Bapaye Eye Hospital

Diabetic Eye Disease & Diabetic Retinopathy

Diabetes mellitus is a lifestyle disease that is rapidly increasing all over the world. India has the dubious distinction of being the diabetes capital of the world. Diabetes causes damage to all the organs in the body. Eye also gets affected in diabetic patients.

Patients with diabetes get

  1. Frequent change in spectacle power,
  2. Repeated Stye formation on eyelids
  3. More prone to glaucoma
  4. Cataract formation
  5. But the most dangerous damage is diabetic retinopathy

Lets us understand more about diabetic retinopathy

Diabetic retinopathy results from damage to the blood vessels of the retina. Over time, too much sugar in the blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. These new blood vessels do not develop properly and can leak easily.

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There are two main stages of DR:

1. Non-proliferative DR (NPDR): In early stages, patient’s have no symptoms. There is minimal or no vision loss. Leaking blood spots and cholesterol deposits can be on retinal examination.

2. Proliferative DR (PDR): In this advanced stage, new blood vessels grow on the surface of the retina. If not treated in time, they can burst and lead to hemorrhage in vitreous cavity leading to sudden vision loss.

Diabetic retinopathy leads to swelling of the central spot of the retina, known as macular edema. Macular edema results from leakage of fluid and cholesterol crystals from leaky blood vessels at the macula. It leads to severe damage to fine vision required for reading, writing etc.  

Risk factors for diabetic retinopathy include,

  1. Duration of diabetes: Longer the duration of diabetes, higher the chances that patient will develop diabetic retinopathy
  2. Poor blood sugar control: If the blood sugar is not under good control, diabetic retinopathy develops earlier in the disease and tends to be more severe
  3. High blood pressure
  4. High cholesterol
  5. Obesity

Early detection and treatment can significantly improve outcomes. Regular eye exams are crucial for people with diabetes!

Symptoms of diabetic retinopathy

In early stages the majority of patients do not have any symptoms. Patients develop symptoms when disease is significantly advanced. They may iclide

  • – Floaters, spots or dark strings in your vision
  • – Blurred vision
  • – Vision that fluctuates
  • – Dark or empty areas in your vision
  • – Dark, floating spots or streaks that look like cobwebs, which are caused by bleeding blood vessels in the retina
  • – Blurry vision, caused by diabetic macular edema (DME) or DME
  • – Glaucoma, caused by neovascular glaucoma
  • – Retinal detachment

It is important to note that not everyone has symptoms in the early stages of diabetic retinopathy, and some only experience mild vision problems. However, as the condition progresses, vision loss can occur, and so it is important for diabetics to get a comprehensive dilated eye exam at least once a year.

If a patient is diagnosed with significant diabetic retinopathy. He may be subjected to following investigations

  1. Retinal Photography/ Fundus photography: This test is done to document the status of the retina when the patient does not have significant diabetic retinopathy.
  2. Fluorescein angiography: Fluorescein dye is injected in the vein of the arm and as the dye reaches retinal circulation, retinal photos are taken with a specialized camera known as fundus camera. It gives a detailed picture of the presence of abnormalities in blood vessels, areas where blood vessels are absent and where new, abnormal blood vessels are grown.
  3. Optical Coherence Tomography (OCT): This non-invasive test is done to diagnose presence and ascertain severity of macular edema. It is also helpful to follow up the patients after the treatment.
  4. OCT Angiography: This is the latest test which is used to evaluate blood vessels using OCT technology.
  5. Ultrasonography of the eye: This test is performed when a patient develops bleeding inside the eye and retina can not be visualized. This is used to see the position of the retina. It is helpful in planning the surgery.

Treatment of diabetic retinopathy:

  • Controlling blood sugar and blood pressure is the first step to stop vision loss.
  • Laser: Retinal laser treatment is done on OPD basis to reduce macular edema ad to shrink abnormal blood vessels
  • Injections: AntiVEGF injections like Avastin, Razumab, Accentrix, Pagenax or Eylea are given inside vitreous cavity. The procedure is performed in the operation room to maintain sterility. It is used to reduce macular edema, shrink abnormal blood vessels, to reduce bleeding inside vitreous cavity or 4 days prior to retinal surgery to improve surgical outcomes.
  • Steroid injection known as Kenacort or a steroid implant known as Ozurdex may also be given in cases of severe macular edema,
  • Surgery: Surgery known as vitrectomy is performed when patients develop vitreous hemorrhage that is not responding to other treatments or if the patient develops retinal detachment.

A diabetic patient must undergo periodic detailed eye examination including retinal examination even if they do not have any symptoms. Here are the recommended intervals for patients with diabetes to undergo retinal examination for diabetic retinopathy ¹:

  • Type 1 diabetes: first retinal examination 3 to 5 years after diagnosis, re-examination every 1 to 2 years
  • Type 2 diabetes: first retinal examination at the time of diagnosis, re-examination every 1 years
  • Pregnant patients with type 1 or type 2 diabetes: first retinal examination soon after conception and early in the first trimester, re-examination every 1 to 2 years
  • Once patient has developed severe disease that requires treatment, patient must undergo retinal examination every 3 months, after conclusion of treatment, for rest of their lives
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