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EDITORIAL
Year : 2014  |  Volume : 62  |  Issue : 8  |  Page : 839-840

The sweeter side of retina


Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt Ltd, Wadala (W), Mumbai - 400 031, Maharashtra, India

Date of Web Publication18-Sep-2014

Correspondence Address:
Sundaram Natarajan
Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt Ltd, Wadala (W), Mumbai - 400 031, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.141032

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How to cite this article:
Natarajan S. The sweeter side of retina . Indian J Ophthalmol 2014;62:839-40

How to cite this URL:
Natarajan S. The sweeter side of retina . Indian J Ophthalmol [serial online] 2014 [cited 2020 Apr 2];62:839-40. Available from: http://www.ijo.in/text.asp?2014/62/8/839/141032

Dear Friends,

According to the International Diabetes Federation, in 2011 there were 366 million people with Diabetes Mellitus, which is expected to rise to 552 million by 2030, mostly in low- and middle-income countries. [1] Diabetic retinopathy (DR) is the most frequent cause of novel case of blindness in adults between 20 and 74 years of age. [2] DR starts as mild non-proliferative diabetic retinopathy characterized by an increase in vascular permeability and progresses from moderate to severe states of non-proliferative diabetic retinopathy followed by proliferative diabetic retinopathy. [3] DR can be treated effectively if detected early during the disease course. The Diabetic Retinopathy Study (DRS) and the Early Treatment DiabeticRetinopathy Study (ETDRS) have shown that early treatment can reduce the risk of relentless vision loss by 57%. [4] Dilated indirect ophthalmoscopy coupled with biomicroscopy and seven standard field stereoscopic 30® fundus photography have been far and wide accepted methods for early diagnosis. [5] While this method require strained personnel, it is time-consuming, costly, and tedious. One method without these limitations are the need of the hour. Although consensus from various national bodies is for diabetics to undergo dilated fundoscopic examination with stereoscopic examination of the posterior pole using slit-lamp biomicroscopy, studies have shown a low screening rate (ranging between 35 and 54%) for diabetic retinopathy. [5],[6] Digital non-mydriatic retinal imaging (NMRI) technique has been developed as an alternative that overcomes some of the above-mentioned barriers where patients will be assessed all the way through remote reading by concerned specialist. [7] Despite being both highly sensitive and specific, proportion of images that could not be graded ranged between 6 and 35% as shown by various studies. [8],[9],[10],[11],[12]

Considering the dearth of data of NMRI in Indian population, Gupta et al. in this issue published an original study evaluating its application in 500 Indian diabetic patients. The authors have found that nearly one-third of the images were not gradable, sensitivity was around 60% and specificity 70%. Presence of elderly individuals with cataract and dark iris were the possible reasons for inability to grade images in the present study. This limits the use of NMRI as a screening technique in Indian patients. It is my goal to spread awareness on DR and prevent blindness due to it. The AIOS President, Dr. Maskati has launched an ambitious nation-wide drive to screen for DR through our 15,000 strong member body from November 14 th to 20 th 2014. I laud him for his initiative and request you all to participate whole-heartedly.

Rhegmatogenous retinal detachment is presently managed by vitreoretinal surgery, pneumatic retinopexy, and scleral buckling. [13],[14] Vitreoretinal surgery is advocated for those patients with complex retinal detachments such as giant retinal tear or proliferative retinopathy involving the vitreous. Scleral buckling has taken a setback as the procedure depends on indirect ophthalmoscopy. [15] This led to the advent of endoilluminator-assisted sclera buckling (EASB) through which it is possible to locate the number and location of breaks more accurately, and one can undertake cryopexy of the breaks and perform drainage of the subretinal fluid. [16] Gogia et al. in this issue has published their experience of EASB in 25 eyes. The authors have found an anatomical success rate of 95.6% and observed a significant improvement in the mean visual acuity, indicating the utility of this technique. Comparable success rate has been reported in earlier studies. [17],[18],[19]

Commotio-retinae (CR) or Berlin's edema is a post-traumatic retinal condition that become sapparenteven after mild blunt trauma. There occurs a disruption at the level of outer and inner photoreceptor layers and retinal pigment epithelial layer which is characterized by whitish grey retinal appearance in optical coherence tomography (OCT), observed several hours after blunt trauma. [20] Rare instances of sub-clinical variant of CR have been reported where retina looks normal, therefore posing a diagnostic challenge. Andrew et al. in this issue published a case report where infrared protocol of OCT was used and it demonstrated infrared hypo-reflectance.

The previous issue of IJO was the last one to be personalized for all our members. But let me assure you that I am always available personally for any of your queries/suggestions.

Happy reading...

