Diabetic Retinopathy

Diabetes is a metabolic disorder in which chronic rise in blood sugar levels affect 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:

Cataract :
Clouding of eye lens.
Glaucoma :
Increase in fluid pressure inside the eye that leads to optic nerve damage. A person with diabetes is twice as likely to get Glaucoma.
Diabetic Retinopathy :
Most common diabetic eye problem & leading cause of blindness caused by changes in blood vessels of retina.
Diabetic Retinopathy occurs when there is a slow gradual damage to blood vessels of retina. The weak blood vessels then either start to leak or they eventually get blocked.

Who Are At Risk?

Patients with long standing uncontrolled diabetes.
Add on factors like Hypertension, Cholesterol, Anemia & Obesity

Many trials done show that "better control of blood sugar levels slow the onset & progression of diabetic retinopathy. Also well controlled "Blood pressure & Cholesterol "can reduce the risk of vision loss.

Symptoms :

No symptoms are experienced in early & intermediate stage. Blood vessels damaged from diabetic retinopathy can cause vision loss in following ways.

Blood vessels leak fluid or lipids in centre of retina. This leads to retina swelling (macular edema) thereby causing "Blurred Vision", a condition called diabetic maculopathy.
Fragile blood vessels may develop on surface of retina & ooze blood into the centre of the eye thereby causing "Floaters" of sudden onset or "Complete loss of vision" from excess bleeding (vitreous hemorrhage).
In severe /advanced cases, it can also lead to retina. detachment due to traction on retina.
Since symptoms are usually experienced in late stages, all patients who have diabetes are required to undergo 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 refina This test detects any leakages / Impaired blood flow in your vessels.

4. Macula OCT : A retinal scan test which allows. detection of swelling in the center of retina (macula)
All the above tests helps in diagnosing the stage of diabetic retinopathy & the treatment plans. The above tests may be repeated on 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 retina away from centre (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 centre of 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 laser Helps avoid repeated laser. Injections show dramatic reduction in macular edema as well as help in resolving the bleedings.
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 a traction (pull) on the retina, Vitrectomy helps in clearing the blood, stabilisir the retina & reducing the chances of blindness.

Please do note that multiple sitting of laser and / or injection may be required in combination / separate, depending upon your disease progression. It is well documented that the above treatment, done on timely basis, can help prevent visual loss.

Some common questions :

1. Doctor my diabetes is under control now but why is my retinopathy not becoming better?
Ans : Diabetes is a chronic disease, the longer you suffer from it (in terms of years) & more the 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 immediate benefit of sugar control but it will definitely help your blood vessels to heal & prevent progression over time.

2. How many laser sittings do I require?
Ans : Depending on your retina condition, your ophthalmologist may suggest 1 to 6 sittings. Even after these sessions, you will need periodic eye evaluations.

3. How many injections would I require ?
Ans : Injection 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 laser.

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.
1. Regular eye checkup as advised.
2. Good control of diabetes along with control of blood pressure, cholesterol, cardiac & renal diseases.
3. Maintain a healthy lifestyle with diet and exercise thereby reducing/maintaining one's weight.

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