New Vision: NMMC Opens Retina Center, Welcomes Surgeon
TUPELO, Miss.—North Mississippi Medical Center recently opened the Retina Center and welcomed Khushboo K. Agrawal, M.D., as this region’s first full-time vitreoretinal surgeon.
Dr. Agrawal treats patients with macular degeneration, retinal detachment, vein or arterial occlusions, diabetic retinopathy and several other conditions, including pediatric retinal diseases. She performs injections and laser procedures at the Retina Center, while outpatient surgery is done at NMMC.
A graduate of Saint Andrews Episcopal School in Ridgeland, Dr. Agrawal graduated summa cum laude from Vanderbilt University in 2004. She earned her medical degree from the University of Mississippi in 2009 and completed an internship in internal medicine at Mayo Clinic in Rochester, Minn. She completed her residency in ophthalmology at the University of Chicago in 2013 and a surgical vitreoretinal fellowship at the New York Eye and Ear Infirmary in New York, N.Y. She is board certified in ophthalmology.
It was during her residency training that Dr. Agrawal decided to specialize in retina surgery. “It seemed like an art rather than a science, and that really appealed to me,” she says. “We have so many different tools now to offer hope to someone who might not have had hope 10 years ago.”
When it comes to eye health, the retina is critical. The retina is a thin layer of light-sensitive tissue that lines the back of the eye. Light rays are focused onto the retina, where they are transmitted to the brain and interpreted as the images you see.
The NMMC Retina Center can treat a variety of vision conditions, including:
Age-Related Macular Degeneration
Age-related macular degeneration is a deterioration of the eye’s macula—the center of the retina that is responsible for central vision. Macular degeneration comes in two types: dry and wet.
Most people have the dry form, in which the macula may gradually become thinner and stop working properly. “Lifestyle modifications can help—adding green leafy vegetables to the diet and smoking cessation,” Dr. Agrawal said. “Oral vitamins are also beneficial.” Individuals should carefully monitor their central vision using a chart called an Amsler grid and report any changes right away, as dry macular degeneration can change into the more damaging wet form.
Wet macular degeneration occurs when the macula becomes unhealthy—abnormal blood vessels form and cause bleeding and scar formation. “Intravitreal injections are now the mainstay of treatment,” she says. “In the past surgery and laser treatments were used, but injections have been proven safer and more effective.” Treatment varies by patient, with most requiring injections every four to six weeks on average. “The medicine in the injections helps to stabilize abnormal blood vessel growth and reduce swelling,” she says.
Agrawal treats vision problems related to diabetes, including diabetic retinopathy, the most common cause of vision loss in diabetes, and macular edema, a consequence of retinopathy that can also cause vision loss.
Dr. Agrawal treats macular edema with laser therapy and intravitreal injections, both performed in her office. “Laser therapy creates a small burn or scar that closes off the area of bleeding and controls abnormal blood vessel growth,” she says
Proliferative retinopathy occurs when too many new blood vessels grow in the vitreous gel, the fluid that fills the eye. These new blood vessels are fragile, which makes them more likely to leak and bleed. “These blood vessels can form scar tissue and cause retinal detachment—the pulling away of the retina from underlying tissue,” she says.
In-office laser treatment can decrease the development of these abnormal blood vessels. “Past a point, the patient may require surgery to remove the scar tissue and blood, and to fix the detachment,” she says.
For patients with diabetes, controlling blood sugar is key. “The better someone has their blood sugar under control, the less likely he or she is to need treatment and develop complications of the disease,” she says.
As we age, the vitreous (clear gel in the middle of the eye) may shrink and pull on the retina. When this happens, Dr. Agrawal says the person may notice “flashes” or “floaters,” peripheral vision loss or feel like a curtain is being lowered over the eyes.
Sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through a retinal tear, lifting the retina off the back of the eye and causing a retinal detachment. “Inciting risk factors for a retinal detachment are trauma, being extremely nearsighted and having had previous eye surgery,” she says. “If you don’t get help in a timely manner, then there is a risk for permanent vision loss.”
When the vitreous gel pulls at the center of the macula, it can pull the retina open and create a hole.
“The person may notice central vision loss or distortion, and what we will find on examination is a full thickness hole in the center of the retina,” Dr. Agrawal says. “Surgery is required to fix a macular hole.”
Retinal Vein Occlusions
The retina is nourished by blood flow, which provides nutrients and oxygen that nerve cells need. When there is a blockage in the veins into the retina, retinal vein occlusion may occur. Dr. Agrawal says high blood pressure is the most likely culprit.
This blockage causes the walls of the vein to leak blood and excess fluid into the retina. “When this happens the person may notice very dark spots floating in front of their eyes or a loss of peripheral vision,” she says. Once the cause is identified, treatment may include intravitreal injections and/or laser treatment, both of which can be done in her office.
While all of these eye conditions may cause visual changes, they are painless—which can be both a blessing and a curse. “Because these conditions are painless, people may tend to ignore the symptoms and delay treatment,” Dr. Agrawal says. “It is important to be evaluated by an ophthalmologist or optometrist to determine if the person needs treatment or is at risk.”
The NMMC Retina Center is located at 606 Brunson Drive and open from 8 a.m.-4:30 p.m. Monday-Friday. A referral is required for most appointments. For more information, call 1-800-THE DESK (1-800-843-3375) or visit www.nmhs.net/retina_center.php.
When Your Glasses Quit Working
The Retina Center offers Low Vision Rehabilitation Services for individuals whose vision loss causes problems with daily activities. The center’s highly-trained occupational therapist helps patients make the most of their remaining vision. For more information, call 1-800-THE DESK (1-800-843-3375).