Retina

ARMD

Age related macular degeneration (ARMD) affects about 9% of the worlds senior citizens, to a lesser or greater degree.  

While chronic smoking and chewing pan has been indisputably linked to this condition, it may also occasionally affect non-smokers as well.

What happens here is a progressive accumulation of by products of metabolism called " druses". These accumulations compress on the surrounding retinal layers and cause a degenerative destruction that progressively leads to initially distortion of vision and later on a gross reduction in the visual potential.

 

 ARMD can be of two types the dry type, or the wet type. In the wet type there is a progressive leakage of blood and blood products at the visual centre of the retina called the fovea, while in the dry type this is absent. The dry type can progress to the wet type as well.

When you visit the eye specialist she will check your visual acuity and give a grid like chart called the amsler's grid and ask you if you can see any distortions, she will then subject to a retinal examination and looks for the signs and extent of the disease.

Treatment:

First quit smoking or using tobacco products

  • Two tests are carried out
  • An FFA or fundus fluorescein angiogram, which will give an idea of whether, we are dealing with a "wet" or "dry" type of ARMD
  • An OCT  or An ocular coherence tomogram which will give an idea of the depth of involvement of the various layers of retina.

While the " dry" type of ARMD  has no definitive treatment. The wet type is amenable to treatment with lasers and intra ocular injections of VEG F inhibitors like " avastin" or " Lucentis”. These agents help to dry up the blood and cause a regression of the abnormal blood vessels.

In addition, in patients with gross reduction of vision low visual aids and oral anti- oxidants may be tried.

Diabetic retinopathy:

The prevalence of diabetes in India is a staggering 20 %. The basic and primary pathology in diabetes is called micro angiopathy, which means that there is an involvement of the small caliber capillaries causing them to shut down and subsequently lead to an oxygen deprivation of the target organs which could primarily be the heart, kidneys and the eye.

In the eye the disease produces a condition known as retinopathy. In the initial stages, there is an outpouching of the blood vessels called micro aneurysms. This is followed by bleeding into the middle layers of the retina known as "dot" & " blot" haemorrhages.. Accumulation of fluid - known as "retinal edema" or of lipid and cholesterol by products known as hard exudates. If these changes occur close to the centre point of the retina, known as the " fovea", it may lead to  distortion and decrease of the vision.

If left untreated the retina produces fragile new vessels in response to the oxygen deprivation - this leads to a condition known as proliferative diabetic retinopathy- which can lead to devastating complications like frank bleeding into the vitreous cavity, fibrous bands over the retina , finally leading to the detachment of the retina when these bands contract. This may completely deprive the patient of all useful vision.

The catastrophic consequences of diabetic retinopathy can be prevented by a tight control of the. Blood  sugar, a disciplined lifestyle .., and most importantly regular visits to your eye specialist who will examine your retina for evidence of early diabetic changes.

The treatment could be in the form of laser treatments in the world early to moderate stages of diabetes, surgery in more advanced cases, with or without the injection of certain drugs called vegf inhibitors.. Your eye specialist will tell you more.,,,When it comes to diabetic retain the dictum is keep it under con lest it controls you....,