✅ Medically reviewed by Dr Sharon Heng
Vision is essential to living a full and active life. Whether you're driving, reading, or simply going about daily tasks, good eyesight is key to your independence and quality of life. Regular eye checks are crucial, especially for those with conditions like diabetes, which requires yearly check-ups to prevent complications like diabetic retinopathy.
What is the Retina?
The retina is the important layer of cells that is responsible for our vision. There are many neural layers within the retina , each with its function to transmit signals within the different layers. For example, the photoreceptor cells (cones and rods) react to light entering the eye, releasing chemicals, which triggers a nerve impulse that is sent to the cerebral cortex via the eye or optic nerve. These electric signals are then interpreted by the brain as images that we see.
Why are Retina Checks Important?
There are numerous benefits to routine retina screening or assessments. Particularly in elderly patients and patients with comorbidities such as diabetes, hypertension, and hypercholesterolemia or patients on certain medications for diseases and certain types of cancer as some medications may cause ocular toxicity.
Early Detection of Eye Diseases
Routine retina checks play a critical role in identifying serious retina conditions before they progress. For example, diabetic retinopathy often develops silently, with no symptoms until the late or proliferative stages or center involving macular oedema.
Regular retina checks ensure that any early signs of eye diseases are caught early, allowing for timely intervention and treatment. This proactive approach can significantly reduce the risk of severe vision loss and maintain long-term eye health.
Vision Preservation
By regularly monitoring your eye health, retina checks can help preserve your vision. Conditions such as cataracts and macular degeneration can deteriorate vision if left untreated.
Through routine exams, eye care professionals can recommend appropriate treatments, such as glasses, medications, or surgical options, to maintain optimal vision. Early intervention can prevent the progression of these conditions, allowing individuals to enjoy their daily activities without impairment.
Comprehensive Health Insights
Retina checks do more than assess vision; they also provide valuable insights into overall health. Certain systemic conditions, such as diabetes, hypertension, and high cholesterol, can manifest in the eyes.
By detecting changes in the retina or blood vessels, we can identify these underlying health issues, prompting further medical evaluation and treatment. This interconnectedness highlights the importance of eye screenings in maintaining overall health.
Enhanced Quality of Life
Good vision is integral to a high quality of life. Regular eye checks help ensure that you can see clearly, engage in daily activities, and maintain your independence. Whether enjoying hobbies, spending time with loved ones, or simply navigating your environment, maintaining optimal vision contributes to your overall well-being. By prioritizing routine eye care, you invest in a better quality of life.
Family History Monitoring
If you have a family history of eye conditions such as macular degeneration, or retinal diseases, routine retina checks become even more critical. Family history is a significant risk factor for many eye diseases. For example, studies have found several genes implicated in age related macular degeneration such as complement factor H and ARMS 2.
Regular visits to an eye care professional allow for tailored monitoring and preventive measures based on your specific risks. This personalized approach ensures that you receive the appropriate level of care and attention for your eye health needs.
Systemic Conditions with Retina Pathologies (This is Not an Exhaustive List)
The eye is a window to predict, monitor and determine systemic diseases. Patients with medical conditions such as diabetes, hypertension or hypercholesterolemia may have retina haemorrhages, exudatives (cholesterol deposits) or retina vasculature changes that may manifest in the retina.
Research has also found that examination of different layers of the retina or its vasculature may predict risks of eye and systemic conditions or neurological conditions including dementia, stroke and multiple sclerosis.
Severity of retina haemorrhages, new vessels, oedema may also indicate severity of cardiometabolic control of an individual.
Medication with Ophthalmic Side Effects (This is Not an Exhaustive List)
Some drugs are known to cause ocular toxicities, some reversible and some irreversible, resulting in visual impairment. This is very rare. Some examples of drug induced retinotoxicity include the following:
Hydroxychloroquine Retinotoxicity
Hydroxychloroquine is a major drug used for treatment and prevention of malaria. It is also used in several autoimmune diseases: rheumatoid arthritis, lupus, and porphyria cutanea tarda, Srojen syndrome.
