For Patients

RETINA : Is the innermost coat lining the inside of the back part of the eyeball. It is a thin sheet of nerve tissue, which turns light into electrical signal producing image of the object focused. Retina can be compared to the film in a camera.

VITREOUS: is a jelly like material that fills most of the space inside the eyeball.  Vitreous is normally loosely adherent to the retina providing support and nutrition to the retina. With age, the vitreous  often liquefies  & separates from retina. This is more likely to occur & occurs earlier in eyes that are myopic  (minus numbers). It can also occur after injury to eye or inflammation in the eye or following eye surgery.

FLOATERS:  appears  as  small black  specks, lines  or ‘cobwebs’  in  front  of  the  eyes  and  moves  with  the movement of the eye. They more prominent against bright and plain background.

Floaters are seen due to shadow cast by small clumps of materials in vitreous, appearing due to liquefaction of vitreous from number of causes, commonest being aging process.

FLASHES: are sensations of light (lightening streaks), when no flashing light is actually present. Flashes may be more obvious with the movement of the eye or in darkness.

Flashes are caused due to pull by vitreous gel on the retina it separates from the retina. These flashes usually last for few seconds, but occur repeatedly and at varying frequency.

SIGNIFICANCE OF FLASHES AND FLOATERS: Presence of one or two floaters is a common phenomenon & usually represents normal aging change of vitreous. However, sudden onset of new floater or many floaters may indicate development of more serious changes in retina. The onset of flashes may also be serious as it indicates pull on retina.

Anyone with FLASHES or SUDDEN ONSET OF NEW FLOATERS should undergo prompt dilated Indirect Ophthalmoscopic evaluation of retina.

TREATMENT: Flashes  go away  without any treatment  within  days  or week as soon as the vitreous is completely separated from retina. This may be true even in presence of retinal tear or detachment. Therefore it is important to be examined even if flashes go away on their own.

Floaters last longer than flashes. Gradually they disturb less over weeks or months. The only treatment is to learn to ignore them. If a large floater appears direct in line of vision, best is to move the eye up and down which will move the floater out of the way.

Retina : is the innermost coat lining the inside of the back part of the eyeball. It is a thin sheet of nerve tissue, which turns light into electrical signal producing image of the object focused Retina can be compared to the film in a camera.

Vitreous : is a jelly-like material that fills most of the space inside the eyeball. Vitreous is normally loosely adherent to the retina providing support and nutrition to the retina. With age the Vitreous often liquefies & separates from retina. This is more likely to occur, &. Occurs earlier in eyes that are myopic (minus numbers). It can also occur after injury to eye or inflammation in the eye or following eye surgery.

What is Retinal Detachment?

The Separation of retina from the back part of the eye is called Retinal detachment. Retinal detachment is a serious eye problem that may occur at any age. If not treated early, retinal detachment may lead to very poor or total loss of vision.Causes of Retinal Detachment : Most retinal detachments are caused by presence of one more small tears or holes in the retina.

Normally, the vitreous is attached to the retina in several places. With aging, changes occur in the vitreous causing it to shrink. During this process occasionally it may pull a piece of retina with it, producing a tear or hole in the retina. This is more likely to develop in people who are myopes (near sighted) or those whose close relatives have had retinal detachments. A direct blow to the eye may also cause retinal tear leading to detachment. Tear may also develop in or adjacent to thin areas in retina called “lattice retinal degeneration”.

Once a retinal tear is present, fluid from vitreous may pass through the hole and separate the retina from the back of the eye causing it to detach.

Symptoms of Retinal Detachment : Many patients notice black spots or cobweb like objects (floaters) and/or flashes of light in their vision before the retina detaches.Floaters & flashes are due to normal aging changes in vitreous and in most cases do not indicate any serious problem. However, sudden appearance of many floaters or flashes may indicate substantial shrinkage of vitreous with tears in retina and requires a thorough retinal evaluation.

