Retinopathy is any acute or chronic damage to the ‘Retina’ of the eye. It is most commonly seen in people with uncontrolled diabetes and also with controlled but long standing diabetes. Second most notable causes of retinopathy is Age Related Macular Degeneration (Dry ARMD) & Choroidal Neovascularisation (CNVM or Wet ARMD). Some form of Dry ARMD is seen normally with an aging retina in 5-10% of people above the age of 70 years and upto 25-30 % of people above the age of 80 years. Other most notable causes of Retinopathy are Retinal Vascular Occlusions (Venous occlusions being much more common than Arterial), Hypertension Related Retinopathy, retinopathy associated with various Bacterial/ Viral & Parasitic systemic infections like Tuberculosis, Syphilis, AIDS, Herpetic,Toxoplasma etc and retinopathy associated with various Systemic inflammatory, autoimmune and connective tissue disorders most notably Sarcoidosis, Behcets and Eale's diseases.

NORMAL RETINA

Any retinopathy can cause a variety of visual symptoms ranging from mild visual disturbances like hazy or distorted Distance or Near vision/ Floaters / Flashes to a Total Loss Of Vision from either vitreous haemorrhage or retinal detachment. A meticulous follow up with both the treating Physician and Retinal Eye Specialist is necessary in order to keep the underlying systemic disease under control via disease-specific medications prescribed by the physician and to monitor the progression of the Retinopathy by 6-monthly or annual ‘Fundus examination’ & to treat the ophthalmic complications by various ocular treatment modalities.

Any suspected case of retinopathy or a previously diagnosed case of retinopathy with suspected progression generally at some point needs certain special ocular investigations to exactly pin point the diagnosis, stage of disease, plan of further treatment required & future visual prognosis of the present condition, generally which are a set of twin investigations namely FFA (Fundus Fluorescine Angiography) to delineate the nature and extent of the disease on the total visible surface of retina and OCT (Optical Coherent Tomography) which tells us the extent of depth and up to which internal layers of retina and choroid the disease has penetrated.

NORMAL FFA PICTURE OF RETINA
NORMAL MACULAR OCT

Depending upon the report of FFA & OCT, the extent and stage of the disease is diagnosed and generally depending upon the amount of ‘Leakages’ on FFA and ‘Swelling or Edema’ on OCT, the treatment is planned which generally can be either some recently approved special intravitreal Anti – VEGF agents like Avastin (Bevacizumab) / Lucentis or Accentrix (Ranibizumab) / Eylea (Aflibercept) or Steroid injections  like Ozurdex (Dexamethazone Sustained release implant) / Retisert (Floucinolone ) implants or the time tested Retinal Argon Laser Photocoagulation therapy (divided in multiple weekly sittings in either  eye stretched over a period of around 1-2 months) in order to stabalize the vision.

FUNDUS PHOTO - SEVERE DIABETIC RETINOPATHY
FFA PHOTO - SEVERE DIABETIC RETINOPATHY
OCT PHOTO - MACULAR EDEMA
FUNDUS PHOTO - DRY ARMD
FUNDUS PHOTO - WET ARMD (CNVM)
FFA - CNVM WITH HAEMORRHAGE
OCT - CNVM

Number of injections and / or Laser may vary from a single injection without any laser in cases like mild non proliferative macular edema, to 3-6 monthly injections with multiple weekly sittings of laser for as long as 3-10 sittings in cases of severe proliferative diabetic retinopathy with macular edema, to 3-12 monthly injections ( sometimes even more ) without any laser, in cases of recalcitrant Wet ARMD with choroidal neovascularisation. All these situations depend on the repeated FFA and OCT reports and the type and stage of the disease problem.

INTRAVITREAL INJECTIONS
ARGON GREEN LASER PAN RETINAL PHOTOCOAGULATION DONE IN 3-4 SITTING TO COVER 360 DEGREE RETINA

Sometimes Vitreo-retinal Surgery (Pars Plana 3-port Core Vitrectomy) may be required in severe cases which are unresponsive to conventional Anti-VEGF or Laser treatment or with persisting Vitreous Haemorrhage / Retinal Detachment, in order to improve vision. 

3 PORT PARS PLANA VITREOUS SURGERY

Of course there is no denial that all this ‘Ocular Treatment’ may eventually fail if the underlying disease is not kept under control. So it goes without saying that any untreated or uncontrolled Retinopathy is a ‘Sight Threatening’ condition and in order to prevent loss of vision, strict and regular follow up with the treating physician & eye specialist along with taking the above said appropriate ocular treatment at the correct time is a MUST.