Diabetic Retinopathy

retinopathyDiabetes is an emerging global health problem today, with India all set to take on the dubious mantle of “The Diabetic Capital Of The World” due to its huge volume of diabetic patients. Diabetes affects all parts of the body, most importantly the eye. In recent years, the prevalence of diabetic eye disease has been increasing at an alarming rate.  Let us address several questions on this burning health problem to get more awareness.

a.)What is diabetic retinopathy?

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in the middle-aged population. It is the affection of the retina (the light sensitive layer of our eyes) due to diabetes. If untreated, it  can cause severe vision loss or even blindness. It usually affects both eyes.

b.)What are the symptoms and signs of diabetic retinopathy?
Often there are no symptoms in the early stages of the disease, nor is there any pain. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.

Diabetic retinopathy has four stages:

  1. Mild Nonproliferative Diabetic Retinopathy. At this earliest stage, there are small areas of balloon-like swelling in the retina’s tiny blood vessels called microaneurysms.
  2. Moderate Nonproliferative Diabetic Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
  3. Severe Nonproliferative Diabetic Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina of their blood supply.
  4. Proliferative Diabetic Retinopathy. At this advanced stage, signals are sent by the retina for more nourishment, which trigger the growth of abnormal and fragile new blood vessels. These leak blood causing spots or floaters. This is called vitreous hemorrhage (bleeding in the vitreous: the gel-like substance that fills the center of the eye).

At any of the above stages, fluid can leak into the macula, (the central part of the retina responsible for your vision) causing blurring of vision. This condition is called macular edema.

c.) What is the treatment of Diabetic Retinopathy?

If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. This helps in planning treatment.

Laser treatment either in the form of pan retinal photocoagulation (PRP) or focal  is usually the treatment of choice for vision threatening diabetic retinopathy. Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.

Vitrectomy is another surgery commonly needed for diabetic patients who suffer vitreous hemorrhage, in which the vitreoretinal surgeon carefully removes blood and vitreous from the eye, and replaces it with clear salt solution (saline). It is important to always remember that although these treatments have high success rates, they do not cure diabetic retinopathy.

d.)What is the bottom line?

Better control of blood sugar levels, regular retinal evaluations, early detection and timely treatment can prevent vision loss due to Diabetic Retinopathy.

This article is written by Dr.Vasumathy Vedantham MS, DNB,FRCS,  Medical Director & Consultant Vitreoretinal Surgeon at Radhatri Nethralaya.

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