Diagnosis

There are several diagnostic tools available to detect Retinal disorders.

Eye conditions like DME and AMD should be diagnosed in the early stages and the diagnosis should be followed up with treatment as soon as possible.9,10 Check with your eye specialist for early signs.

Before diagnosis, it is important to consider the history of the patient. In terms of medications, one should check for the use of insulin, oral hypoglycemics/anti-diabetics, antihypertensives, and lipid-lowering drugs in the past. Systemic history - past glycaemic control (Haemoglobin A1c), renal disease, cardiovascular events, hypertension, lipid levels, pregnancy – should be considered.

Here are a few diagnostic tools to help you detect these retinal disorders:

 

Amsler Grid20

  • A square of straight vertical and horizontal lines that resembles a checkerboard
  • Tests the clarity of central vision
  • Changes in central vision cause the lines in the grid to disappear or appear wavy
  • Doctor may also ask to check vision daily at home and report any changes immediately
  • The test is carried out by checking one eye at a time to ensure that the unaffected eye doesn’t compensate for the vision loss of the affected eye

Visual Acuity Test18,19,24

 

  • Visual Acuity commonly refers to clarity of vision
  • Visual Acuity is measured according to the size of letters viewed on a Snellen/ETDRS chart
  • A reference value above which visual acuity is considered normal is called 6/6 or 20/20 vision
 

Dilated Eye Exam18,19,24

  • Doctors put drops in the eyes to widen or dilate the pupils
  • Provides a better view of the back of the eye
  • Using a special magnifying lens, retina and optic nerve are examined

Fluorescein Angiography (FA)18,19,23

 

  • Gold standard to differentiate between wet AMD and dry AMD
  • Injecting dye through patient’s peripheral veins (arm or hand)
  • A series of photographs are taken after the injection
  • Helps to identify areas of leakage
 

Optical Coherence Tomography (OCT)18,24

  • Newer, non-invasive technique similar to ultrasound; however instead of sound waves, light rays are used
  • Provides a detailed, highly magnified, cross-section view of a patient’s macula
  • Eyes are dilated, patient is asked to place their head on a chin rest and images are obtained
  • Light beam is painless

References:

1. Ciulla TA, et al. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003;26:2653-2664.

2. National Eye Institute. Facts About Diabetic Eye Diseases. Available at: http://www.nei.nih-gov/health/diabetic/retinopathy.asp; Accessed on Mar 30, 2016.

3. Fareed A. A review of diabetic macular edema. Digital Journal of Ophthalmology. 1997;3[6].

4. Watkins PJ. Retinopathy. BMJ. 2003;326:924-926.

5. American Diabetes Association. Living with diabetes. 2011. Available at: http://www.diabetes.org/living-with-diabetes/cornplications/eye-complications/; Accessed on Mar 30, 2016.

6. Canadian Diabetes Association. Diabetes and you: vision health. 2011. Available at: http://www.diabetes.ca/diabetesandyou/living/complications/vision-health/; Accessed on Mar 30, 2016.

7. Royal College of Ophthalmology. Diabetic Retinopathy Guidelines. 2012. Available at: http://www.rcophth.ac.uk/wp-content/uploads/2014/12/2013-SCI-301-FINAL-DR-GUIDELINES-DEC-2012-updated-July-2013.pdf; Accessed on Mar 30, 2016.

8. Varma R, et al. Visual Impairment and Blindness Avoided with Ranibizumab in Hispanic and Non-Hispanic Whites with Diabetic Macular Edema in the United States. Ophthalmology. 2015;122(5):982-989.

9. Revisiting DME. Available at http://www.retinalphysician.com/printarticle.aspx?articlelD=106441; Accessed on Mar 30, 2016.

10. Eyre H and Kahn R. Preventing cancer, cardiovascular disease, and diabetes. Diabetes Care. 2004;27:1812-1824.

11. National Diabetes Information Clearinghouse. Prevent diabetes problems: Keep your diabetes under control. 2008; NIH Publication No. 08-4349.

12. Mayo Clinic Staff. Lifestyle and home remedies. Available at: http://www.mayoclinic.org/diseases-conditions/wetmacular-degeneration/basics/lifestyle-home-remedies/con-20043518; Accessed on Mar 30. 2016.

13. WHO. Fact sheet 312: Diabetes. 2011. Available at: http://www.who.int/mediacentre/factsheets/fs312/en; Accessed on Mar 30, 2016.

14. The Amsler Grid. Available at http/www.amd.org/the-amsler-grid/; Accessed on Oct 05, 2017.

15. Crossland M, Rubin G; The Amsler chart: absence of evidence is not evidence of absence. Br J Ophthalmol.2007;91:391-393.

16. LUCENTIS® Summary of Product Characteristics. Novartis AG; Sept. 2015.

17. Hariprasad SM, et al. Vision-related quality of life in patients with diabetic macular edema. Br J Ophthalmol. 2008;92:89-92.

18. Facts About Age-Related Macular Degeneration. Available[online] at URL: https://nei.nih.gov/health/maculardegen/armd_facts. As accessed on June 19, 2018.

19. Macular Degeneration. Available [online] at URL: http://www.northtexasretina.com/macular-degeneration.html. As accessed on June 19, 2018.

20. Age related macular degeneration. Available [online] at URL: http://rgw.com/patient-education/eye-diseases/age-related-macular-degeneration. As accessed on June 19, 2018.

21. Macular Degeneration. Available[online] at URL: https://patient.info/health/visual-problems/age-related-macular-degeneration. As accessed on June 19, 2018.

22. Age-Related Macular Degeneration Treatment. Available [online] at URL: https://www.webmd.com/eye-health/macular-degeneration/age-related-macular-degeneration-treatment#1. As accessed on June 22, 2018.

23. Diabetic Macular Edema. Available[online] at URL: https://www.webmd.com/diabetes/diabetic-macular-edema#1. As accessed on June 19, 2018

24. Raman R and Bhende M. Sci J Med & Vis Res Foun June 2015 | volume XXXIII | number 2.

25. Diabetic Macular Edema. Available [online] at URL: http://eyewiki.aao.org/Diabetic_Macular_Edema. As accessed on June 22, 2018.

26. Anti-VEGF treatment. Available [online] at URL: https://www.rnib.org.uk/eye-health-eye-conditions-z-eye-conditions/anti-vegf-treatment. As accessed on August 9, 2018.

27. DME. Available[online] at URL: https://www.preventblindness.org/diabetic-macular-edema-dme. As accessed on June 22, 2018.