Medical retina specialists: Medical retina meeting
Medical retina is a subspecialty of ophthalmology, which deals with the retina in a medical and not in a surgical way. The conditions treated by medical retina specialists include previously undiagnosed or established diabetic retinopathy and inherited retinal diseases such as Best disease, Retinitis Pigmentosa, Stargardt’s Disease, acute retinal necrosis resistant to Acyclovir, Age related Macular Degeneration, retinal vein or artery occlusion, Macular Oedema, and the management of complications such as subretinal haemorrhage.
A recent meeting of The Medical Retina Group (24th annual meeting) was held in Oxford on 2nd July, at which they had several talks by leading medical retina specialists in age related macular degeneration and on optical coherence tomography (OCT) and the occasional advantages of optical coherence tomography angiography OCT-A in certain cases of Age-related Macular Degeneration.
Modern technology can be used in assessing these challenging cases, especially those who have multiple comorbidities such as diabetes, hypertension, cataract, glaucoma, and where standard investigations such as a simple OCT with separate fluorescein angiography can be equivocal in decision making for treatment with anti-VEGF intraocular injections.
They also discussed hydroxychloroquine screening guidelines, because hydroxychloroquine use is increasing. The Royal College of Ophthalmologist this year of 2017 has brought out guidelines about when patients should be screened for hydroxychloroquine retinopathy.
The medical retina specialists have realised that hydroxychloroquine retinopathy is much more common than previously reported. The prevalence is around 7.5% and depends on the dose and duration of therapy, and affects vision eventually. This prevalence can increase to 20-50% after 20 years of therapy. The risk also increases with patients who are taking more than 5 mg/kg of hydroxychloroquine per day. The hydroxychloroquine retinopathy is seen as damage to the receptors and degeneration of the retinal pigment epithelium RPE, giving a typical bull’s eye maculopathy with a central visual loss. The retinopathy risk is also increased if the patient is also on Tamoxifen, for instance for breast cancer, and in those with renal impairment.
Professor Michel Michaelides and Mr Jaheed Khan actively screen patients for hydroxychloroquine retinopathy as part of their role as a Medical Retinal Specialists. They also look after patients with diabetic retinopathy and age related macular degeneration. Professor Michel Michaelides has conducted research into both diabetic retinopathy and hydroxychloroquine retinopathy.