Some retinal detachments may begin as a gradually enlarging dark area which gives a feeling of curtain coming down or a shade being drawn in front of the eye. Once the detachment affects the central part there is marked reduction in vision.

Diagnosis : A detached retina cannot be seen from outside of the eye. If symptoms are noticed, an ophthalmologist (preferably retinal specialist) should be visited at the earliest.The retina is checked thoroughly by an instrument called Indirect Ophthalmoscope Sometimes other specialized diagnostic procedure such as Ultra sonography may be needed.

Treatment : If the retina is only tom & detachment has not occurred, further problem may be prevented by prompt treatment by producing controlled scar around the tear either by laser or cryopexy. Once the retina is detached, it has to be repaired surgically.

Laser photocoagulation : When there are only retinal tears with little or no detachment, the tears can be sealed by laser. Laser burn produces scars that seal down the edges of the tear and prevents fluid from passing under the retina. This is done as an outpatient procedure and does not need any surgical incision.

Cryopexy (Freezing) : This is another method of producing a scar to seal the retinal tears. Cryopexy is also an outpatient procedure but requires topical/local anaesthesia.Once there is significant amount of detachment, some form of operative procedure is required. The type of operation depends on the extent and position of the detachment.

Scleral Buckling : In this, the retinal tears are located and treated with freezing (Cryo) technique to produce a scar to seal them tear. A silicone piece is sutured to the White of the eye (sclera) to support the retina in the area of tears. This is called ‘buckling’. Fluid may or may not be drained from under the detached retina. Gas may also be injected inside the eye to support the retina temporarily from inside.

Pneumatic Retinopexy : This is another type of surgery in which cryo or laser treatment is done to seal the retinal tear followed by injection of a gas bubble inside the vitreous Cavity. In this nothing is sutured on the outside of the eyeball. The patient has to keep his head in a particular position so that the gas bubble pushes the retina against the wall of the eyeball. The advantage is that it is a relatively minor procedure and in case it fails scleral buckling or vitreous surgery can be performed. The disadvantage is that not all cases can be treated by this and chances of success is slightly less than with scleral buckling.

Vitrectomy : In case of progressive shrinkage of vitreous and/or development of growth of excess of scar tissue on the surface of retina, the sclera buckling surgery may fail. This is because the shrinking vitreous and the scar tissue pulls the retina causing it to redetach. This is called Proliferative vitreoretinopathy (PVR). Some times, the detachment may be more complex with shrunken vitreous and puckered retina due to long standing retinal detachment.In such complicated cases it may be necessary to use a technique called vitrectomy. In this 3 small opening are made in the eyeball. Through one opening, fluid is put in the eye while one opening is used to introduce fiber optic light to illuminate the inside of the eye. The third one is used for introduction of instrument (vitreous cutter), which cuts and removes the shrunken vitreous ft the instruments used to peel scar tissue from the surface of retina. At the end of surgery, laser or cryo is done and the vitreous cavity is filled fluid ,gas, or silicone oil, depending on the need.

Results : Success depends on many factors.

Incase of fresh detachments about 80% to 90% (8 or 9 out of 10) can be reattached by modern surgical techniques. Occasionally, more than one operation may be needed. In case of old retinal detachments or fibrous tissue on the retina the chances of success is somewhat less.

Successful reattachment does not necessarily mean fully restored vision. Vision depends on whether, and for how long the macula was detached prior to surgery. If macula was detached, normal vision is rarely achieved. However, if the retina is reattached successfully, the vision usually improved and blindness have been prevented. Also, the vision usually improved gradually over period of months.

Post-operative Period : The surgery is usually performed under local anaesthesia. The patient can be discharged few hours after the surgery. The eye will be red and swollen for some days. Watering is also common in the early postoperative period. Mild pain may be there, but severe pain is unusual. The eye pad is removed on second day. Tablets and eye drops have to be used a prescribed. Sometimes a particular head posture is advised depending on the need.

