Conditions| Raj Mukherjee-Retina Specialist

Age-related macular degeneration (AMD)

AMD is one of the commonest causes of visual loss in those older than 50 years of age. Early in the disorder, vision becomes distorted or blurred but in advanced cases, central vision can be lost completely. The decline in central vision makes reading, recognising faces, watching television and driving more difficult. Early signs of AMD include deposits at the macula called drusen. At late stages, AMD can be classified as either dry or wet. In dry AMD, there is progressive loss of cells and thinning at the macula. In wet AMD, bleeding or leakage of fluid in the macula causes rapid loss of vision unless urgent treatment is initiated.

Diabetic eye disease

Diabetes is a chronic health condition that affects several organs in the body including the eye. Besides accelerating the formation of cataract and increasing the risk of eyelid infections, the retina is the main tissue affected by diabetes. Two different problems, retinopathy and maculopathy, affect the retina of patients with diabetes. Diabetic retinopathy affects the whole of the retina. In the early stages, small haemorrhages and microaneurysms appear in the retina. Later in the disease, larger haemorrhages and multiple areas of blocked blood supply develop which commence development of abnormal new vessels within the retina. Untreated, this can lead to big bleeds within the jelly of the eye (vitreous), retinal detachment and eventual loss of sight. Simultaneously, leakage and accumulation of fluid within the most sensitive part of the retina, called the macula can transpire. This condition is called diabetic maculopathy and it also results in the blurring of vision. The treatment of these conditions includes injections in the eye or retinal laser.

Retinal vein occlusion (RVO)

This condition of the retina presents variably from mild blurring of vision to a painful blind eye. Retinal examination shows multiple haemorrhages which either affect a limited area of the retina (branch retinal vein occlusion) or the whole of the retina (central retinal vein occlusion). Frequently associated with problems in general health like high blood pressure or diabetes, this condition needs careful monitoring and treatment to improve vision and to prevent the development of complications like glaucoma. This condition is primarily treated with injections in the eye and/or retinal laser. However, management should be tailored to individual patients to achieve maximal visual benefit.

Retinitis pigmentosa (RP)

One of the commonest genetic cause of visual loss, this condition affects 1 in 3-4000 of the population. RP is a progressive eye disorder, which is caused by mistakes in many different genes. RP can affect multiple generations within a family or present in only one generation. Some types of RP can be gender-specific, predominantly affecting males. Variability of the signs can make RP difficult to diagnose and patients should be referred to a specialist with experience in managing genetic eye disorders. Recently, treatment of some of the types of RP has begun using a technique called gene therapy. Other therapeutic options are being tested in several clinical trials all over the world.

Stargardt’s disease

Stargardt’s disease is a genetic eye disorder, predominantly affecting the most sensitive part of the retina called the macula. The affected individuals present principally with discomfort in bright light and blurry reading vision. Stargardt’s disease, which is caused by faults in the ABCA4 gene, can appear in only one generation or a single person in the family. Results of clinical trials for the treatment of this condition are eagerly awaited.

Choroidal naevus

Affecting about 5% of adults above 40 years of age, choroidal naevus is a benign pigmented lesion of the retina. Although less than 1% of choroidal naevi turn into a melanoma, it is essential to identify the risk factors which predict such a transformation. Rigorous monitoring of these lesions by retina specialists is particularly important to identify these risk factors early.

Central serous chorioretinopathy (CSCR)

CSCR is an acute condition where fluid collects underneath the retina and causes a limited retinal detachment. If this involves the macula, the most sensitive part of the retina, it results in blurring of vision. There is a strong association of this condition with steroid use. Although usually self-resolving, sometimes the fluid does not improve and there is a risk of permanent visual impairment. In this situation need treatment mainly by photodynamic therapy which is delivered using a special kind of laser.