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RETINA VITREOUS SERVICE

The Retina is the light sensitive film in the back of the eye. The image is perceived here and transmitted to the brain by the optic nerve. The vitreous is the clear gel that fills the back of the eye. Diseases of the retina can affect any age.

Premature infants can be affected by a disease called - ROP (Retinopathy of pre-maturity). Heredity and age related degenerations can affect the retina - especially the central most sensitive part of the retina called 'macula'.

The retina can detach from the back of the eye - a condition called 'Retinal Detachment'. The Vitreous gel can become opaque due to blood - a condition called 'Vitreous hemorrhage’ this condition can occur in diabetes, following injury and in other conditions too.

FFA (FUNDUS Fluorescein Angiography) Fluorescein angiography, is a clinical test to look at blood circulation inside the eye, it aids in the diagnosis of retinal conditions associated with diabetes, age-related macular degeneration, and other eye abnormalities.

Fluorescein, an orange-red dye, is injected into a vein in the arm. The dye travels through the body to the blood vessels in the retina. A special camera with a filter flashes a blue light into the eye and takes multiple photographs of the retina and also helps to monitor the course of the disease and its treatment. It may be repeated on multiple occasions. No X-rays are involved.

If there are abnormal blood vessels, the dye leaks into the retina or stains the blood vessels. Damage to the lining of the retina or a typical new blood vessels may be revealed as well.These abnormalities are determined through a careful interpretation of the photographs by an ophthalmologist.

Doctors Available For Retina Consultation:
1. Prof.Dr.S.Natarajan
2. Dr.Chinmay Nakhwa

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PDF Retina and Its Complications
PDF Retina Vein Occlusion
PDF Diabetic Retinopathy Brochure
  1. INDOCYANINE GREEN ANGIOGRAPHY (ICG)
    1. An Indocyanine Green study (ICG) is a special dye test used to evaluate the circulatory system of the choroid; the layer just behind the retina. ICG reacts to light with a longer wavelength than fluorescein dye, allowing the doctor to pinpoint the location of leaking vessels deeper within the eye that may not be apparent with Fluorescein Angiography.
  2. OPTICAL COHERENCE TOMOGRAPHY III
    1. OCT with maximum resolution gives an excellent cut section optical view for in depth analysis of the retina. We at Aditya Jyot began the use of this diagnostic modality for macular diseases for the first time in India. OCT is a non-invasive, non-contact, trans-pupillary imaging technology which can image retinal structures in vivo, with a resolution of 10 to 17 microns. Cross sectional images of the retina are produced using the optical backscattering of light in a fashion analogous to B scan ultra sonography.The anatomic layers within the retina can be differentiated and retinal thickness can be measured. Besides this the optic disc and nerve fiber layer can be assessed in cases of Glaucoma.
  3. HEIDELBERG RETINAL ANGIOGRAPHY
    1. Is a State- of- the- art system to perform Fluorescein and Indocyanine Green Angiography in patients with retinal disorders. An HRA-movie of the early phase of the angiogram can be taken. Very useful for the central pathology with facility of highlighting 10°, 20°, 30° of central macula.
  4. ELECTRORETINOGRAM (ERG):
    1. ERG is the diagnostic procedure to evaluate and confirm diffuse retinal degenerations with the help of mass electric response generated by the retina when subjected to flashes of light.

