Diabetic Retinopathy

In patients with diabetes, the body is unable to effectively make or process insulin, the hormone that regulates the level of sugar in the blood. Diabetes can interfere with the normal functioning of many parts of the body, including the eyes. Diabetic retinopathy is a common vision problem that affects diabetics.

Effect of Diabetes on the Retina

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• People with diabetes have an increased chance of developing a variety of eye problems, including cataracts and glaucoma. However, the effect of diabetes on the retina is the most serious threat to vision. Typically, changes begin to take place in the retina after a patient has been living with diabetes for 10 to 15 years. The effect of diabetes on the retina and vitreous is called diabetic retinopathy.
• Over time, diabetes begins to affect the circulatory system of the retina. In the earliest phase of the disease, known as background diabetic retinopathy, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina, which may result in decreased vision.
• The next stage is known as proliferative diabetic retinopathy. In this stage, circulation problems lead to oxygen-deprivation in some areas of the retina. New, fragile, blood vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called neovascularization. The delicate vessels hemorrhage easily and blood may leak into the retina and vitreous, causing spots or floaters, and an overall decrease in vision.
• As the disease progresses even further, continued abnormal vessel growth and scarring can result in serious problems such as retinal detachment and glaucoma.

Signs and Symptoms

The effect of diabetic retinopathy on vision varies widely, depending on the stage of the disease. Some common symptoms of the disease are listed below;

• Blurred vision – often linked to blood sugar levels
• Floaters and flashes
• Sudden loss of vision

Though the symptoms listed above can signal diabetic retinopathy, diabetes can cause various other eye symptoms as well. If you are diabetic and experiencing any type of vision problem, you should seek treatment from a doctor immediately. Many diabetic retinopathy patients are examined by an internist or endocrinologist before they are referred to our retina specialists for treatment.

Diabetic Retinopathy Treatment

There are several diabetic retinopathy treatment options available. Your treatment will be selected based on the stage of the disease and the specific problem that requires attention. Your surgeon may use tests such as fluorescein angiography, retinal photography, and ultrasound imaging of the eye to determine the appropriate course of treatment for you.

Pan Retinal Photocoagulation (PRP)

To treat the abnormal growth of tiny blood vessels and bleeding that often result from diabetic retinopathy, our surgeons frequently use a type of laser surgery called pan retinal photocoagulation (PRP). When performing this diabetic retinopathy treatment, the surgeon uses a laser to destroy oxygen-deprived retinal tissue outside of a patient’s central vision. This prevents further growth of fragile blood vessels and seals leaking ones, helping to stop the disease from progressing. The tradeoff of this treatment is that it creates some blind spots in the patient’s peripheral vision.

Avastin therapy

A new mode of therapy has emerged for advanced diabetic retinopathy, proliferative diabetic retinopathy, vitreous hemorrhage and macular edema. It involves administration of a monoclonal antibody (bevacizumab) into the eye by injection.

It is a simple OPD procedure and does not need admission into the hospital.

Vitrectomy

Vitrectomy is surgery that is frequently performed on diabetic patients who suffer a vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the eye). When performing this procedure, the surgeon carefully removes blood and vitreous from the eye, replacing it with a saline solution. The surgeon may also gently cut strands of vitreous that are attached to the retina and could lead to retinal tears or detachment.

Maintaining Eye Health

To minimize vision problems associated with diabetes, patients should;

• Maintain appropriate blood sugar levels when possible
• Follow a healthy diet
• Get sufficient amounts of exercise
• Schedule routine examinations with an ophthalmologist so problems can be caught early
• Lose weight when indicated, as per your primary care physician’s direction