Discussion on Retinal and Eye Problems by Dr Somdutt Prasad

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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.

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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

Slide3:

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?

DIABETIC VITRECTOMY :

DIABETIC VITRECTOMY

What do I do?:

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

Diabetes:

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:

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

Slide14:

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

India:

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:

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:

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

Slide40:

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

Slide41:

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

Ranibizumab:

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:

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

Slide46:

somduttprasad@gmail.com 09830507754

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