Diabetic Retinopathy

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Diabetic Retinopathy

Diabetes Mellitus is a condition which impairs the body’s ability to use and store sugar. The past two decades have seen an explosive increase in the incidence of Diabetes in India, which has the largest number of diabetics in the world today. The increased incidence of Diabetes Mellitus and its complications have been attributed to changes in life style caused by increased urbanization, high calorie diet, decreased physical activity and stress. Another cause for concern is that Diabetes Mellitus has been striking at an early age among the urban population. Diabetics are at a higher risk of developing blindness, getting a stroke, suffering from myocardial infarction, developing kidney disease or undergoing amputation.

It is a common disease with serious ocular complications and one of the leading causes of blindness in the world. Diabetics are at high risk for eye complications, the most common being Diabetic Retinopathy. Certain studies have shown that the development of Diabetic Retinopathy depends greatly on the duration of Diabetes Mellitus. Other associated factors that increase the chances of this disease are hypertension, smoking and presence of renal diseases.

Diabetes Mellitus does not just affect the retina. It has been found to promote cataract formation, an increased incidence of open angle Glaucoma, etc. Unfortunately, it is mainly the effect of Diabetes Mellitus on the retina that causes blindness.

FFA

Green Laser

Q. What is Diabetic Retinopathy?
It is a stage of the disease process in which the blood vessels in the retina are damaged and leak fluid or blood. It has been seen that 25% of all diabetics develop this complication after 10 years of developing Diabetes and 50% develop it after 20 years of developing diabetes. People with Type 1 Diabetes (Diabetes since childhood) are more likely to developDiabetic Retinopathyat a younger age. Diabetics also have a higher incidence of cataract and glaucoma and those with poorly controlled blood sugar and blood pressure are at a higher risk of losing vision.

Q. What are the symptoms of Diabetic Retinopathy?
EarlyDiabetic Retinopathy usually has no symptoms. Gradual blurring of vision may occur if fluid leaks in the central part of the retina (the macula). In lateDiabetic Retinopathy (proliferative stage), new abnormal blood vessels begin growing on the surface of the retina or the optic nerve. These vessels have weak walls and leak blood into the retina and vitreous (jelly that fills most of the eye). Presence of blood in the path, from where the light enters the eye, blocks vision.

Q. How isDiabetic Retinopathydiagnosed?
Complete eye examination is required for the detection of diabetic retinopathy. The retina of the eye is examined using an instrument called the indirect ophthalmoscope after dilating the pupils. IfDiabetic Retinopathyis detected, a special test called Fluorescein Angiography may be performed where a dye is injected in the vein of the arm and serial photographs of the retina are taken.
Optical Coherence Tomography (OCT) is another test used for detection and evaluation of Diabetic Macular Edema (DME) which is swelling and fluid accumulation in the most important area of the retina.

Q. How isDiabetic Retinopathytreated?
The first step is that all diabetics must maintain strict control of blood sugar and follow a regular exercise regime and healthy diet. In early cases only regular follow-up may be necessary. More advanced cases require treatment to control the damage of Diabetic Retinopathyand improve sight in the form of lasers, injections or surgery.

Indirect Ophthalmoscope

Vitrectomy Unit

Operating Mi

1. Laser Treatment:
There are two types of laser treatments done for Diabetic Retinopathy:
(a)Focal Laser: Focal Laser is done for swelling of the macula due to leakage from damaged blood vessels. There is usually no pain from this laser and there will be some slight blurring of vision initially after treatment.
(b)Peripheral Laser or Pan Retinal Photocoagulation (PRP): This type of laser is done for severeDiabetic Retinopathywhich has developed new vessel formation or bleeding into the vitreous gel. This type of laser may lead to loss of peripheral vision, decreased night vision and may be painful with the need to give an injection on around the eyeball for anaesthesia.

2. Vitrectomy Surgery:
In the event of the patient presenting with very advanced Diabetic Retinopathy, a microsurgical procedure known as Vitrectomy is recommended. Blood-filled vitreous gel of the eye is replaced with a clear solution to aid in restoring vision. Sometimes the retina may also be detached. Vitrectomy surgery is then performed to reattach the retina.

3. Intraocular Injections:
Newer modality of treatment includes use of intraocular injections (Anti VEGF and Steroids) for diabetic macular edemas or as a preoperative tool to reduce the incidence of bleeding during Vitrectomy Surgery.

Q. How is to prevent visual loss in Diabetes?

Early detection of Diabetic Retinopathyand timely laser treatment is the best protection against loss of vision. Diabetics must have their eyes examined regularly. Our diabetic clinic is designed towards providing regular preventive care as well as follow-up for patients with established diabetic retinopathy. Additionally, all diabetics must maintain control of blood sugar and blood pressure and follow a regular exercise regime and healthy diet.

Our State-Of-The-Art Equipment forDiabetic RetinopathyTreatment

Slit Lamp Biomicroscopy ( Zeiss, Germany)
Indirect Ophthalmoscope (Heine, Germany)
Optical Coherence Tomography OCT (Nidek, Japan)
Digital imaging DI / Fluorescein Angiography FFA (Zeiss VISUCAM 500, Germany)
Green Laser (Zeiss, Germany)
Vitrectomy Unit (Oertli Faros, Switzerland)
Leica 822 Operating Microscope (Germany)