Complications: As with any other surgery, some complications may occur. Scleral buckling surgery may cause bleeding under the retina, vitreous haemorrhage, cataract, glaucoma, double vision, infection of buckle etc. However, retinal redetachment is the most commonly occurring problem.

EARLY DIAGNOSIS AND EARLY SURGERY IS THE KEY FOR SUCCESSFUL RESTORATION OF VISION IN THIS COMPLEX PROBLEM.

Diabetes Mellitus is a condition which decreases the ability of the body to use & store sugar due to a deficiency in the synthesis of insulin, the hormone of the pancreas, or an insensitivity to the action of insulin.

Diabetic Retinopathy, a complication of diabetes, is caused by changes in the small blood vessels of the retina. These damaged blood vessels may leak fluid & blood, or show growth of fragile new vessels and scar tissue thereby affecting vision.Diabetic retinopathy is one of the most common causes of blindness in those over 45 years of age.

Diabetes is a rapidly emerging problem in developing world.  India is estimated to have 33million diabetics and this is likely to increase to 57 millions by 2025.

It is estimated that 80% of diabetics will have some form of diabetic retinopathy and 25% will have advanced form of diabetic involvement of retina (proliferative diabetic retinopathy) at 15years. Compared to non diabetic, a diabetic with retinopathy has 25 times greater risk of blindness. Hence, diabetic involvement of the eye has a major affect not only on the individual but also places a great burden on the family. This is particularly tragic because timely treatment can prevent up to 60-70% of vision loss due to D.R provided the condition is detected early and treated adequately.

Types of Diabetic Retinopathy :

Background disease (BDR) is an early stage in which sight is not seriously affected.

Fig. 1 Diabetic maculopathy

In some cases vision is affected when the leaking fluid collects at the macula, the part of retina responsible for detailed vision. This is called ‘diabetic maculopathy’.

Proliferative diabetic retinopathy (PDR) is the more serious type of retinopathy in which there is growth of abnormal, fragile new blood vessels and scar tissue on the surface of retina and optic nerve. These new vessels have weak walls and may rupture and bleed producing vitreous haemorrhage which blocks the light from reaching the retina while the scar tissue contracts and exerts pull on the retina lifting it up from its normal position. This is called tractional retinal detachment.

Symptoms :

Patients with significant changes of diabetic retinopathy can have good vision and be totally asymptomatic. Sight is usually unaffected in background diabetic retinopathy unless there is macular edema.

Black spots (floaters) of sudden onset often indicate a minor bleed in the eye, while sudden visual loss may occur due to extensive bleeding into the vitreous.Vision is also affected when there is traction at macula or traction induced detachment of retina involving macula.

Detection and Diagnosis :

Functional vision can be preserved or restored in many patients with even severe disease. However, accurate & timely detection of retinopathy remains a major problem as serious retinopathy can be present without symptoms. Therefore, a diabetic should be aware of the risks & have their eyes (& retina) examined regularly as suggested below –

Some studies have shown that pregnancy may aggravate existing retinopathy. To minimise potential visual loss, a retinal examination is recommended in diabetic patient during the first trimester & every 3 months thereafter.

Besides the routine examination, to detect diabetic retinopathy, the inner part of the eye has to be examined using an instrument called Indirect Ophthalmoscope. If diabetic retinopathy is noted, depending on the need, special tests may have to be performed. These include Fundus Fluorescein Angiography (FFA), Optical Coherence Tomography (OCT) and Ultrasonography (USG).

During FFA, a fluorescent dye is injected into a vein in the arm. Photographs of the retina are taken in rapid succession as the dye passes through the retinal blood vessels. This test is used to detect the sites of leakage in the retina or the presence of new blood vessels thereby helping to determine if treatment is necessary.

OCT is a new and very useful diagnostic tool in which a beam of light is used to scan the central area of retina (Macula). This gives a cut sectional view of retina and a detailed picture of retinal structure can be seen. This helps in detection of extent of fluid in the retina as well as any traction and also to judge the response of treatment.

