Diabetic-Retinopathy

Diabetes mellitus is emerging as a major public health problem in India. It is a multisystem disorder which affects the heart, kidneys, peripheral nerves and the eyes. Involvement of the retina is called diabetic retinopathy, and can lead to blindness. In patients with more than twenty years of diabetes, nearly all patients with type I diabetes (insulin-dependent) and more than 60% of those with type II diabetes (non-insulin dependent) will have some degree of retinopathy. This also depends on how well the disease has been controlled.
Narayana Nethralaya offers comprehensive facilities for the medical and surgical management of diabetic retinopathy.

What is diabetic retinopathy?
Diabetic retinopathy is an eye problem that can be caused by either type 1 or type 2 diabetes mellitus. Retinopathy occurs when diabetes damages the tiny blood vessels in the retina. The weakened blood vessels may leak fluid and blood.

Who are at risk for developing diabetic retinopathy?
Those with poorly controlled blood sugar levels are at a high risk of developing diabetic retinopathy. In addition, high blood pressure, high cholesterol, anemia, kidney disease and pregnancy can all place a patient at greater risk of suffering from diabetic eye disease.

How frequently should I get my eye examined?
If you have diabetes, you should get a yearly examination by your ophthalmologist. Once you develop diabetic retinopathy, your ophthalmologist may advise further investigations or treatment. A periodic follow up as advised by your ophthalmologist is mandatory. The frequency of these follow up visits is decided based on the severity of the disease.

What are the symptoms of diabetic retinopathy?
There may be no symptoms in the early stages, especially when the central portion of the retina is not involved. As the retinopathy progresses, you may have:

  • Blurred vision
  • Floaters, which can look like black spots, little threads, or cobwebs
  • Bleeding in the eye causing sudden loss of vision
  • Temporary or permanent loss of vision.

Pain is not a common feature of the disease.

What are the types of diabetic retinopathy?
There are two forms of diabetic retinopathy: non-proliferative (NPDR) and proliferative (PDR). Non-proliferative diabetic retinopathy refers to the early stages of the disease, while proliferative diabetic retinopathy refers to the severe, progressive stage.
Macular edema : The fluid and exudates collect in the macula, the central part of the retina that helps us in fine central vision.

Moderate NPDR

Moderate NPDR

Proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

Vitreous hemorrhage

Vitreous hemorrhage

What is laser treatment? Will I regain my vision after laser treatment?
The aim of this treatment is to protect central vision. It does not restore lost vision, but it can prevent further deterioration, which is why early diabetic retinopathy diagnosis through periodic eye examination is imperative.

Laser photocoagulation involves tiny burns to seal the capillaries. This may cause small spots to appear in your field of vision after the procedure. These spots generally fade and disappear with time. Some patients may experience difficulties in dim illumination and while reading following multiple sittings of laser treatment.

How many sittings of laser treatment are required?
With the PASCAL® (Pattern Scan Laser), the entire session can be completed in on sitting. It may however vary from patient to patient. The severity of diabetic retinopathy plays an important role in deciding the number of sittings required.

PASCAL laser being performed

PASCAL laser being performed

What are Anti VEGF agents, and what is their role in managing diabetic retinopathy?
Anti VEGF agents (Lucentis, Avastin, Macugen) are emerging as the new modality of treatment for various stages of diabetic retinopathy. These agents are injected into the eye (intravitreal injection). They are commonly used in diabetic maculopathy and proliferative diabetic retinopathy. They may also be used as an adjunct before surgery for diabetic vitreous hemorrhage and retinal detachments.

What is vitrectomy?
Vitrectomy is a surgical procedure in which cloudy, blood filled vitreous and scar tissue causing tractional retinal detachments are removed from the eye.

OCT of a patient with taut posterior hyaloid and tractional retinal detachment- pre and post vitrectomy

Pre

Pre

Post

Post