The Vitreoretina service at The Himalayan Eye Institute is a major referral center that deals with the management of diabetic retinopathy, retinal vein occlusion, age-related macular degeneration, retinal detachment, infections, trauma & various other retinal disorders. Our diagnostics are equipped with the most advanced machines, such as Optical Coherence Tomography (3D OCT-1 Maestro, Topcon, Japan), and Fluorescein Angiography (Carl Zeiss, Germany) for accurate diagnosis of retinal disorders. Purepoint Laser (Alcon, USA) is available for laser photocoagulation of the retina in disorders such as proliferative diabetic retinopathy, retinopathy of prematurity, central serous chorioretinopathy, retinal vein occlusion, and peripheral retinal hole/tear. Our OT is equipped with the Constellation® Vision system (Alcon, USA), which is the most advanced machine for vitreoretinal surgeries.
The retina is the sensory membrane which lines the inner surface of the back of the eyeball. It converts light into electrical signals which are then transmitted to the brain through optic nerve, which helps us to "see". A healthy retina is necessary for good vision.
The common diseases affecting the retina are:
It is recommended for anyone above the age of 40 years to get their full eye checkup, including retina examination, once in a year. Apart from this, individuals who have the following risk factors are at a higher risk of retinal disorders:
Retina checkup is mandatory for such individuals.
A retina examination takes a little more time than a routine eye exam. It involves dilation of your pupils, examination by the retina specialist and diagnostic testing if required. It may take about 2-3 hours for the complete examination. Dilation enlarges your pupils to allow the doctor a better view inside your eye. It is important to know that your vision will be blurred and you will be sensitive to light (photophobic) for several hours following this. Therefore, we recommend that you bring sunglasses and not drive after your appointment. It is better to have an attendant with you for this test.
If required, the patient’s eye is then examined using advanced diagnostic technologies such as OCT, angiography, and fundus photography. A photographic documentation of the retina helps to make an accurate diagnosis and keep a track of the improvement in the eye.
Retinal laser or photocoagulation is a process by which laser is applied through a binocular indirect ophthalmoscope or slit lamp laser delivery system for treatment of leaking blood vessels (diabetic retinopathy/retinal venous occlusion) or peripheral retinal holes and lattice degenerations.
Intravitreal injection involves using a very fine injection to deliver a medicine directly into the vitreous cavity of the eyeball. They can be of the following types:
a) Anti-VEGF injections: These injections are given in patients of diabetic retinopathy, retinal venous occlusion, wet age related macular degeneration, CNVM and retinopathy of prematurity. These drugs allow rapid resolution of fluid inside the retina, as well as prevent growth of new leaky blood vessels, hence preventing bleeding inside the eye. Following anti-VEGF injections are available at the Himalayan Eye Institute:
*anti-VEGF injections are not suitable for any patient who has a history of a heart attack or stroke in the last 3 months, or in pregnant women.
b) Steroid injections: In certain patients (diabetic retinopathy/retinal venous occlusion) for whom anti-VEGF injections are not suitable, or are not giving adequate results, intravitreal steroid may be used, if suggested by your doctor. The following injections are available:
*Intravitreal steroid may cause increase in intra-ocular pressure and cataract formation, and requires regular monitoring for the same.
c) Antibiotic Injections - In endophthalmitis cases, intravitreal antibiotic injections are required.
*It is pertinent to note that intra-vitreal injections may need to be repeated multiple times for adequate treatment, depending on the stage of the disease. They help to stabilise the disease progression, and may provide limited visual gain.
Intravitreal injection is a very fine injection given inside the OT. The eye is anesthetized using eyedrops, making the injection painless. It is a day care procedure, and the patient is discharged soon after.
Vitrectomy is a surgery done to repair or prevent retinal detachment, especially when it threatens to affect the macula. Vitrectomy is also carried out to clear bleeding inside the eye i.e, vitreous haemorrhage which can occur in cases of diabetics, trauma or venous occlusions. Advanced macular surgeries for macular hole, epiretinal membrane, vitreo-macular traction, are also available. We have the most advanced vitrectomy machine and the expertise to deal with complex retinal problems.
In fundus angiography, a small amount of yellow fluorescein dye is injected which travels to the eye, where it highlights the blood vessels. It is particularly useful in showing leaking blood vessels and highlighting where the blood supply in the eye is poor. After this, photographs of the eye are taken.
What is diabetic retinopathy?
Diabetic retinopathy (DR) is a common vascular retinal disease affecting about 40% of type 1 diabetics and 20% of type 2 diabetics. Duration and control of diabetes is the most important risk factor for DR.
All people with diabetes - both type 1 and type 2 - are at risk. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy.
Diabetic retinopathy is symptomless in the early stages. By the time symptoms appear it becomes too late to stop the process of deterioration.
Nonproliferative diabetic retinopathy is characterized by leakage of small blood vessels in the retina, which causes reduced vision. Proliferative retinopathy is characterized by the growth of new blood vessels on the surface of the retina, which may lead to vitreous hemorrhage and retina detachment.
Diabetic retinopathy is detected during a comprehensive eye exam that includes:
What is a retinal detachment?
A retinal detachment is a separation of the neurosensory layer from the Retinal Pigment Epithelium. In other words, the retina is displaced from its normal position, causing sudden vision loss. Most retinal detachments are a result of a retinal break, either a hole or a tear.
Retinal detachment can be prevented by doing a prophylactic barrage laser. Barrage laser is indicated in the following conditions.
A tear or hole of the retina that leads to a peripheral retinal detachment causes the loss of side (peripheral) vision. Almost all of these patients will progress to a full retinal detachment and loss of all vision if the problem is not repaired. Early diagnosis and repair are urgent since visual improvement is much greater when the retina is repaired before the macula or central area is detached.
What is age-related macular degeneration?
Age-related macular degeneration (AMD) is an age-relateddisease that affects the macula (central part of the retina)by accumulating metabolic by-products and thus blurs the sharp, central vision for activities such as reading, sewing, and driving.
Retinopathy of prematurity ( ROP ) is a disease affecting the retina of babies born premature i.e, born early, < 34 weeks of gestation or who weigh less than 2 kilograms at birth.
A patient from Rangpur, Bangladesh was delighted to receive treatment for BRVO (Branch Retinal Vein Occlusion) at our hospital today. He has been suffering from this retinal disease for more than a year and was regularly visiting eye hospitals in Southern India. Since retinal treatment requires regular follow-ups, he was looking for a good treatment center nearby. Rangpur is closer to Siliguri, hence it is very convenient for him to make multiple short trips.
Age-related wet macular degeneration (wet AMD) is a rare disease. In this disease, abnormal blood vessels form under the retina. Blood or fluid leaks from these blood vessels and damages the macular part of the retina. If the macula does not work properly, a round black shadow or a black screen appears in front of the eyes when reading books or watching something. Straight lines appears to be wavy, the picture on the TV screen seems colorless. Day by day the vision decreases, and even the vision may disappear suddenly. Riding a bike or car in these conditions is extremely difficult and dangerous. Bike Ambulance Dada "Padmashri" Karimul Haque is suffering from this rare retinal disease. At The Himalayan Eye Institute, Retina Surgeon Dr. Sangeeta D. Goswami successfuly treated Padmashri Karimul Haque with anti-VEGF injections. Now he is able to see better.