Ultrasonography is a non-invasive diagnostic test utilizing ultrasonic waves. This test is used to rule out presence of tractional retinal detachment in eyes with vitreous haemorrhage or cataract.

Treatment :

Not all cases of diabetic retinopathy require treatment. Several factors such as patient’s age, history and degree of damage to the retina have to be considered before deciding for the treatment.

Many studies have shown that good control over glucose levels delays the onset & decreases the severity of retinopathy. Numerous drugs have been tried in an effort to alter the course of retinopathy, but none of these have shown to be effective in arresting or reversing the retinopathy. Diabetic retinopathy is frequently found in conjunction with hypertension. Controlling hypertension may also help the retinopathy from becoming worse.

Laser Photocoagulation  is the most important mode of treatment of diabetic retinopathy. Laser beam is used to seal the leaking vessels and destroy the new vessels. It must be remembered that laser treatment is performed to maintain vision and NOT to improve it. Hence, to be most helpful, the laser treatment must be delivered before patient complains of visual loss.

Laser treatment does not require hospitalisation and is performed on an out-patient basis. It may be performed in one sitting or may have to be repeated depending upon the severity of the retinopathy. After photocoagulation, patient is asked not to bend down, not to strain or lift heavy objects at least for 3-4 weeks, to sleep with head raised using 2-3 pillows and to control coughing and sneezing with appropriate medicines.

Laser photocoagulation is very safe and essential with negligible side effects if any.

Intravitreal Injections :  In certain conditions, where laser is not possible or is not effective, certain medicines are now used in form of injections in the eye. This is a painless procedure and done in operation theatre to ensure sterility. This form of treatment may also be combined with either laser or surgery.

Vitrctomy : In most cases disease is controlled by laser but more than one sitting may be required. In some patients with advanced proliferative diabetic retinopathy, extensive haemorrhage may occur clouding the vitreous for long time or a retinal detachment may be present. In presence of fresh vitreous haemorrhage without retinal detachment, at first strict rest with head-up is advised. No oral medicine or drops has been found to be of use in helping the absorption of vitreous haemorrhage. If the haemorrhage does not show signs of absorption after 2-3 months or if retinal detachment is suspected, in such cases vitrectomy operation may be needed.

Vitrectomy  is a sophisticated microsurgical operation in which cloudy vitreous and scar tissue over retina are removed from the eye. Along with this, laser treatment can also be given at the same sitting by means of an instrument called ‘endolaser’. Being a complex surgical procedure with many potential complications, vitrectomy is reserved only for selected patients in whom all other treatment modalities have failed.

Conclusion :

With progress in the medical management of diabetes and the increasing life span of diabetics, it is inevitable that unless treated, most diabetics will suffer some degree of visual loss in decades after onset of the disease. Early detection of the retinopathy is the best protection against loss of vision. It should be remembered that laser treatment only helps in preventing further loss of vision, hence, it is most useful when used before the patient complains of decreased vision. Thus regular retinal check-up in diabetic patient is very important for early diagnosis and treatment to prevent blindness.

Recommended Schedule for Retinal Check-Up :

Recommended by American Academy of Ophthalmology.

Hypertensive retinopathy is retinal vascular damage caused by hypertension. Signs usually develop late in the disease. Funduscopic examination shows arteriolar constriction, arteriovenous nicking, vascular wall changes, flame-shaped hemorrhages, cotton-wool spots, yellow hard exudates, and optic disk edema Treatment is directed at controlling BP and, when vision loss occurs, treating the retina.

Retinal vein occlusion is a blockage of the small veins that carry blood away from the retina. The retina is the layer of tissue at the back of the inner eye that converts light images to nerve signals and sends them to the brain.

What is Macular Degeneration?

Macular degeneration is a deterioration or breakdown of the macula. The macula is a small area in the retina are the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. When the macula does not function correctly, your central vision can be affected by blurriness, dark areas or distortion. Macular degeneration affects your ability to see near and far, and can make some activities like threading a needle or reading – difficult or impossible.