 
  References Top

1.
Whiting DR, Guariguata L, Weil C. IDF diabetes atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011;94:311-21.  Back to cited text no. 1
    
2.
American Diabetic Association. Diabetic retinopathy. Diabetes Care 2002;25:590-3.  Back to cited text no. 2
    
3.
Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallereno GD, et al; American Diabetes Association. Retinopathy in diabetes. Diabetes Care 2004;27:S84-7.  Back to cited text no. 3
    
4.
Fong DS, Ferris FL 3 rd , Davis MD, Chew EY. Causes of severe visual loss in the early treatment diabetic retinopathy study. ETDRS Report No. 24. Early Treatment Diabetic Retinopathy Study Research Group. Am J Ophthalmol 1999;127:137-41.  Back to cited text no. 4
    
5.
Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520-6.  Back to cited text no. 5
    
6.
Schoenfeld ER, Greene JM, Wu SY, Leske MC. Patterns of adherence to diabetes vision care guidelines: Baseline findings from the Diabetic Retinopathy Awareness Program. Ophthalmology 2001;108:563-71.  Back to cited text no. 6
    
7.
Ward MM, Yankey JW, Vaughn TE, Boots Miller BJ, Flach SD, Welke KF, et al. Physician process and patient outcome measures for diabetes care: Relationships to organizational characteristics. Med Care 2004;42:840-50.  Back to cited text no. 7
    
8.
Ryder RE, Vora JP, Atiea JA, Owens DR, Hayes TM, Young S. Possible new method to improve detection of diabetic retinopathy: Polaroid non-mydriatic retinal photography. Br Med J (Clin Res Ed) 1985;291:1256-7.  Back to cited text no. 8
[PUBMED]    
9.
Hansen AB, Hartvig NV, Jensen MS, Borch-Johnsen K, Lund-Andersen H, Larsen M. Diabetic retinopathy screening using digital non-mydriatic fundus photography and automated image analysis. Acta Ophthalmol Scand 2004;82:666-72.  Back to cited text no. 9
    
10.
Ahmed J, Ward TP, Bursell SE, Aiello LM, Cavallerano JD, Vigersky RA. The sensitivity and specificity of nonmydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathy. Diabetes Care 2006;29:2205-9.  Back to cited text no. 10
    
11.
Neubauer AS, Kernt M, Haritoglou C, Priglinger SG, Kampik A, Ulbig MW. Nonmydriatic screening for diabetic retinopathy by ultra-widefield scanning laser ophthalmoscopy (Optomap). Graefes Arch Clin Exp Ophthalmol 2008;246:229-35.  Back to cited text no. 11
    
12.
Cavallerano JD, Aiello LP, Cavallerano AA, Katalinic P, Hock K, Kirby R, et al. Nonmydriatic digital imaging alternative for annual retinal examination in persons with previously documented no or mild diabetic retinopathy. Am J Ophthalmol 2005;140:667-73.  Back to cited text no. 12
    
13.
Leese GP, Morris AD, Swaminathan K, Petrie JR, Sinharay R, Ellingford A, et al. Implementation of national diabetes retinal screening programme is associated with a lower proportion of patients referred to ophthalmology. Diabet Med 2005;22:1112-5.  Back to cited text no. 13
    
14.
Nemet AY, Ferencz JR, Segal O, Meshi A. Orbital cellulitis following silicone-sponge scleral buckles. Clin Ophthalmol 2013;7:2147-52.  Back to cited text no. 14
    
15.
Ma J, Lin J, Yao K. A new sclera locator for marking the retinal tears on the sclera during scleral buckling. Retina. 2013;33:1086-7.  Back to cited text no. 15
    
16.
Nam KY, Kim WJ, Jo YJ, Kim JY. Scleral buckling technique using a 25-gauge chandelier endoilluminator. Retina 2013;33:880-2.  Back to cited text no. 16
    
17.
Venkatesh P, Arora T, Garg S. Endoilluminatin assisted sclera buckling: The future approach to retinal detachment surgery. Del J Ophthalmol 2011;22:115-7.  Back to cited text no. 17
    
18.
Tayyab H, Haider MA, Jahangir S, Qureshi BZ. Endoillumination and non contact wide angle viewing system. Pak J Ophthalmol 2014;30:103-7.  Back to cited text no. 18
    
19.
Venkatesh P, Garg S. Endoillumination-assisted scleral buckling: A new approach to retinal detachment repair. Retin Physician 2012;9:34-7.  Back to cited text no. 19
    
20.
Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH, et al. Scleral buckling versus primary vitrectomy inrhegmatogenous retinal detachment: A prospective randomized multicenter clinical study. Ophthalmology 2007;114:2142-54.  Back to cited text no. 20
    




 

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