Diabetic Retinopathy Demystified: Insights from Dr. Ashish Markan
Welcome to Docscopy section, Priya Bairagi and Himani of MedBound Times had an opportunity to have an exciting conversation with Dr. Ashish Markan
Dr. Ashish Markan completed MBBS from Government Medical College, Patiala, India in 2013, MD(Opthalmology) from AIIMS, Delhi, India in 2017, MCh Vitreoretina from PGIMER Chandigarh, India in 2022 and also FRCS from Glasgow, Scotland in 2022. Currently he is working in iseven hospital, Delhi, India.
Hello sir and welcome to this DocScopy session with MedBound Times. Please tell us something about your professional life.
Dr. Ashish Markan: I am Dr. Ashish Markan, a consultant and vitreoretinal specialist. I currently work at iseven Hospital, which is part of a chain of eye hospitals located in New Delhi. The iseven chain comprises a total of six hospitals across Delhi. My role involves providing consultation services and performing surgeries. My specialization lies in the field of retina and uveitis.
My journey to this point has taken around 13 to 14 years of dedication. I embarked on my MBBS journey in 2008 when I joined Government Medical College (GMC). I successfully completed my MBBS in 2012 and concluded my internship in 2013. Following that, I gained admission to the MD Ophthalmology program at the prestigious All India Institute of Medical Sciences (AIIMS), New Delhi. My post-graduation was completed at AIIMS, and subsequently, I underwent senior residency training in Vitreo-Retina and Uveitis for a duration of two years.
To further specialize in my field, I pursued an MCh (Master of Chirurgical) degree from the renowned Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. PGIMER is the sole institute in India offering MCh degrees in both Vitreo-Retina and Cornea specializations. I was fortunate to secure a spot in the competitive entrance exam for the program. Over three years, I underwent specialized training in Vitreo-Retina at PGIMER, Chandigarh.
Following my time in Chandigarh, I spent seven to eight months working at the Delhi Ophthalmology Institute. More recently, around seven to eight months ago, I joined iseven hospitals, where I continue to contribute to the field of ophthalmology through my expertise and passion.
What motivates you to pursue ophthalmology?
Dr. Ashish Markan: To be frank, ophthalmology wasn't my initial choice. When you're an MBBS student, you tend to observe your interns and postgraduates, observing how the hospital functions and how your senior's work. During those years, most of us aspired to pursue orthopedics. Orthopedics was the dream field for all my friends and me. Although I did have the opportunity to get into orthopedics, it wasn't at the AIIMS.
However, the allure of the AIIMS made me rethink my choice. I realized that I could still opt for ophthalmology. While orthopedics was the popular choice, I held onto my desire to specialize in a surgical branch. Ophthalmology offered a unique blend of both surgical and medical specialties. It provided a chance to engage in diagnostics and perform intricate microsurgeries.
In hindsight, I'm grateful for this decision. At present, I'm focused on vitreous surgeries, a niche field within ophthalmology. Vitreous surgeons are relatively scarce in India, and the procedures require a high level of skill. Looking back, I'm content with choosing ophthalmology over orthopedics. The path I've taken has led me to a specialized and fulfilling area of practice.
What are the specific guidelines for diabetic patients in terms of retinal evaluation and follow-up, particularly for type one and type two diabetics, and why is early detection of diabetic retinopathy important?
Dr. Ashish Markan: It is a retinal disease that occurs due to diabetes. everyone should understand that India is currently considered the diabetic capital of the world, with approximately 77 million people in the country suffering from diabetes. Among these patients, around 21% experience diabetic retinopathy. This condition is vision-threatening and progresses through different stages.
Vision compromise typically begins at stage three or stage four of diabetic retinopathy, which is known as a severe or proliferative stage. At this point, the vision can become irreversible. Person who is diabetic and their family members should be aware of this disease, which can impact their eyes. Diabetic retinopathy is often overlooked compared to other diabetes-related complications like diabetic nephropathy (affecting the kidneys) or diabetic neuropathy (affecting nerves).
Unfortunately, many people only become aware of diabetic retinopathy when they are diagnosed or experience a sudden drop in vision. By this time, it's often late to significantly improve their vision. A significant challenge with diabetic retinopathy is that we have two eyes. If the disease affects one eye, the patient may not notice vision loss because they can rely on the other eye.
We follow specific guidelines for different types of diabetic patients. Type one diabetics, who require insulin and are usually younger, should undergo a fundus evaluation (retina check) five years after their diabetes diagnosis. On the other hand, type two diabetics, who are non-insulin dependent and are usually older, should have a retina evaluation immediately and then annually.
We emphasize to all patients, including those coming for screening, that even if their retina appears fine today with no signs of diabetic retinopathy, they should return for an evaluation after a year. This early detection allows us to provide preventive measures and tailored treatment to prevent irreversible vision loss.
What are the common symptoms and early signs that we can diagnose it is a diabetic retinopathy.
Dr. Ashish Markan: The primary cause of vision loss in diabetic retinopathy is swelling in the retina, which is known as diabetic macular edema. Patients with diabetic macular edema can present with three to four types of symptoms. The first is blurred vision, followed by loss of vision and a condition called metamorphopsia.
Metamorphopsia refers to distorted vision. For example, when looking at a line, it might appear curved or wavy. Additionally, patients may experience floaters and dark spots, also known as scotomas, in their vision. These signs can be early indicators of diabetic macular edema. If a patient experiences sudden loss of vision, this may be due to vitreous hemorrhage, means there's bleeding inside the eye.
In this, the eye contains blood, which affects the retina and leads to a sudden drop in vision. The early signs to watch out for include visual disturbances, metamorphosis, or distortion in vision. Patients may struggle to focus or read, as the letters might appear smaller or distorted. Recognizing these early signs is crucial, and individuals experiencing them should promptly seek a retina examination.
Are there any specific tests and screenings for diabetic retinopathy?
Dr. Ashish Markan: The aspect of screening is of utmost importance. Currently, the Government of India, along with various guidelines, has taken steps to address the issue that retina specialists may not be accessible in every center, especially in peripheral locations such as PHCs (Primary Health Centers) and CHCs (Community Health Centers). These centers lack dedicated retina specialists or eye doctors.
In response, the government has provided non-mydriatic fundus cameras. These cameras can be operated by ophthalmic assistants or optometrists. This is a significant development. Patients should take advantage of this initiative by visiting nearby centers and identifying where screening camps are being held.
Many hospitals are organizing diabetic screening camps. During these camps, they capture photographs of the retina and assess for any signs of disease. If any issues are detected, they can refer the patient to a retina specialist for further evaluation and care. This approach helps in reaching more people and detecting potential retinal problems early.
Stay tuned for the second part of this interview!