It appears that the left eye has already had Panretinal Photocoagulation (PRP). I don't see that it has had grid laser, either eye. I would probably recommend grid laser and possibly PRP for the right eye. And possibly grid laser for the left eye. Grid laser is done near the macula outside of the foveal avascular zone with much lower energy and spot size...goal is to seal off the leaky blood vessels. Whereas the goal for PRP is larger energy and spot size its job is to "kill" off the irregular cells "telling" the blood vessels to make more, irregular blood vessels (neovascularization).
Timothy McGarity, M.D.
Hello Doctor Timothy,
Thanks a lot for responding on this. I really appreciate your time and effort for responding.
As far as I am aware these scans are of same right eye.
Here is the whole scenario: these are my dad's scans who is 70 years old. He was being treated in LEFT eye for last six months. He was treated for
2. Retinopathy: They injected avastine followed by 8 sessions of Laser treatment ( I am not sure if it was grid laser)
3. Glaucoma: He was operated for glaucoma also in left eye
Then they started treating RIGHT eye
1. Did Cataract operation
2. In 3 weeks time they took this scan
and they now they say, they need to observe the eye as this may require avastine and/or laser treatment( again I don't know if this is grid laser)
I got confused at this stage, so I posted the scan on internet.
I'm not sure how did you comment about the left eye ( as I think these are right eye scans)
Docs have asked us to wait for some more time and observe the eye.
Do you think it will heal on its own or we will have to treat it further
Diabetic Retinopathy can heal on its own at an early stage,ie,if only microaneurysms or small haemorhages are noted and for that you won't need laser treatment however he has to take his meds on time and try to control what he eats and also encourage him to do physical activities,by that way if he goes again for his eye check up and a photo is taken you will be able to note the difference.
There is one image for the left eye, the first of the coloured images. If you look on the left hand side you will see what looks like half a white semi circle right at the edge. This is the optic disc and its position tells us its the left eye. If you notice on the other images its on the right hand side, therfore right eye.
The left eye has recieved PRP lazer as you can just see the small whitish circular laser pigment changes/scars on the peripheral of the images.There are still signs of retinopathy in this eye, but your consultant may be treating these as stable treated retinopathy.
Looking at the images of the right eye, there does not appear to be any laser treatment on the images youve given. There are signs of retinopathy present such as deep retinal haemorrhages.The thing that concerns me more with this eye is there are signs of diabetic maculopathy present. If you look towards the centre of the image you will see what looks like yellow streaks tracking towards the centre.
This central part of the eye (located between the upper and lower blood vessels - or arcades) is the part of the retina we call the macula. this is very important part that deals with detailed vision. Right at the centre of this macula area is a part we call the fovea that contains a very high concentration of these cells.
In maculopathy the blood vessels can start to leak fluids and fats into the macula. Fats that leak into here are called exudates. They appear as bright yellow specks on your images and can be found as a single exudate, as a circular shaped group, or in a line that looks like its tracking towards the macula.
If fluid leaks into the retina it can cause excess fluid to gather in this area, this is called oedema. If this happens in the macular it can lead to some loss of vision and can be treated with laser.
Sometimes the blood vessels in the macular can become so constricted that the macular itself can become starved of oxygen and nutrients, causing your sight to get worse. This is called Ischaemic Maculopathy.
The yellow streaks are what we call exudate and if we see these in the macula it is an indication that fluid can be leaking in this area, causing odema (almost like become water logged). We would normally perform an OCT (3D scan of the area) to ***** if the fluid was building up here. Some times these exudates can appear on a 2D image but when we see a 3D scan we can see if the fluid is affecting the retina. In some cases treatment would not be given and the patient very closely monitored first.
Many patients who have sight threatning retinopathy will not have any visual symptoms as they may not have maculopathy present. Maculopathy normally does have some affect on the vision.
Focal Grid Laser - If you have changes in the macular region of your eye, or maculopathy, gentle laser burns are applied to the central part of the retina. These laser burns are either aimed directly at the leaking areas or in a small grid pattern within the macular avoiding the fovea.
Laser treatment for macular changes prevents serious sight loss in 60% to 70% of cases.
Although I can not comment on what treatment would be needed, I hope this may help you to have a bit of a better understanding of the condition. I work as a diabetic retinal screener/grader - so I basically scan and photograph the retina then look at these images for signs of dibetic damage.
The color images include right and left eye. The angiograms are of the right eye. Another cause of vision loss with diabetic retinopathy is macular ischemia from loss of capillary blood flow. It sounds like your doctors are doing the right stuff for you. Stay the course and hopefully your vision will recover. Best wishes,
Timothy D. McGarity, M.D.
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