Retinopathies & the challenges it presents to the Primary Eyecare Optometrist in The Nigerian Setting

Optom
The Retina is the light sensitive portion of the eye located posterior to the cornea. It is an exension of the central nervous system that processes the sense of sight. It consist  lots of motor and sensory neural pathways, pigment proteins, and blood vessels. Anatomically, it sits on the Brush's membrane of the Choroid while been bathed by the vitreous body ventrally!
Diseases of the Retina could involve inflammations (as in uveitis etc) , weakening of blood vessels (as in Retinopathies) or formation of thrombosis (embolus embedded in the weakened retinal blood vessels!) or idiopathic retinal neural fibre cell apoptosis (as in Glaucoma) or degenerations of the rods & cone (as in Retinitis pigmentosa or Albinoic retina).
Retinopathy is a disease of the blood vessels of the retina which subsequently affects the other components of the retina by the formation of aneurysms, formation of retinal & sub-retinal haemorrhages, formation of new retinal vessels (neovascularizations), sipping of lipids or other intra-vascular fluids into the surrounding intra-retinal surroundings (hard exudates), apoptosis of retinal nerve endings (soft or cotton wool exudates) or the the formation of vitreous traction and subsequent retinal detarchment or retinal tear etc. This retinal disease can show symptoms almost immediatly or can take very long periods of time especially if it does not affect the macula.
Retinopathy could either be caused by Diabetes, Hypertension, Syphilis or as a result of premature delivery or due to unknown cause. Its very common in adults from 30 years and above and in preterms. Retinopathies can cause various vision problems ranging from low vision to outright blindness. Macula edema is one of the most important cause of low vision in patients with retinopathy. A detarched retina is one hell of a consequence of Retinopathy.
Retinopathy could be quiet but a comorbid condition of the disease causing condition can exaggerate the symptoms. The management of retinopathy with glasses is greatly affected by the presence of co-morbidity. A proliferative kind of retinopathy gives off a poor prognosis for glasses and other invasive procedures. Referal to a Retinal surgeon will suffice it but meanwhile patients are adviced to go for regular eye checks, they are made to understand the need to clinically reduce the primary disease and do alot of adjustments in their lives like to quit smoking etc.
The prevailing picture puts the Optometrist in a very tight corner when it comes to interventions against Retinopathies.  It should be understood that any patient with Retinopathy who visits an Optometrist with reduced vision, sudden or delayed, expects sight restoration. Eye glass option is often the patient's first instincts, these patients are by now low vision patients. At this point it seems the uninformed Optometrist is merely walking the tight rope. If the Retinopathy is either proliferative or that the patient's macula was involved, the prognosis for glasses will look even more gloomier! It is therefore expected of us (Practicing Optometrists) to understand the pathogenesis of Retinopathy and hence play the card of preventive medicine as early as possible before the ugly sequela of this retinal disease but it should be understood that nothing will equate regular eye checks by risk group. Such persons that are 30 years and above are of high risk, patients suffering from Hypertension, Diabetes or combiniation of the two whose chronic disease conditions are not managed properly increases the chances of Retinopathy, patients with positive family history of Retinopathy are also at higher risk etc.
Finally, I will discuss different types of Retinopathy and how the Optometrist factors in in the different types of this retinal disease in subsequent blogs! Happy new month folks!

Dr Ezebuiroh Okwudiri Victor

N/B: No financial interest is attached to this blog...it's principally & technically free!