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Diabetic Retinopathy

What is Diabetic Retinopathy ?

An increasing incidence of diabetes mellitus poses a major health problem in India. The contributing factors are:

  • an inappropriate diet, high intake of fat and carbohydrates
  • sedentary lifestyle

Diabetes may affect both the young (type I) and the old (type II). The latter type is far more common. Regardless of the type of diabetes, many diabetic patients develop a complication called diabetic retinopathy, a change in the retinal blood vessels that leads to loss of vision.

How does diabetes affect the eye?

Diabetes causes weakening of the walls of the blood vessels in the body. The tiny, delicate retinal blood vessels are particularly susceptible. This deterioration of retinal blood vessels, accompanied by structural changes in the retina, is termed diabetic retinopathy and leads to loss of vision. Diabetic retinopathy is gradual in onset and is related to the duration of diabetes. High blood glucose levels, high blood pressure and genetics influence the development and progression of diabetic retinopathy

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What are the stages of Diabetic Retinopathy?

    There are two main stages of Diabetic Retinopathy:

    Non-proliferative Diabetic Retinopathy (NPDR): In this stage you may not have much of visual symptoms, but the retinal findings can be noted only by your ophthalmologist after dilated fundus examination. The leaky blood vessels in Diabetic Retinopathy lead to leakage of fluid (retinal edema), leakage of blood (retinal hemorrhages), and small out-pouching of the retinal blood vessels (micro-aneurysms). NPDR is further sub divided into 4 stages depending on the clinical findings.
  • Retinal edema in the central area is called as diabetic macular edema (DME) may occur, thereby reducing vision.
  • These changes in the retinal blood vessels can also lead to their blockage and retinal ischemia, which is also a cause for decreased vision.
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    Proliferative Diabetic Retinopathy (PDR): This is the next stage of Diabetic Retinopathy wherein new, weak blood vessels grow or proliferate at the back of the eye. These weak new blood vessels may bleed into the vitreous cavity and cause severe visual loss.

What are the symptoms of Diabetic Retinopathy?

In the early stages, you may not have any symptoms. However, as the Diabetic Retinopathy progresses, you may perceive the following symptoms:

  • Blurred vision
  • Darkened or distorted images (commonly noticed in DME)
  • Dark / Black spots (floaters) in vision
  • Total loss of vision

What are the risk factors of Diabetic Retinopathy?

Anyone with Type 1 or Type 2 Diabetes is at risk for Diabetic Retinopathy. You are at a higher risk if you have:

Uncontrolled and high blood sugar

Number of years of diabetes

Uncontrolled blood pressure (uncontrolled hypertension)

Increased cholesterol

Kidney disease (Diabetic Nephropathy)

Pregnancy

In some cases, people with good blood sugar, blood pressure, and cholesterol may still develop Diabetic Retinopathy. To be safe, all diabetics should regularly see an eye doctor for screening.

How is Diabetic Retinopathy diagnosed?

Diabetic Retinopathy can take years to cause blindness. In the early stages, it is treatable. If you are a diabetic, visit your eye doctor every year. Early detection is very important and can save your eyesight.

  • Every eye examination the following tests would be adviced by your doctor

Visual aquity testing (distance and near)

Detailed eye examination (slit lamp biomicroscopy)

Dialated fundus examination (ophthalmoscopy / fundoscopy)

  • Depending on your retinal findings, the doctor may advice for some special tests:

Fundus photography

Fundus Flurescein Angiography (FFA)

Optical coherence tomography (OCT)

OCT Angiography (OCT – A)

Your eye doctor would decide on the stage of Diabetic Retuinopathy in your eye, based on these tests. He / She would then plan on further management in the form of observation or treatment. Anjani Eye Hospital, is equipped with top of the class equipment (FFA & OCT-A) from Carl Zeiss, Germany in the diagnosis and treatment of Diabetic Retinopathy.

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What are the treatment options of Diabetic Retinopathy?

Depending on the stage of Diabetic Retinopathy your eye doctor would suggest various treatment options: Observation – If your doctor feels that your Diabetic Retinopathy does not require any treatment as of now, he / she may advise you for periodic followup visits (ranging from 3 monthly to yearly reviews).

Retinal Lasers (laser photocoagulation) – Laser photocoagulation for Diabetic Retinopathy is used to prevemt further loss of vision and not to restore lost vision. It can be used in 2 scenarios for traetment of Diabetic Retinopathy.

  • Diabetic Macular Edema (DME) – Laser is used here to reduce the swelling in the retina by treating the leaky blood vessels (microaneurysms). However, laser is used lesser now a days for this indication with the routine use of intravitreal injections.
  • Proliferative Diabetic Retinopathy (PDR) – Pan Retinal Photocoagulation (PRP) also called as scatter laser treatment is used in PDR to reduce the possibility of retinal ischemia and in turn reduce the formation / regress the new retinal vessels. This laser is done in multiple sittings (commonly 3sittings).
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Intravitreal Injections – In Diabetic Retinopathy these are used to prevemt further loss of vision and not to restore lost vision. The commonly used injections in Diabetic Retinopathy treatment are:

  • Anti Vasculo– Endothelial Growth Factors (Anti-VEGF)– These are used commonly for treatment of DME (may need 5-6 injections), fresh vitreous hemorrhage (bleeding in the eye), or pre-operatively (before vitectomy surgery). The various Anti-VEGF injections available are Lucentis / Accentrix, Eylea, Razumab and Avastin.
  • Steroids – These are used for the treatment of DME. The commonly used intravitreal steroids are Ozurdex (dexamethasone) or Triamcinolone Acetonide (TA).

Vitrectomy Surgery – In some eyes with PDR, laser treatment or intra-vitreal anti-vegf would not be able to restore or save vision. In such eyes the eye doctor would suggest vitrectomy surgery to clear the blood in the eye. He / she would also treat the underlying cause of the bleeding (new vessels) and additionally laser the retina.

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Your doctor may use either one of the above mentioned treatment options or may combine laser with injections for the management of the Diabetic Retinopathy.

Eye examination in diabetic retinopathy: Every diabetic is a potential candidate for diabetic retinopathy. There are no symptoms at the initial stages. Periodic eye examination with dilated pupils is the only way to detect early disease and prevent further deterioration of vision.

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Contact

Address: 20, Farmland, Central Bazar Road, Near Lokmat Square, New Ramdaspeth, Nagpur – 440010, Maharashtra, India. Phone:+91 712 2425 839/2425 869/2425 899 For Appointment:+91 78755 20005 WhatsApp:+91 78755 10002 Email:anjanieyehospital1976@gmail.com Hospital Working Hours: 7:30 AM – 5:30 PM (Monday to Friday) 7:30 AM – 3:30 PM (Saturday) Sunday Closed

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