Total care for your eyes

KozhencherryKozhencherry, Pathanamthitta District

Kerala, India - 689641Phone : +91 468 2213644, 2279744, 2279844

Fax: +91 468 2214044

Pathanamthitta Stadium Junction, College Road, Pathanamthitta

Kerala, India - 689645 Phone : +91 468 2272144 (5 lines)

Fax: +91 468 2214044

e mail : appt@mulamoottileyehospital.com

www.mulamoottileyehospital.com

Understanding DIABETIC

RETINOPATHY

Invetigations(1) Blood Sugar FBS/PPBS(2) Cholesterol (Lipid profile)High Triglycerides cause pancreatitis damaging the pancreas which is responsible for insulin production.(3) HbA1C-will help the surgeon to determine the level of diabetes control over the last three months.(4) Renal function test (Blood Urea, Serum creatinine, Albumin)

Recommended Sugar LevelsFBS < 110 PPBS < 150 BP < 130/85 mm Hg

LaserLaser treatment indents to control the bleeding points in the eye and prevent further damage.It is not expected that lost vision be regained following the laser, but some people regain some percent of their lost vision.Laser is done only to preserve the existing vision. However, successful Laser does not guarantee good vision forever. The chance of vision remaining good depends on the diabetes control. If diabetes is not controlled well, sight may come down and further lasers may be required.

Results of treatment

The above pictures also highlight the decreased blood on the retina and the diminished leaks on the FFA after laser.

Effects of NOT following treatment guidelines.

The above pictures show the retina a person who disregarded advice regarding treatment. These photos show the various stages of damage due to the effects of diabetes. That person has gone on to become totally blind. We have come across several persons who are prepared to spend lakhs to restore the vision once blind but hesitate to spend few thousand to preserve existing vision.

At Mulamoottil Eye Hospital We are committed to preventing blindness from diabetes.The cost of laser treatment is negligible compared to the distress and cost of managing a blind person at home.

Remember, your sight is a precious gift from god. You have a responsibility to preserve it.

The above pictures clearly show that the bleeding sites have decreased following the

laser treatment. If your doctor advise you to do laser after doing FFA, kindly follow the advise.

This latest and revolutionary technology facilitates rapid scanning and 3D imaging of retina. With a never-before level of precision and superior imaging quality. Compared to the existing 10 micron resolution imaging, OCT SLO makes possible an imaging resolution of 5 microns. Thanks to such high resolution, the different layers of the inner retina can be viewed in utmost clarity. The resulting diagnostic accuracy helps early detection of glaucoma. Also, the 3D topographic mapping of the retina brings higher accuracy to the modern treatments of AMD and Diabetic Retinopathy.

Used for Glaucoma, Diabetic Retinopathy, Macular degeneration, decreased vision after Cataract surgery or Laser surgery or for any other retinal disease

3-6 micron high-resolution imaging

T O T A L C A R E F O R Y O U R E Y E S

For the first time in India Advanced retinal scanning

for eye treatment

Introducing Advanced OTI Spectral OCT SLO Combination Imaging System

For the most modern and economical retinal scanning

DIABETIC RETINOPATHY

Diabetes can affect mostly all parts of the eye but the most serious complications occur when it effects the retina (the seeing part of the eye which is situated at the back end of the eye ball)

Normal Retina of Right eye)

Normal Retina of Left eye)

Normal Angiogram (FFA) of RE

Normal Angiogram (FFA) of LE

Diabetic Retinopathy is caused when diabetes affects the small blood vessels which carry nutrients to the retina.

Damage to the retina is of two types:(1)There may be small leaks from the blood vessels causing bleeding or exudation:

Eraly Bleeding

Exudations

Retinal Bleed and exudates

FFA of the leakages (White color)

or (2) There may be small blockages (occlusions) stopping blood from flowing to one part of the retina

Colour Photo of occlusion

FFA – dark areas with no blood flow

Diabetic Eye ExamFirst retinal exam should be immediately upon diagnosis of diabetes as the eye surgeons can record what the normal appearance of the retina is, and also find out any early damage.

Next eye exams will depend on the report of the first exam.

If damage is not evident : every yearIf mild retinopathy : every six months

If severe retinopathy : every 1-3 months

Stage of Diabetic RetinopathyThere are some terminologies to understand The most disastrous complications occur when new blood vessels start to grow from the retina in order to take blood to the parts where normal blood vessels are blocked

These blood vessels are not strong and hence give rise to heavy intraocular bleeding (vitreous hemorrhage) even on sneezing, coughing, lifting objects, etc.

Based on whether new blood vessels are present or not, diabetic retinopathy is divided in to proliferative (where new blood vessels are present) and non-Proliferative (where new blood vessels are absent)

If heavy exudations occurs in the macula, (the central, most important part of the retina) then diabetic maculopathy is said to exist) Both diabetic maculopathy and proliferative diabetic retinopathy require urgent laser therapy.

Angiography (FFA)Angiography is done to find out where exactly the bleeding is on the retina. In a normal FFA, only the blood vessels show the white colour inside them. If any white colour is seen outside the blood vessels, there is a leak present.

Without doing FFA, it is impossible to do a good laser, as it is difficult to find out the exact location of the damage (bleeding, occlusion or exudation).

FFA should be done once more after a minimum for three months following laser to find out if the damage has resolved and if there is any more new bleeding sites.

Non-Proliferative Diabetic Retinopathy (NPDR) Mild:

Yellow colour denotes exudates

White colour in areas other than vessels

If proper treatment is not instituted at this stage, the eye becomes progressively affected with the retinopathy and relentlessly proceeds to visual loss.

Moderate:

Severe:

Maculopathy:When diabetes affects the central part of the retina (macula), usually visual loss is very profound. The following pictures demonstrate the extent of leak at the center of the retina.

Mild:

Severe:

Proliferative Diabetic Retinopathy (PDR)In PDR, blood may be evident in the eye as in the following pictures. Active bleeding is shown in FFA as bright white color.

Damage may be invisible on routine eye exam. In that case, FFA will reveal the true picture

Sometimes it is possible to see the new vessels:

If no treatment has been done by this stage, the eye continues to become worse and may lose all visual potential.

The following picTures show The gradual conTracTion and deTachmenT of The reTina.