Retina

What is Retina? How is the examination performed?

Retina is the light-sensing layer of the eye. It covers the entire inner wall of the eye. It consists of vessels and nerves coming from the brain.
For the retinal examination, the degree of vision is measured and microscopic examination is performed, after which drops are instilled to dilate the pupil.
The pupil enlarges at different times depending on the person and the disease. This period should be waited before the examination.
Then the intraocular transparent media (lens and vitreous) and the retina are examined in detail with different instruments.

Which tests are performed for the diagnosis of retinal diseases?

• Biomicroscopic and indirect retinal examination.
• Optics Koherens Tomography ( OCT )
• Colour Fundus Photograph
• Fundus Fluorescein Angiography (FFA)
• Indosyn Green Angiography (ICGA)

Yellow spot disease Amsler card is given to people at risk and they are asked to look at certain intervals. When they notice a distorted vision, they are asked to come to the examination immediately.

What are the Symptoms of Retina Patients?

Retina diseases;

• Decreased vision,
• Distorted or distorted vision,
• Half or blurred vision,
• Black flights,
• Light flashes, ghosting,
• Complaints such as low vision or even no vision in darkness or light occur.

What are Retinal Detachment and Symptoms?

There are complaints such as flashes of light, floaters and shadowing in the eye. High myopia and blows to the eye are the most important risk factors.

If the tear is diagnosed at an early stage, its progression is prevented by laser. If there is a delay or negligence in diagnosis and treatment, the tear grows larger and the retinal layer is detached. In this case, which we call retinal detachment, the only treatment method is surgery.

What kind of eye disorders does diabetes cause?

Diabetes is a systemic disease that causes various diseases in the eye. It accelerates the formation of cataracts, causes changes in spectacle numbers, paralyses in eye muscles and consequent double vision.

The most important one is the damage to the retina (nerve) layer of the eye. In this condition called diabetic retinopathy, haemorrhages, vascular occlusions, new vessel formations and retinal oedema are observed in the retinal layer.

How often should diabetics be examined? How is the treatment?

An annual eye examination is recommended for patients who have been diagnosed with diabetes but have not started to have damage to the fundus of the eye. Patients with diabetes retinopathy should be followed up every 6 months.

If the damage is advanced, fundus fluorescein angiography (FFA) and/or optical coherence topography (OCT) films are taken to determine the degree of diabetic retinopathy. If there are areas with impaired nutrition in the retinal layer, if new vessels are formed or if there are leaking vessels, laser treatment is required. In cases where the leakage close to the yellow spot is widespread and cystised, medication is administered into the eye.

In untreated cases, haemorrhages filling the inside of the eye occur. In these patients, the haemorrhages are cleaned with vitreoretinal surgery. During the operation, the recesses and membranes are separated and the laser is completed.

Treatments in diabetic retinopathy are aimed at preserving the vision determined at the start of treatment. Improvement of vision is rare. If treatment is neglected, it results in blindness.

What kind of a disease is yellow spot disease (macular degeneration)?

Age-related macular degeneration affects approximately 1/3 of the population over the age of 70. It leads to difficulty in central vision and especially in close reading, with loss of central vision and staining over time.

In patients with distorted or trapezoidal vision complaints at the beginning, vision may decrease from a few metres to the level of counting fingers in more advanced periods.

Although it does not cause total blindness, vision can be reduced to a level that can legally be considered blindness. Patients become unable to see the point they are looking at, that is, they cannot see the face of a person standing in front of them, but they can see their arms and legs. Such patients can hardly go out on the street alone. Although they can do their own work at home, they have to get help from others to do some jobs. They cannot read and write because they cannot see.

This condition is observed in two types: dry and wet type. Dry type is seen in 80-85% of such patients and vision decreases gradually and over a period of years. Protective, antioxidant pills are recommended as treatment for these patients. In the wet type, haemorrhage and oedema develop at the visual point and vision decreases rapidly. The patients we are currently treating are patients with this age type of yellow spot degeneration.

Is Yellow Spot Disease Treatable?

Until ten years ago, we could not help such patients much in terms of treatment. After the 2000s, various treatment methods started to develop. These developments, which started with photodynamic therapy (laser application by giving intravenous medication to the patient), have continued to develop until today with the application of some substances injected into the eye. Finally, apart from the drug that came to Turkey a few months ago and which we had the opportunity to apply to patients, which is applied all over the world, numerous researches are still continuing rapidly, and the possibility of blindness from this disease will be minimised with the discovery of much more effective drugs and methods in the near future.

Although the cause of this disease is not certain, heredity and metabolic disorder are thought to be the most important factors. In the future, people who will be diagnosed with this disease at an early age can be identified and treated with gene or other treatment methods before the disease occurs.

Who Needs Regular Eye and Retinal Examination?

• People who have diabetes in their family or themselves,
• Patients with hypertension,
• High Cholesterol,
• Those with cardiovascular disease.
• Those who have yellow spot disease in themselves or in their family.
• Those with congenital or acquired visual impairment in the family.

What is Retinopathy of Prematurity (ROP)?

ROP is a disease seen in premature babies with low birth weight and can lead to blindness.

What are the Risk Factors for ROP?

All babies born under 1300 g or under 30 weeks.
Babies born under 1500 g or under 32 weeks and receiving oxygen therapy in intensive care.

Babies born prematurely with bronchopulmonary dysplasia, respiratory distress syndrome or patent ductus arteriosus who have recurrent apnoea, sepsis, blood transfusion or blood exchange intracranial haemorrhage, and babies whose mothers have pre-eclampsia and diabetes are at risk for ROP development.

How is ROP Examination and Follow-up Performed?

ROP examination is an examination performed under topical anaesthesia by enlarging the pupils of babies and examining the nerve layer of the eye called retina. The first ROP examination in premature babies should be performed 4-6 weeks after birth. The examination is then repeated at intervals of 1 or 2 weeks, depending on the presence and extent of the disease, until the baby is term (when it should be born).

What are the Treatment Alternatives in ROP?

The most important stage in the treatment of ROP is regular follow-up. Statistically, 80% of patients who develop ROP regress spontaneously and treatment is required in 8% of the babies followed up. However, timely detection of the disease level, which we call threshold disease, and urgent laser treatment (within 3 days) is the most important factor that prevents babies with ROP from going blind. Vitrectomy surgery is performed in cases that cannot be detected in time and the disease progresses despite laser treatment.

Photodynamic Treatment ( PDT )

Photodynamic therapy is applied in some patients with yellow spot disease (macular degeneration), chronic central serous chorioretinopathy and polypiodal choroidal vasculopathic cases.

Photodynamic therapy is based on the principle of intravenous administration of a light-sensitive chemical substance into the body followed by stimulation of this substance with a low-energy light (cold laser) in the target tissue and destruction of the target tissue by occlusion of the vascular component in the target tissue without damaging the surrounding tissues.

Photodynamic therapy can be repeated if necessary. If there is damage in both eyes, it is applied to both eyes simultaneously if the doctor deems appropriate.
Patients undergoing treatment are asked not to be exposed to intense light for 48 hours.

You can reach our hospital for all kinds of issues about eye health, you can get detailed information about your eye problems and learn the process information for treatment.

Prepared by the Editorial Board of Göz Vakfı Hastaneleri.