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Diabetic Retinopathy

Complications of diabetes in the eye remain the leading cause of legal blindness in people in the age group of the working population. Most of this vision loss is preventable if vision-threatening changes at the back of the eye are detected early enough and treated ,where appropriate, with laser treatment.

In the average group of people with diabetes at least one third of them will have some retinopathy. In the majority of people it is at an early stage with no immediate risk of sight loss. The longer one has diabetes the more likely retinopathy becomes and the poorer the control of blood sugar levels the more likely the chance of developing retinopathy and the greater the likelihood it will deteriorate.

High blood pressure ,high cholesterol and kidney damage may aggravate diabetic retinopathy and sometimes pregnancy may do the same.

Most people with diabetic retinopathy are not aware of any problem with their eyes and have normal vision. One can have advanced vision-threatening retinopathy with no symptoms or change in vision until there may be a sudden drop in vision. Unfortunately once advanced diabetic retinopathy is present with a drop in vision it is often not possible to regain lost vision. Nevertheless, although laser treatment will probably not be able to improve your vision it should prevent or slow down any further visual loss.

If you have diabetes you know that your body can't use or store sugar properly. When you blood sugar gets too high, it can damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy.

In later stages , the disease may lead to new blood vessel growth over the retina. The new blood vessels can cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as Retinal Detachment and can lead to blindness if untreated.. In addition abnormal blood vessels can grow on the iris which can lead to glaucoma.

Sometimes diabetic retinopathy can hasten the development of cataracts. This can be treated with modern small incision cataract surgery.

Signs of Diabetic Retinopathy

Everyone who has Diabetes is at risk for developing diabetic retinopathy, but not everyone develops it Diabetic Retinopathy often has no early warning signs. When blood vessels in the retina are damaged they can leak fluid or blood. This causes the retina to swell and form deposits called Exudates.This is an early form of diabetic retinopathy called Nonproliferative or Background Retinopathy.You may not notice any change in your vision at this stage but it can lead to other more serious forms of retinopathy that affect your vision. Sometimes, difficulty reading or doing close work can indicate that fluid is collecting in the macula , the most light sensitive part of the retina.. This fluid build up is called Macular Oedema.

In Proliferative Diabetic Retinopathy new fragile blood vessels grow on the surface of the retina. These new blood vessels, called Neovascularization, form at the back of your eye and can bleed and blur vision or cause blood clots to float in front of the vision. This occurs when the blood enters the vitreous ,the clear jelly-like substance that fills the centre of the eye. The first time this happens it may not be severe. However this is often followed within a few days or weeks by a much greater leakage of blood. This blood will blur your vision. It may take the blood days , months or even years to clear. In some cases the blood will not clear.

Diabetic Retinopathy is often detected during a routine examination by your doctor or optometrist. Your doctor may suggest you have a test called Fluoroscein Angiography. In this test a special dye is injected into your arm. Pictures are then taken as the dye passes through the blood vessels in your retina.This allows the doctor to find the leaking blood vessels.

How is it treated?

There are two treatments for diabetic retinopathy and they are very effective in reducing vision loss from this disease.These are Laser Photocoagulation and Vitrectomy. However, they do not cure diabetic retinopathy.

Laser photocoagulation
Laser treatment is performed in your doctor's office and is used to treat macular oedema and proliferative retinopathy.

Macular Oedema
Often more than one treatment is required. The laser is used to seal the vessels and stop them from leaking.

Proliferative Retinopathy
The laser is used to destroy the abnormal blood vessels that form on the retina. Hundreds of small laser burns away from the centre of the retina are placed to shrink the abnormal blood vessels. Often some of your side vision is lost after this treatment as well as night vision in order to save the rest of your sight. Multiple treatments are required.

Vitrectomy

A vitrectomy is performed if you have a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a salty solution.
Vitrectomy is performed in a day surgery or hospital under local anaesthetic.Your surgeon will make a microincision in the sclera, the outer white layer of your eye. Next a small instrument is placed and the vitreous removed and replaced with a salty solution.

What can you do about Diabetic Retinopathy?

1. Keep your blood sugar under control. Better control of blood sugar levels slows the onset and progression of retinopathy and lessens the need for laser treatment for severe retinopathy.
2. Keep your blood pressure under control.
3. Maintain a healthy diet
4. Exercise regularly
5. See your eye doctor or optometrist for a dilated eye examination at least once a year
6. If you notice blurring of your vision or have difficulty reading or if your vision becomes hazy or you develop spots in front of your vision contact your doctor for an appointment.

FAQ

Q: What exactly is Diabetic Retinopathy?
A: Diabetic Retinopathy is a condition in which high blood sugar causes retinal blood vessels to swell and leak blood and new fragile blood vessels to form which bleed.

Q: Who's at most risk for diabetic retinopathy?
A: Those with poor blood sugar control and diabetes for several years especially if not diagnosedearly.

Q: Is there any way to prevent diabetic retinopathy?
A: Keeping your blood sugar level at an even level will help. Also keeping your blood pressure within normal. However, even with these measures you may develop diabetic retinopathy therefore you must have your eyes examined yearly.

Q: What are the signs and symptoms of diabetic retinopathy?
A: In the early stages you may not have any symptoms. Later on you may develop blurred vision or floaters in front of your sight.

Q: What are the different types of diabetic retinopathy?
A: Nonproliferative or background retinopathy is the early stage where small retinal blood vessels brealk and leak.
In Proliferative retinopathy new blood vessels grow abnormally on the retina. These new vessels may bleed into the vitreous gel or cause scarring and lead to retinal detachment. Proliferative retinopathy is much more serious and if untreated can lead to blindness

Q: Is diabetic retinopathy curable?
A: No. Early treatment can slow its progression.

Q: What treatment is currently available?
A: The best treatment is to keep your blood sugar level and blood presure under control.
Photcoagulation may be used to seal leaking blood vessels and to destroy new blood vessel growth.
Vitrectomy, may be required to remove blood from the vitreous gel.