Although macular degeneration reduces vision in the central part of the retina, it usually does not affect the eye’s side, or peripheral, vision. For example, you could see the outline of a clock but not be able to tell what time it is. Macular degeneration alone does not result in total blindness. Even in more advanced cases, people continue to have some useful vision and are often able to take care of themselves.

In many cases, macular degeneration’s impact on your vision can be minimal.

What causes Macular Degeneration?

Many older people develop macular degeneration a part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD). Exactly why it develops is not known, and no treatment has been uniformly effective. Macular degeneration is the leading cause of severe vision loss in people over age 50 years of age.

The two most common types of AMD are “dry (atrophic) and “wet” (exudative):

ATROPHIC

“DRY” Macular Degeneration (Atrophic)

Most people have the “dry” form of AMD. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.

“WET” Macular Degeneration (Exudative)

The “wet” form of macular degeneration accounts for about 10% of all AMD cases.

It results when abnormal blood vessels form underneath the retina at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.

EXUDATIVE

Deposits under the retina called are a common feature of macular degeneration.

Drusen alone usually do not cause vision loss, but when they increase in size or number, this generally indicates an increased risk of developing advanced AMD.

People at risk for developing advanced AMD have significant drusen, prominent dry AMD, or abnormal blood vessels under the macula in one eye (“wet” form).

What are the symptoms of Macular Degeneration?

Drusen

Macular degeneration can cause different symptoms in different people. The condition may be hardly noticeable in its early stages.

Sometimes only one eye lose vision while the other eye continues to see well for many years.

But when both eyes are affected, the loss of central vision may be notices more quickly.

Following are some common ways vision loss is detected

1. Words on a page look blurred;
2. A dark or empty area appears in the center of vision;
3. Straight lines looks distorted, as in the following diagram

How is Macular Degeneration Diagnosed?

Many people do not realize that they have macular problem until blurred vision becomes obvious. Your ophthalmologist (Eye Doctor) can detect early stages of AMD during a medical eye examination that includes the following :

• A simple vision test in which you look at a chart that resembles graph paper (Amsler grid);
• Viewing the macula with an opthalmoscope;
• Taking special photographs of the eye called fluorescein angiography to find abnormal blood vessels under the retina.
• Taking scans through the macula (OCT)

Fluorescein Angiography & Macula (OCT)

How is macular degeneration treated?

Nutritional Supplements

Although the exact causes of macular degeneration are not fully understood, antioxidant vitamins and zinc may reduce the impact of AMD in some people.

A large scientific study found that people at risk for developing advanced stages of AMD lowered their risk by about 25% when treated with a high-dose combination of vitamin C, vitamin E, beta carotene and zinc. Among those who have either no AMD or very early AMD, the supplements did not appear to provide an apparent benefit.

It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision that you may have already lost from the disease. However, specific amounts, of these supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. You should speak with your ophthalmologist to determine if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.

Laser surgery, PDT and anti-VEGF treatments

Certain types of “wet” macular degeneration can be treated with laser surgery, a brief outpatients procedure that uses a focused beam of light to slow or stop leaking blood vessels that damage the macula. This may be an option in case the new blood vessel comply is among from center of macula.

A treatment called photodynamic therapy (PDT) uses treatment to slow or stop leaking blood vessels. This is currently used in special situation.

Another form of treatment targets a specific chemical in your body that is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage. Currently, this is the best treatments for Wet AMD.

These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, many people with macular degeneration still experience some vision loss.

Adapting to low vision

To help you adapt to lower vision levels, your ophthalmologist can prescribe optical devices or refer you to a low vision specialist or center. A wide range of support services and rehabilitation programs are also available to help people with macular degeneration maintain a satisfying lifestyle. Because side vision is usually not affected, a person’s remaining sight is very useful. Often, people can continue with many of their favorite activities by using low-vision optical devices such as magnifying devices, closed-circuit television, large-print reading materials and talking or computerized devices.

