Un­der­stand­ing vas­cu­lar dis­eases

The Star Malaysia - Star2 - - HEALTHY EYES -

THERE is a close as­so­ci­a­tion be­tween vas­cu­lar ( blood ves­sels) health and eye health. The retina ( nerve layer of the eye) is de­pen­dent on a con­sis­tent sup­ply of oxy­gen and nu­tri­ents by thou­sands of blood ves­sels.

Cer­tain sys­temic con­di­tions that af­fect the health of blood ves­sels can have sig­nif­i­cant im­pli­ca­tions on the eye and con­se­quently re­sult in vis­ual loss or blind­ness.

Reti­nal vas­cu­lar dis­eases are linked to high blood pres­sure ( hy­per­ten­sion), di­a­betes and artheroscle­ro­sis ( thick­en­ing of the artery walls). The most com­mon of th­ese dis­eases are: Hy­per­ten­sive retinopa­thy Di­a­betic retinopa­thy Reti­nal artery oc­clu­sion Reti­nal vein oc­clu­sion

Hy­per­ten­sion causes reti­nal blood ves­sels to nar­row, har­den and leak over time. Some­times, it can also cause swelling of the op­tic nerve.

Peo­ple with hy­per­ten­sive retinopa­thy may ex­pe­ri­ence vis­ual loss or headaches.

It is im­por­tant to have reg­u­lar eye ex­am­i­na­tions as the eye is of­ten the only place in the body that can show blood ves­sel dam­age from hy­per­ten­sion even at an early stage.

The main aim of treat­ment is to limit or pre­vent dam­age to the retina by op­ti­mis­ing blood pres­sure with the use of med­i­ca­tions or life­style changes.

In Malaysia, it is es­ti­mated that one in five in­di­vid­u­als above the age of 30 may have di­a­betes.

High sugar lev­els in the blood cause dam­age to blood ves­sels and in the eye, re­sult­ing in di­a­betic retinopa­thy.

Vis­ual loss from di­a­betic retinopa­thy can oc­cur grad­u­ally ( as leak­age of blood and fluid causes reti­nal swelling) or sud­denly when a blood ves­sel bursts and blood fills the cav­ity of the eye ( vit­re­ous haem­or­rhage).

Treat­ment of di­a­betic retinopa­thy starts with op­ti­mal man­age­ment of all risk fac­tors, in­clud­ing sugar lev­els, blood pres­sure and choles­terol lev­els.

Laser treat­ment is of­ten re­quired to pre­vent fur­ther bleed­ing. In the past decade, anti- VEGFs ( anti vas­cu­lar en­dothe­lial growth fac­tor) med­i­ca­tions have been in­jected into the eye to re­duce leak­age and swelling.

Surgery is needed in ad­vanced cases. Known as a vit­rec­tomy, it is usu­ally car­ried out by a sub­spe­cial­ist vit­re­o­reti­nal sur­geon.

Artery oc­clu­sions are caused by a clot or plaque ( em­bo­lus), which breaks free from the ma­jor artery in the neck ( carotid) or the valves or cham­bers in the heart.

Cen­tral reti­nal artery oc­clu­sion is a se­ri­ous con­di­tion and can re­sult in pro­found and per­ma­nent vis­ual loss.

Emer­gency treat­ment is re­quired to lower the eye pres­sure. Oc­u­lar mas­sage and prompt treat­ment im­prove the chances of re­cov­ery.

It is im­por­tant to man­age all sys­temic risk fac­tors ( such as hy­per­ten­sion and di­a­betes) and have reg­u­lar eye ex­am­i­na­tions to pick up warn­ing signs.

Vein oc­clu­sions are caused by a lo­calised clot ( throm­bus), which form as a re­sult of the hard­en­ing of the artery ad­ja­cent to the vein.

The reti­nal ar­ter­ies and veins cross over each other and it is at th­ese cross­ings where vein oc­clu­sions can oc­cur.

Vis­ual loss may be par­tial if a branch vein is blocked or se­vere if the cen­tral vein is af­fected.

Treat­ment in­cludes man­age­ment of risk fac­tors, anti- VEGF or steroid eye in­jec­tions, or laser treat­ment in ad­vanced cases.

Glau­coma can be a se­vere com­pli­ca­tion of reti­nal vas­cu­lar dis­eases and prog­no­sis for such eyes are usu­ally poor.

When reti­nal ves­sels get blocked, the lack of oxy­gen sup­ply trig­gers the re­lease of hor­mones that stim­u­late the growth of ab­nor­mal blood ves­sels. This can cause an ob­struc­tion of the out­flow, lead­ing to neo­vas­cu­lar ( or rubeotic) glau­coma.

Treat­ment in­volves ex­ten­sive laser treat­ment and/ or anti- VEGF in­jec­tions and in some cases, drainage surgery is re­quired to con­trol the glau­coma.

Reti­nal vas­cu­lar dis­eases are po­ten­tially blind­ing con­di­tions and of­ten re­lated to other vas­cu­lar prob­lems in the body.

It is vi­tal that if you have hy­per­ten­sion, di­a­betes or heart dis­ease, th­ese con­di­tions are op­ti­mally con­trolled.

For more in­for­ma­tion, con­tact Lee Eye Cen­tre Sdn Bhd.

Go­ing for reg­u­lar eye checks will en­able op­tometrists to iden­tify early signs of op­ti­cal vas­cu­lar dam­age.

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