Is Hydroxychloroquine Use Harmful to the Eye?
Recent epidemiological data indicate that the prevalence of toxicity amongst long-term ( 5 years) hydroxychloroquine users is approximately 7.5%. This risk increases to 20- 50% after 20 years, depending on individual risk factors.
What are Known Risk Factors for Hydroxychloroquine Retinotoxicity?
Factors associated with higher risks for toxicity including the following:
Patients on chloroquine or high dose hydroxychloroquine (>5mg/kg/day)
Patients with renal disease and impaired renal function (estimated glomerular filtration rate of less than 60ml/min/1.73m2)
Patients on Tamoxifen treatment
Patients who are on hydroxychloroquine should have annual monitoring once they have had the treatment for 5 years or if they have the above risk factors, then they should start annual monitoring.
Tamoxifen Retinotoxicity
Tamoxifen is a selective estrogen receptor modulator used as a treatment for breast cancer. Studies have found that retinopathy may occur in 12% of patients who consume 20mg Tamoxifen over 2 years. Half of these are visually symptomatic. Clinically, retinal changes consist primarily of crystalline deposits, cystoid macular edema, or hyper-reflective deposits in the macular.
Once visual symptoms occur, discontinuing treatment may no longer improve vision. Patients on Tamoxifen who have had the treatment in excess of 2 years may benefit from 6 monthly reviews to screen and monitor for retinal changes so early subclinical changes may be detected and their physicians may then adjust their cancer treatment accordingly before permanent visual impairment.
How is Retina Assessment Conducted?
Retina assessments may be conducted differently in different settings. With her experience within the National Health Service in developing protocols for various retina pathways, Ms Heng conducts comprehensive assessments and imaging pathways to ensure the most detailed and refined retina assessment/screening for her patients.
What to Expect During the Process
Initial Assessment: the process will typically start with an initial assessment, where we will ask about your eye health and medical history. This information helps us understand your specific concerns and needs, allowing for a more tailored examination.
Vision Tests: You will undergo a series of vision tests designed to measure your visual acuity. This may involve reading letters from an eye chart at varying distances. Intraocular Pressure Check: A vital component of the screening is measuring the pressure inside your eyes. This quick and painless test will identify high eye pressure
Slit Lamp Examination: During this examination, your eye care provider will use a specialized microscope (slit lamp) to closely inspect the front structures of your eyes, including the cornea, iris, and lens. This detailed evaluation helps identify abnormalities, infections, or signs of cataracts, ensuring prompt diagnosis and treatment.
Multimodal Retinal Imaging: Advanced imaging techniques, such as Optical Coherence Tomography (OCT), fundus autoflorescence and widefield imaging, may be performed to assess the health of your retina. These tests provide detailed images that help detect early signs of conditions such as macular degeneration and diabetic retinopathy, which may not present symptoms until significant damage has occurred.
Results Consultation: After completing the tests, you will have a consultation with Ms Heng who is a retina specialist to discuss the results. This conversation is essential as it allows you to receive timely feedback on your eye health, ask any questions, and understand the next steps for maintaining or improving your vision.
How Often Should I Have My Retina Checked?
If you are fit and well, we would advise an annual check from the age of 60 , if you have comorbidities such as diabetes then we would advise to start screening on diagnosis of systemic disease and then depending on findings, at least on an annual basis.
If you are on treatment such as Hydroxychloroquine, Tamoxifen or Desferoxime, then again retina monitoring on at least an annual basis would be prudent for early or subclinical detection of anomalies with multimodal imaging.
Ms Sharon Heng is a retina specialist and clinical lead of the medical retina digital clinics in Moorfields Eye Hospital. She has developed various pathways for multimodal imaging retina digital clinics to identify, screen and monitor patients with retina pathologies. She believes strongly in preventative medicine and early detection of diseases.
For private consultations, please contact us as follows:
Email: info@retina-eye.co.uk
Telephone: 07886 677351
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