Testing your vision with the Amsler Grid

You can check your vision daily by using an Amsler grid like the one pictured here. You may find changes in your vision that you wouldn’t notice otherwise. Putting the grid on the front of your refrigerator is a good way to remember to look at it each day.

To use the Grid :

• Wear your reading glasses and hold this grid 12-15 inches away from your face in good light
• Cover one eye.
• Look directly at the center dot with the uncovered eye.
• While looking directly at the center Dot, note whether all lines of the grid are straight or if any areas are distorted, blurred or dark.
• Repeat this procedure with the other eye.

If any area of the grid looks wavy, blurred or dark, contact your ophthalmologist immediately.

What is uveitis?

Uveitis (pronounced you-Vee-EYE-tis) is inflammation of the uvea, the middle layer of your eye. The eye is shaped much like a tennis ball, with three different layers of tissue surrounding a central gel-filled cavity.

The innermost layer is the retina, which sense light and helps to send images to your brain. The middle layer between the sclera and retina is called the uvea. The outermost layer is the sclera, the strong white wall of the eye.

What is the importance of the uvea?

The uvea contains many blood vessels, the veins and arteries that carry blood flow to the eye. Since it nourishes many important parts of the eye (such as the retina), inflammation of the uvea can damage your sight.

What are the symptoms of uveitis?

• Symptoms of uveitis include :
• Light sensitivity
• Blurring of vision
• Pain
• Redness of the eye
• Floaters

Uveitis may come on suddenly with redness and pain, or sometimes with painless blurring of your Vision. A case of simple “red eye” may in fact be a serious problem if uveitis. If your eye becomes red or painful, and does not clear up quickly, you should be examined and treated by an ophthalmologist (medical eye doctor).

What cause Uveitis ?

Uveitis has many different causes :

• A virus, such as shingles, mumps or herpes;
• A fungus, such as histoplasmoisis;
• A parasite, such as toxoplasmosis;
• Related disease in other parts of the body, such as arthritis;
• A result of injury to the eye. Inflammation in one eye can result from a severe injury to the opposite eye (sympathetic uveitis); Bacteria, such as syphilis. In most cases of uveitis the cause remains unknown.

How is uveitis diagnosed

A carful eye examination by an ophthalmologist is extremely important when symptoms occur inflammation inside the eye can permanently affect sight or even lead to blindness, if it is not treated.

Your ophthalmologist will examine the inside of your eye. He or she may order blood tests, skin tests or X-rays to help make the diagnosis. Since uveitis can be associated with disease in the rest of the body, your ophthalmologist will want to know about your overall health. He or she may want to consult with your primary care physician or other medical specialists.

Are there different kinds of uveitis?

There are different types of uveitis, depending on which part of the eye is affected:

• When the uvea is inflamed near the front of the eye in the iris, it is called iritis. Iritis usually has a sudden onset and many last six to eight weeks; usually the eye is red and painful.
• If the uvea is inflamedinthe middle of the eye, it is called intermediate uveitis. Intermediate uveitis affects the muscle that focuses the lens. It can also come suddenly and last for several months.
• An inflammation in the back of the eye is called retinitis or choroiditis. This is slower to begin and may last longer. The retinal vessels  may also be inflamed. This is called vasculitis.

How is uveitis treated?

Uveitis is a serious eye condition that may scar the eye. You need to have it treated as soon as possible. Eye drops especially steroids and pupil dilators, can reduce inflammation and pain. For more severe inflammation oral medication or injections may be necessary.

Uveitis can have these complications:

• Glaucoma (increased pressure in the eye);
• Cataract (clouding of the eye’s natural lens);
• Neovascularization (growth of new, abnormal blood vessels)

These complications also may need treatment with eye drops, conventional surgery or leaser surgery.If you have a “red eye” that does not clear up, see your ophthalmologist.

