment
  • Get advice if you have a problem with your sight
  • Check your cholesterol levels regularly
  • Stop smokingtop smoking

4. Age - Related Macular Degeneration (ARMD)

Age-related macular degeneration (ARMD) is the most common cause of irreversible vision loss in people over age of 60 years. Cells in the macula degenerate (the central, and most sensitive part of the retina at the back of the eye), that is, they become damaged and die. Damage to the macula affects your central vision which is needed for reading, writing, driving, recognizing people's faces and doing other fine tasks.

  • Blurred or distorted central vision
  • Colours look dim
  • Words on a page look blurred
  • Straight lines appear distorted
  • Dark or empty areas appear in the center of vision permanent loss of your central vision

Types of ARMD:

ARMD is of two types:
  • Dry ARMD – (90%): LESS SEVERE
    Vision loss is usually gradual. These patients need to monitor their central vision regularly. If you notice any change in your vision, you should tell your eye doctor right away, as the dry form can change into the more damaging form which is wet (exudative) macular degeneration. While there is no medication or treatment for dry macular degeneration, some people may benefit from vitamin supplements (anti-oxidants).
  • Wet AMD – (10%): MORE SEVERE
    This can cause more damage to your central vision than the dry form. Wet macular degeneration occurs when abnormal blood vessels begin to grow underneath the retina. This blood vessel growth is called choroidal neovascularization (CNV) because these vessels grow from the layer under the retina called the choroid. These new blood vessels may leak fluid or blood, blurring or distorting central vision. Vision loss from this form of macular degeneration may be faster and more noticeable than dry AMD.

There is NO TREATMENT for dry AMD, although high dose multivitamin combination has been shown to decrease the risk of visual loss.
There are a few treatment options for wet AMD although the best outcomes occur when this disease is detected early.

  • Laser
  • Photodynamic therapy (PDT)
  • Anti-VEGFs (Lucentis, Avastin, Macugen)
  • Combinations of the above mentioned
Not all patients may benefit from these, and treatment may not prevent further vision loss.

5. Retinal Detechment

The Retina:
The retina is a nerve layer at the back of the eye that senses light and sends images to the brain.

Meaning of Retinal Detachment:
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. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

  • High Myopia (near-sightedness)
  • Injury to the eye
  • Previous retinal detachment in the other eye
  • Family history of retinal detachment
  • Areas of thin/weak retina

  • Floaters which are little "cobwebs"
  • Light flashes in the eye
  • Sudden blurry vision
  • An area of dark vision, like a curtain or a veil coming from above or below or from the sides. Floaters are a common symptom in otherwise normal individuals. However if these are accompanied by persistent flashes, they could be symptoms of a retinal tear or detachment.

Retinal tears without detachment - Laser photocoagulation or cryotherapy is performed around the tear to seal the retina to the back wall of the eye.

Retinal tears with retinal detachment - Requires surgery as soon as possible to put the retina back in its proper position. The longer the retina stays detached, the less the visual improvement after surgery. Scleral buckle surgery - A flexible silicone band is placed around the eye to counter the force pulling on the retina after removing the fluid under the detached retina.