Discussion on Retinal and Eye Problems by Dr Somdutt Prasad

Category: Others/ Misc

Presentation Description

Noted ophthalmologist and retinal specialist Dr Somdutt Prasad conducted a discussion on various retinal and eye problems. Dr Prasad put up slides on various retinal conditions and discussed general eye problems too. Visit www.somduttprasad.com for more info.


Presentation Transcript

Retina – what are your concerns:

Retina – what are your concerns Somdutt Prasad MS FRCSEd FRCOphth FACS Consultant Ophthalmologist I4vison, 13 A, Jatin Bagchi Road, Kolkata 70029 AMRI Medical Centre, 97 A, Kolkata 700029 Divyadrishti , Howrah Westbank Hospital, Andul Road, Howrah sprasad@rcsed.ac.uk 098 30 50 7754

UK Training:

UK Training Dorchester – Rick Powell – 1994 Swindon – Paul McCormack – 1995 Oxford – 1996 – Paul Rosen & Hung Cheng Wirral – Russell P Phillips -1997-1999 Sheffield – Prof Ian Rennie, John Talbot, James West – 2000-2001


MS Kolkata – 1993 FRCS Edinburgh – 1994 CCST - 2001 FRCOphth (London) – 2006 FACS American College of Surgeons – 2008 AAO Achievement Award 2008 AAO International Education Award 2009 ASCRS Film Festival Award 2010 ASRS Honors Award 2013

The Retinal Surgeon - 1995:

The Retinal Surgeon - 1995 Is your retina detached? Do you have a cataract? No! What are you doing in my clinic?



What do I do?:

What do I do? Medical Retina Vitreo-retinal surgery Cataract surgery Premium IOLs Toric IOLs Multifocal IOLs


Diabetes 1550 BC - Ebers Papyrus of ancient Egypt too great emptying of urine “the river Nile between the thighs” Remedies recommended diet of wheat grains, grapes, honey and berries Papyrus discovered - Luxor 1872 George Maurice Ebers


Diabetes 17.1 crores worldwide India – 2000 – 3.17 crores 36.6 crores in 2030 Maximum increase in India 7.94 crores India 4.23 crores China


Life Expectancy of Function (Years) Behaviour & Environment Good Bad Vital Function % Failure 0 100 100 25 50 75


India One Ophthalmologist / 1 lakh population UK 2.3 Ophthalmologists / 1 lakh population 70% + specialists - Urban 70% + population - Rural

Diabetic Retinopathy - Classification:

Diabetic Retinopathy - Classification Background Proliferative Advanced Diabetic Eye Disease Preproliferative Maculopathy The commonest cause of decreased visual acuity due to diabetic retinopathy is maculopathy


Examination Slit lamp External exam Pressure measurements Fundus examination

Retinal Examination:

11 November 1998 Retinal Examination Direct Ophthalmoscope small field 2 D view Uniocular

Retinal Examination …(2):

Retinal Examination …(2) Slit lamp biomicroscopy Large field 3 D view Binocular

Binocular indirect ophthalmoscope:

Binocular indirect ophthalmoscope

Retinal Examination:

Retinal Examination Fundus photography Large field Can be done by technician

Laser treatment for diabetic retinopathy is effective…….:

Laser treatment for diabetic retinopathy is effective…….

Diabetic maculopathy:

Diabetic maculopathy

Diabetic maculopathy:

Diabetic maculopathy 12% of treated eyes developed moderate visual loss in spite of treatment Less than 3% of treated eyes improved VA significantly (15 ETDRS letters)

Intra vitreal triamcinolone:

Intra vitreal triamcinolone IVTA

Personal experience…10+ years:

Personal experience…10+ years Pre 6/60 Post 6/9 5 days

Case …2:

Case …2 Pre RE 6/36 Pre LE 6/60 Post RE 6/9 Post LE 6/12


Steroids Triamcinolone Pseudophakic eyes Resistant cases Dexamethasone Ozurdex Fluocinolone Acetonide Iluvien , Retisert


Sustained Delivery Fluocinolone Acetonide Vitreous Inserts Provide Benefit for at Least 3 Years in Patients with Diabetic Macular Edema  Peter A. Campochiaro , MD, David M. Brown, MD, Andrew Pearson, MD, Sanford Chen, MD, David Boyer, MD, Jose Ruiz-Moreno, MD, Bruce Garretson, MD, Amod Gupta, MD, Seenu M. Hariprasad , MD, Clare Bailey, MD, Elias Reichel , MD, Gisele Soubrane , MD, Barry Kapik , MS, Kathleen Billman , BS, Frances E. Kane, PhD, Kenneth Green, PhD   Ophthalmology   Volume 119, Issue 10, Pages 2125-2132 (October 2012 ) Copyright © 2012 American Academy of Ophthalmology Terms and Conditions


Figure 5 Ophthalmology  2012 119, 2125-2132DOI: (10.1016/j.ophtha.2012.04.030) Copyright © 2012 American Academy of Ophthalmology Terms and Conditions


Ranibizumab 9 RCTS in DME READ-2 REVEAL RESOLVE RESTORE RISE & RIDE DRCRN trial 2 years ≥10 letters gain in BCVA No difference between Ranibizumab + prompt laser (deferred laser worse) Laser alone


Bevacizumab 8 RCTS in DME BOLT Avastin vs Laser N=80, two years iVB +8.6 letters Laser -0.5 letters

Key points:

Key points Laser therapy = standard of care non- center -involving oedema DME without decreased VA anti-VEGF treatment standard in center -involving DME and VA of 6/9 or worse Ranibizumab injections monthly for 3 visits, then as needed depending on VA (with or without OCT) stability


somduttprasad@gmail.com 09830507754

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