“Take Care Of Your Premature Baby’s Vision“

Why should I worry about the eyes of a premature baby?

The inside of the eye (the retina) is not fully developed in a premature baby due to the early birth. Abnormal blood vessels can develop in a such a retina; this can cause bleeding inside the eye and even progress to retinal detachment. This is called Retinopathy of Prematurity (ROP). The result is irreversible low vision or blindness.

How can we detect ROP?

A trained ophthalmologist can detect ROP by dilating the pupils of the eye using eye drops. An indirect ophthalmoscope is used to scan the entire retina to detect ROP and gauge the state of retinal maturity.

Do all babies need a Retinal examination for ROP?

Babies with a birth weight of less than 1700 gm or those at less than 35 weeks of pregnancy are most likely to ROP. Any other preterm baby who has had problems after birth (lack of oxygen / infection/ blood transfusion / breathing trouble, etc) is also vulnerable.

Is it too late for my baby’s eyes?

Follow the “Day-30” strategy. The retinal examination should be completed before “Day-30” pf the life of a premature baby.It should preferably be done earlier (at 2-3 weeks of birth) in very low weight babies (less than 1200 gm birth weight).

What is the treatment for ROP?

ROP is treated with laser rays or a freezing treatment (cryopexy). The treatment helps stop further growth of abnormal vessels thus preventing vision loss. Occasionally some injection (anti VGEF) may be used in the eyes where disease is progressing very rapidly and not responding. Surgery may be need for stage IV and V disease.

How often Should the retina be examined?

ROP can progress in 7-14 days and, therefore, needs a close follow up till the retina matures.

When should we treat ROP?

ROP needs to be treated as soon as it reaches a critical stage called threshold ROP. There is a 50% or greater risk of vision loss if left untreated after this. Time is crucial !

After Treatment

If treated on time, the child is expected to have reasonably good vision. All premature babies need regular eye examinations till they start going to school. They may need glasses or treatment for lazy eyes/ cross eyes and, sometimes, for cataract, glaucoma, retinal detachment

What is MicroPulse Laser Therapy?

In contrast to conventional laser treatment, MicroPulse Laser therapy (MPLT) has been proven effective without producing laser burns. MPLT chops the continuous wave laser beam into a train of tiny, repetitive low energy pulses separated by brief rest period in between. This “microplusing” allows the retina to cool between laser pulses, preventing burns and retinal damage.With MPLT, risks are reduced or eliminated, with less pain and discomfort than conventional laser treatment; and therefore can be repeated as needed without harm to your vision.

What to Expect During MPLT

Before Treatment : Your doctor will make the diagnosis of DME based on a thorough clinical history and examination, usually involving retinal imaging tests to confirm the diagnosed and to provide additional important information. If MPLT is recommended, an informed-consent form will be given to you for your review and signature, and all of your questions regarding treatment will be answered.

During Treatment : To perform MPLT, your eye must be dilated. The lights in the office will be dimmed and you will be seated facing the laser machine with your doctor facing you. A special viewing lens will be placed on the front of your eye to perform MPLT. A drop of a topical anesthetic makes this comfortable. Your doctor will place several laser application in the areas of DME. Treatment usually takes minutes, and is painless.

Based on the laser wavelength used, you may experience some flashing lights during the procedure, If you move during treatment there will be no harm to your eye, but it may lengthen the treatment time. At the end of MPLT, the special viewing lens on your eye will be removed.

After Treatment: For the rest of the day, your vision may be a little blurry. Due to the lens placed on your eye during treatment it is common to experience a little irritation on the front of your eye for a few hours after treatment. This irritation is usually mild and lessened by use of frequent artificial teat drops. Significant pain after treatment should not occur. If it does, contact your doctor. By the next day, your vision improvement typically occurs after month; however patients may notice better vision within days to weeks after treatment.

Following MPLT, it is important for you to continue to follow-up with your doctor on a regular basis for continued monitoring of your condition. How soon and how often follow-up examination is required will be determined by your doctor.