Diabetic Retinopathy .

At a glance: Diabetic Retinopathy

Early Symptoms: None

Later Symptoms: Blurry vision, floating spots in your vision, blindness

Diagnosis: Dilated eye exam

Treatment: Injections, laser treatment, surgery

Three Ways Diabetes CAN AFFECT YOUR VISION

Diabetes is a metabolic disorder in which a chronic rise in blood sugar levels affects the Heart, Nerves & Eyes.

Increased incidence of diabetes has been attributed to changes in lifestyle caused by increased urbanisation, high-calorie diet, decreased physical activity & stress.

Diabetic Eye Disease May Cause :

1) Cataract: Clouding of the eye lens.

2) Glaucoma: Increase in fluid pressure inside the eye leads to optic nerve damage. A person with diabetes is twice as likely to get Glaucoma.

3) Diabetic Retinopathy: Most common diabetic eye problem & leading cause of blindness is caused by changes in blood vessels of the retina.

Diabetic Retinopathy occurs when there is slow gradual damage to the blood vessels of the retina. The weak blood vessels then either start to leak or they eventually get blocked.

Who Are At Risk?

1) Patients with long-standing uncontrolled diabetes.

2) Add on factors like Hypertension, Cholesterol, Anemia & Obesity.

Many research shows that “better control of blood sugar levels slows the onset & progression of diabetic retinopathy. Also well-controlled “Blood pressure & Cholesterol” can reduce the risk of vision loss.

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"Blurred Vision" also known as Diabetic Maculopathy

Blood vessels damaged from diabetic retinopathy can cause vision loss in the following ways.

Blood vessels leak fluid or lipids in the centre of the retina. This leads to retina swelling (macular edema) thereby causing "Blurred Vision", a condition called “diabetic maculopathy”.

"Floaters" or "Complete loss of vision"

Fragile blood vessels may develop on the surface of the retina & ooze blood into the centre of the eye thereby causing "Floaters" of sudden onset or "Complete loss of vision" from excess bleeding (vitreous haemorrhage).

retina detachment

Retina Detachment

In severe /advanced cases, it can also lead to retina detachment due to traction on the retina.

Eye Examination For Diabetic Retinopathy

Since symptoms are usually experienced in late stages, all patients who have diabetes are required to undergo a detailed retinal check-up at the time of diagnosis of diabetes. After that, they are to maintain regular follow-ups as advised by their ophthalmologists. Eye Examination Involves 1) Dilated & Detail retina checkup. 2) Retina Photography (Fundus Photos) 3) Retina Angiography In this test, a special dye (fluorescein) is injected into your arm. Pictures are taken as dye passes through the blood vessels in your retina. This test detects any leakages/ Impaired blood flow in our vessels 4) Macula OCT A retinal scan test which allows detection of swelling in the center of the retina (macula). All the above tests help in diagnosing the stage of diabetic retinopathy & the treatment plans. The above tests may be repeated on a regular basis to know the progression of your diabetic retinopathy.

Treatment The following modalities are usually advised

1) Laser Photocoagulation:

Scatter laser treatment involves placing 1000 to 2000 burns in the area of the retina away from the center (macula) so as to shrink the abnormal blood vessels. Focal laser treatment is used to treat macular edema (swelling) whereby small laser burns are placed in the area of leakages. These burns slow the leakage & reduce the amount of fluid in the center of the retina. Laser treatment can reduce the risk of blindness by 90%. However, laser treatment cannot restore vision that has been already lost. It mainly helps to stabilise the existing vision.

2) Intra viteral injections:

They are an adjunct to the laser. Helps avoid the repeated laser. Injections show a dramatic reduction in macular edema and help resolve the bleeding.

New-generation injections are so effective that sometimes they have come to become the first line of treatment

3) Vitrectomy (Retinal Surgery):

If the bleeding is severe or if there is traction (pull) on the retina, Vitrectomy helps in clearing the blood, stabilizing the retina & reducing the chances of blindness.

Overview & FAQ

Doctor my diabetes is under control now but why is my retinopathy not becoming better?

Diabetes is a chronic disease, the longer you suffer from it (in terms of years) & more the more fluctuations you would have had in sugar level, the more the retinal blood vessels get weak and the damage initiates. If you start to control your sugar level after the damage has already occurred, then it takes time for the weak blood vessels to heal. So you may not see the immediate benefit of sugar control but it will definitely help your blood vessels to heal & prevent progression over time.

How many laser sitings do l require for the treatment of Diabetic Retinopathy?

Depending on your retina condition, your ophthalmologist may suggest 1 to 6 sittings. Even after these sessions, you will need periodic eye evaluations.

How many injections would I require?

Injections have improved the outcome of diabetic retinopathy in a significant way. But the action of injection is short-lived, so repeat injections are required till your retinopathy settles down. Injections also help to reduce the necessity of frequent lasers

Final Words

In today’s era of advancements in retinal treatment, we are able to achieve satisfactory results. It is advisable that the patient complies with the following.

Regular eye checkup is advised.
Good control of diabetes along with control of blood pressure, cholesterol, cardioc& renal diseases.
Maintain a healthy lifestyle with diet and exercise thereby reducing/maintaining one’s weight.