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Diabetic Retinopathy

4.5% of India’s population is suffering from Diabetes Mellitus and by year 2025 around 57 million people will have this disease. At present diabetic retinopathy is the leading cause of blindness in United States and is becoming an important cause of blindness in the developing countries also. In India, it was the seventeenth cause of blindness twenty years ago. But today diabetes related blindness has rapidly ascended to the sixth position.

Early detection and timely treatment of diabetes can substantially reduce the risk of vision loss or blindness from diabetic eye disease.

Are the eyes of all diabetics affected?

Eyes of about 80% of the diabetic patients are affected over time. The longer the duration of diabetes greater are the chances of developing retinopathy.

What are all the ways in which diabetes can affect the eye?

Eye can be affected in many ways; important among these are:

a)Diabetic Retinopathy
b)Early Cataract formation (i.e. clouding of the lens)
c)Glaucoma (i.e. Increase pressure inside the eye)

What is diabetic retinopathy?

Diabetic retinopathy is a disorder of retinal blood vessels resulting from diabetes mellitus. In this condition, the retinal blood vessels are affected causing insufficient supply of oxygen and nutrients needed by the retina to remain healthy. There are bleeding spots and deposits of fatty material with swelling of the retina. Thus the retina is unable to transmit visual messages to the brain resulting in low vision or blindness.

How does diabetic retinopathy cause low vision or blindness?

In moderate cases, the visual loss is due to swelling and bleeding within the retina. But in many cases vision is lost due to severe bleeding inside the eye from the abnormal blood vessels in the retina, leading to blindness. In advanced cases it may be because of tractional retinal detachment

What are the symptoms by which diabetic retinopathy can be identified?

Usually diabetic retinopathy is symptomless. Some people have slight decrease of vision or foggy vision. Some may have normal vision till they develop sudden blindness due to bleeding. As there are no symptoms in early stages diabetic retinopathy, it is essential that diabetic patients undergo a routine checkup by an eye specialist every six months.

 

How is diabetic retinopathy diagnosed?

1. Retinal Examination: Under dilatation by an ophthalmologist will help to detect diabetic retinopathy in early stages.
2. Fundus Fluorescein Angiography (FFA): In FFA, we take photographs of the Retina after injecting a dye in the arm. It helps us to diagnose the stage of Diabetic Retinopathy in selected cases and localizing leaking new vessels which can be lasered later.
3. Ocular Coherence Tomography (OCT): This advanced imaging modality allows scanning of the retina. This helps visualize and document the swelling and deposits in the retina and may also reveal the presence of tractional bands.

 

How is diabetic retinopathy treated?

1. Early diagnosis of Diabetes Mellitus and effective control of blood sugar through diet, exercise and medication can help reduce your risk of developing these eye problems associated with Diabetes Mellitus.

2. Laser photocoagulation is the main treatment of diabetic retinopathy.
Diabetic retinopathy: before LASER treatment

Laser treatment is an OPD procedure. After putting anesthetic/numbing drops in the affected eye, the patient is comfortably seated on a stool/chair with chin and forehead stabilized. A contact lens is then inserted in the eye and laser beam is focused onto the retina. The light is absorbed by pigment layer of the retina, where it is converted into heat.

Laser photocoagulation helps to preserve vision by preventing new blood vessel formation. It may also help in reducing the swelling of thickened retina in some cases and prevent further deterioration of vision.

Photocoagulation may not be appropriate for everybody. If the condition is too advanced laser treatment is not possible. In such cases, vitrectomy may be required.
Diabetic retinopathy: resolution after treatment with LASER