Confronted with eye stroke and sudden abnormally low vision in left eye, a 62-year-old-woman was at the verge of losing her eye sight , when she was saved from the tragedy through correct and timely action. Helen Dorothy Briston, a South African expat, was already wearing glasses for myopia, suffering from glaucoma and using drops in both eyes to alleviate the condition when things took a turn for the worse three years ago.She began complaining of sudden loss of vision in her left eye, which brought her to RAK Hospital.
On examination, doctors at RAK Hospital found haemorrhage in all quadrants of the retina due to obstruction of blood supply to the eye leading to vision loss. The doctors diagnosed the case as Central Retinal Vein Occlusion (CRVO) – or eye stroke -- in which the retina's main vein gets blocked. Moreover, there was a massive swelling on the retina, so much so that the central part of the macula showed a swelling of 464 microns – when the normal reading is around 250 microns.
Doctors believe that if proper action is not taken at the right time, the swelling can increase progressively and potentially lead to permanent loss of vision. Worse still, at times it can increase the eye pressure to dangerous levels which may be difficult to treat. The condition is known as Neo-vascular glaucoma.
“Since eye stroke is painless and often asymptomatic, the first clue that something is wrong could be pain or pressure in the affected eye, but more often than not, it manifests with a sudden vision loss,” explained Dr Mohit Jain, Specialist ophthalmologist at RAK Hospital who handled the case, “Fortunately in the case of Helen,she opted for timely medical help which eased her condition. It’s important to remember that gaining such a good vision is only possible if the patient takes timely, regular and long-term treatment’’.
The patient underwent a long term treatment spanning over three years to finally maintain a good vision of 0.6. Moreover, and her retinal thickness reduced to 224 micron, well within the normal limit with no sign of swelling in the eye. She was treated with anti-vascular endothelial growth factor therapy and Dexamethasone intravitreal implant. Anti-vascular endothelial growth factor (Anti-VEGF) are humanized antibodies laboratory produced engineered small and precise molecules which work on the newly growing blood vessels or blood vessels which are leaky because of the swelling inside the eye. The injection is given by a fine needle inserting the molecule directly inside the eye.
“We gave few injections on monthly basis and did the retinal laser in 3 sittings in a gap of one week. After a few months of the treatment she improved significantly. However, since this disease is known to cause recurrent retinal swelling on long term, eye injections were repeated as and when required. Now patient is stable and maintaining good vision without injections for several months”, Dr Mohit Jain further explained.
“While it is difficult to identify the reasons behind eye stroke, the condition is often linked to high blood pressure and diabetes which can increase the risk. Surprisingly, despite the fact that this is not an unusual occurrence, there’s a low level of awareness regarding the disease and its treatment,” added Dr Mohit.
RAK Hospital has always been at the forefront to raise awareness for timely treatment and preventive measure. Its ongoing initiative to prevent eye diseases and blindness among the residents of Ras Al Khaimah, “Nazar Ayeni” (“My Eyesight”) focuses on the prevention of Preventable Blindness and Visual Impairment. The program is in line with WHO Global Initiative to Eliminate Avoidable Blindness, "VISION 2020: The Right to Sight", which aims to eliminate causes of blindness and vision disorders as a public health problem by the year 2020.