  5. MULTIFOCAL ELECTRORETINOGRAM (MFERG)
    1. THE MULTIFOCAL ERG which has been introduced for the first time in Mumbai, is used to study local responses from the retina and to determine focal retinal degenerations and lesions.
  6. ELECTRO-OCULOGRAM (EOG)
    1. Is the only means of understanding the measure of retinal function that depends upon the integrity of retinal pigment epithelium layer of the retina.
  7. MULTIFOCAL VISUAL EVOKED POTENTIAL (VEP)
    1. Is useful to objectively evaluate visual acuity and aid in perfect diagnosis by topographically mapping brain activity and determining the presence of visual field and visual acuity deficits.
  8. PREFERENTIAL HYPERACUITY PERIMETER (PHP)
    1. The most sensitive method in the world to detect the beginning of wet age related macular degeneration in the most severe form of ARMD and designed to detect and monitor the progression of the disease in a non-invasive manner.The PHP examination is easy to administer and takes just 3-5 minutes providing a comprehensive examination covering 14° of the macular area.
  9. TREATMENTS
    1. for Diabetic Retinopathy, Central Retinal Vein Occlusion (CRVO), Branch Retinal Vein Occlusion (BRVO), Retinal Holes, Lattice Degeneration, Central Serous Retinopathy (CSR) and more.
    2. pulse diode laser-low intensity red laser for macula.
    3. Photodynamic Therapy where a combination of a dye-like substance and laser are used to reduce the leakage from abnormal vessels (choroidal neovascularization) under the macula.
    4. The patient is injected with verteporfin which selectively collects in the abnormal leaking vessels under the fovea, the part of the eye that is responsible for our color vision and ability to see detail. A non-thermal laser is then used to "activate" the dye in the leaky vessels. Because the laser used in photodynamic therapy is less intense than that used for laser photocoagulation, this treatment is believed to prevent damage to the retina and fovea.
    5. Transpupillary Thermotherapy is an alternative therapy for choroidal neovascularization. This procedure involves the use of a special lens that is placed over the cornea. A laser beam is then passed through the lens to treat leaking vessels.
    6. Endoscopic Vitreo Retinal Surgery the first of its kind in Asia.
    7. All types of simple and complex Vitreo Retinal Surgeries.
  10. CONDITIONS
    1. Lattice Degeneration Lattice degeneration is the thinning and weakening of the retina, the light-sensitive layer of cells lining the back of the eye that can lead to a retinal tear. The vitreous, a clear gel-like substance that fills the inside of the eye, is contained in a sac loosely attached to the retina. As one grows old; the vitreous takes on a more fluid consistency and the sac sometimes separates from the retina. In lattice degeneration, there are places where the sac is strongly attached to the retina and pulls on it. This pulling weakens the retina and creates lattice lesions that look like white crisscrossing lines on the retina. If part of the vitreous sac becomes detached from the retina, the friction and pulling where it is still attached can create a tear in the retina. Lattice degeneration can sometimes cause retinal detachments when holes or tears in the lattice formation permit vitreous fluid to get under the retina. Fortunately most people with lattice degeneration do not develop a retinal detachment. Though preventive treatment of lattice degeneration has not been shown to prevent retinal detachment lattice degeneration should be monitored. If you have a history of lattice degeneration, you should be aware of the symptoms of retinal tears and detachment.
  11. Detached and Torn Retina
    1.  A retinal detachment is a very serious problem that almost always causes blindness unless treated. The appearance of flashing lights, floating objects, or a gray curtain moving across the field of vision are all indications of a retinal detachment. If any of these occur see an ophthalmologist immediately. As one gets older the vitreous; the clear gel-like substance that fills the inside of the eye, tends to shrink slightly and take on a more watery consistency. Sometimes as the vitreous shrinks it exerts enough force on the retina to make it tear.Retinal tears increase the chance of developing a retinal detachment. Fluid vitreous passing through the tear lifts the retina off the back of the eye like wallpaper peeling off a wall. Laser surgery or cryotherapy (freezing) is often used to seal retinal tears and prevent detachment.
  12. Macular Edema
    1. Macular edema is the swelling of the macula, the small area of the retina responsible for central vision. The edema is caused by fluid leaking from retinal blood vessels. Central vision, used for reading and other close detail work, is affected. Because the macula is surrounded by many tiny blood vessels, anything affecting them, such as a medical condition affecting blood vessels elsewhere in the body or an abnormal condition originating in the eye, can cause macular edema. Retinal blood vessel obstruction, eye inflammation, diabetes, and age-related macular degeneration have all been associated with macular edema. The macula may also be affected by swelling following cataract extraction, though typically this resolves itself naturally. Eye drops, injections of cortisone around the eye or laser surgery can be used to treat a macular edema. Recovery depends on the severity of the condition causing the edema.
  13. Myopic Degeneration
    1. A retinal detachment is a very serious problem that almost always causes blindness unless treated. The appearance of flashing lights, floating objects, or a gray curtain moving across the field of vision are all indications of a retinal detachment. If any of these occur see an ophthalmologist immediately. As one gets older the vitreous; the clear gel-like substance that fills the inside of the eye, tends to shrink slightly and take on a more watery consistency. Sometimes as the vitreous shrinks it exerts enough force on the retina to make it tear.Retinal tears increase the chance of developing a retinal detachment. Fluid vitreous passing through the tear lifts the retina off the back of the eye like wallpaper peeling off a wall. Laser surgery or cryotherapy (freezing) is often used to seal retinal tears and prevent detachment.
  14. Retinitis Pigmentosa
    1.  What is Retinitis Pigmentosa?

