Diabetes is a very serious condition that affects majority of population in our country and has a extreme effects on all major body parts like the heart, kidneys, liver and most commonly the eyes. We need to follow a healthy diet and lifestyle to be able to control our blood sugar level and diabetes; this means regular exercise, proper diet, selective food choices and special medication.
Diabetes directly leads to vision loss if not treated in the early stages and the loss of sight is not recoverable. But if treated in the early stages, the damage to your vision can be prevented and a healthy vision can be assured.
What is Diabetic Retinopathy?
Diabetic Retinopathy is a condition that is caused by the changes in the blood vessels of the retina. In people with diabetes, the blood vessels of the retina swell and bleed and as the condition progresses, abnormal new blood vessels grow on the surface of the retina. All these changes in the retina result in the decrease in vision and sometimes can lead to blindness.
What are the symptoms of Diabetic Retinopathy.
In the early stages of Diabetic Retinopathy, there are no visual symptoms and no considerable change in vision.
In the later stages, blurry vision can occur and floating spots can be seen in front of the eyes.
In certain extreme cases, diabetic retinopathy can cause sudden loss of vision when there is extensive bleeding inside the eyes.
What are the Stages of Diabetic Retinopathy?
1. Non-Proliferative Retinopathy - Mild, Moderate, Severe
In non-proliferative retinopathy, tiny vessel abnormalities called micro-aneurysms, form in the retina. These weakened vessels may bleed within, or underneath the retina. Some signs may include the formation of “Cotton Wool” Spots, along with small bodies called exudates
2. Proliferative Retinopathy - Mild, Moderate, Severe
If no treatment is provided in the early stages of Retinopathy, it becomes proliferative. This is noted by the growth of Fibrovascular tissue within the vitreous cavity. In severe cases it requires a surgery to remove the fibrovascular tissue, release all traction on the retina, and remove a vitreous hemorrhage.
What is Macular Edema?
The MACULA is a part of the Retina that provides sharp central vision. When this macula swells due to leaking fluid, it can cause blurred vision. This condition is called ‘Macular Edema’. This can also occur in the early stages of Retinopathy and is detected with the help of OCT.
How is Diabetic Retinopathy detected/What are the tests to detect Diabetic Retinopathy?
1. Visual Acuity Test or Distance Vision Test
This is an eye chart test that helps to determine your vision at distance.
2. Dilated Eye Exam
In this test, drops are administered into your eyes to widen the pupils of your eyes. This helps to examine the retina and optic nerves. Following this test, your near vision is affected for a couple of hours.
This is a procedure that measures the pressure of your eye with an instrument called the tonometer.
4. OCT (Optical Coherence Tomography)
This procedure is similar to having a scan of your entire eye that helps to scan the inner and outer parts of the eye (from Cornea to Retina). Every layer of the retina gets scanned that provides better results to decide the best type of treatment.
5. Fluorescein Angiography (FFA)
In this procedure, a special dye is injected into your arm and as the dye passes through the blood vessels in your retina, pictures are taken. This helps us to identify any leaking blood vessels so as to facilitate the ideal treatment. Due to the advancements in the field, Angiography is done in rare cases due to its invasive technique.
What is the treatment for Diabetic Retinopathy?
Note: For all diabetic patients, it is imperative that they undergo regular checkups to maintain a control over their vision. All the treatments are focussed on preventing further damage to the eye and saving the central vision. Vision can only be restored if treatment is done in early stages.
1. Green Laser Photocoagulation
Diabetic Retinopathy can be treated with a Green Laser, where the surgeon places small laser spots in areas of the retinal leakage surrounding the Macula. These spots slowdown the leakage of the fluid and reduce the swelling. In case of proliferative retinopathy (late stage), the whole retina needs to be treated with the green laser (Pan Retinal Photocoagulation).
2. Anti VEGF Injections
Anti VEGF stands for Anti Vascular Endothelial Growth Factor and they prevent the growth of the protein called VEGF produced by cells in the retina. These injections are given into the vitreous (fluid in the eyeball). These injections are recommended for patients with macular oedema
3. Surgery (Vitrectomy)
Vitrectomy is a surgical procedure where the blood filled vitreous and scar tissue that can cause retinal detachment is completely removed from the eye. A surgery is recommended in advanced cases where there is sufficient damage to the retina and the above procedures are not producing successful results.
NOTE: Your doctor will be able to guide you what will be the best course of treatment for you.
Green Laser Photocoagulation
Can Diabetic Retinopathy be prevented?
1. No, not completely, but the potential risks involved in diabetic retinopathy can be reduced to a considerable extent by regular checkups and control of blood sugar levels.
2. Control of blood sugar level, cholesterol and blood pressure can lessen the need for laser treatments and can prevent damage to the retina.
3. The ETDRS (Early Treatment Diabetic Retinopathy Study) established that regular eye check-up and laser treatment reduced the risk of severe vision loss in diabetic patients.