      Retinitis pigmentosa (RP) is the name given to a group of inherited eye diseases that affect the retina. RP causes the degeneration of photoreceptor cells in the retina. Photoreceptor cells capture and process light helping us to see. As these cells degenerate and die, patients experience progressive vision loss RP symptoms can vary. In a person with classic or typical RP, night vision and peripheral (or side) vision will be affected initially. Night blindness is one of the earliest and most frequent symptoms of RP. The loss of peripheral vision is often called tunnel vision. If you imagine peering down a tunnel, able only to see what is in front of you and nothing to the side, this is what it is like to lose peripheral vision. As vision loss progresses, the tunnel becomes more and more narrow. In the later stages some patients may also lose central vision. What is common to all cases of RP is the progressive nature of the disease. Not much is known about the cause of retinitis pigmentosa, except that it is inherited or a parent will be a carrier. Other forms of RP and related diseases include Usher syndrome, Leber’s congenital amaurosis, rod-cone disease, and Bardet-Biedl syndrome, among others.

      (Signs and Symptoms)
      • Since retinitis pigmentosa begins as rod degeneration, the patient first notices increasing difficulty in night vision, followed by difficulty seeing in the periphery. Slowly progressive constriction of the visual field leads to tunnel vision.
      • A small area of central vision in both eyes usually persists for years.
      • Later on, central vision may also get affected, making detailed work like reading or threading a needle difficult.
      • You may also see small shimmering flashes of light (called photopsia).
      • Generally night blindness precedes tunnel vision by years or even decades. Total blindness eventually ensues in most cases. The age of appearance of legal blindness ranges from as early as childhood to as late as the 40s

      What is the treatment for retinitis pigmentosa?

      • As of now there is no specific cure for retinitis pigmentosa. For years, vitamin A therapy has been recommended for many RP patients, based on research dating back to the early 1990s.

      Vitamin A, Omega 3 rich diet may be beneficial. Sunglasses should be used to protect the retina from the damaging effects of UV light.

      Recent Research Advances in Retinitis Pigmentosa

      1) Argus II Retinal Prosthesis System:
      The Argus® II Retinal Prosthesis System (“Argus II”) is also known as the bionic eye or the retinal implant. It is intended to provide electrical stimulation of the retina to induce visual perception in blind individuals. It is indicated for use in patients with severe to profound retinitis pigmentosa. A miniature video camera housed in the patient’s glasses captures a scene. The video is sent to a small patient-worn computer (i.e., the video processing unit – VPU) where it is processed and transformed into instructions that are sent back to the glasses via a cable. These instructions are transmitted wirelessly to an antenna in the retinal implant. The signals are then sent to the electrode array, which emits small pulses of electricity. These pulses bypass the damaged photoreceptors and stimulate the retina’s remaining cells, which transmit the visual information along the optic nerve to the brain, creating the perception of patterns of light. Patients learn to interpret these visual patterns with their retinal implant

      The Argus II was approved by the Food and Drug Administration in February 2013. It was developed by Second Sight Medical Products, Inc. and is now offered at the University of Michigan Kellogg Eye Center, one of 13 major centers across the country to offer the implant.

      How Is Argus® II Designed To Produce Sight?

      In a healthy eye, the photoreceptors (rods and cones) in the retina convert light into tiny electrochemical impulses that are sent through the optic nerve and into the brain, where they are decoded into images. If the photoreceptors no longer function correctly—due to conditions such as retinitis pigmentosa—the first step in this process is disrupted, and the visual system cannot transform light into images.

      The Argus II Retinal Prosthesis System ("Argus II") is designed to bypass the damaged photoreceptors altogether. A miniature video camera housed in the patient’s glasses captures a scene. The video is sent to a small patient-worn computer (i.e., the video processing unit – VPU) where it is processed and transformed into instructions that are sent back to the glasses via a cable. These instructions are transmitted wirelessly to an antenna in the implant. The signals are then sent to the electrode array, which emits small pulses of electricity. These pulses are intended to bypass the damaged photoreceptors and stimulate the retina’s remaining cells, which transmit the visual information along the optic nerve to the brain. This process is intended to create the perception of patterns of light which patients can learn to interpret as visual patterns.

      2) Retina Implant AG:

      Retina Implant AG is another company based in Germany that is developing their own retinal implant for patients with retinal degenerations. With their chip, they envisage that it should become possible again for a patient to move freely and independently without another person’s assistance. It is also conceivable that objects and faces could become recognisable again. A component of the early research into this implant was performed by the Tyndall institute in Cork and was funded by Fighting Blindness. One of the founders of Retina Implant AG, Professor Eberhart Zrenner was the keynote speaker at the Retina 2012 conference organised by Fighting Blindness in Dublin.

      They are developing microchips to be surgically implanted beneath the transparent top membrane of the retina and into the macular region. The chip senses light and transmits light signals back to the brain. The implant is controlled by a handheld, battery powered device which receives signals from a small device that is implanted under the skin behind the ear.

  15. PDF Understand Retinitis Pigmentosa

    PDF Retinitis Pigmentosa Research Advances 2014