What is diabetic retinopathy?
20% of the people with diabetes mellitus are at risk of developing diabetic retinopathy. Diabetic retinopathy is a condition that occurs as a result of damage to the blood vessels of the retina in people who have diabetes. Diabetic retinopathy can develop if you have type 1 or 2 diabetes and a long history of uncontrolled high blood sugar levels, or if blood sugar levels are fluctuating. While you may start out with only mild vision problems, you can eventually lose your sight. Untreated diabetic retinopathy is one of the most common causes of blindness.
What are the types of diabetic retinopathy?
Nonproliferative diabetic retinopathy (NPDR)
NPDR is also known as background retinopathy. During the early stages of retinopathy, damaged blood vessels often leak blood and fluid into the eye. In some cases, the center of the retina, or macula, begins to swell. This causes a condition called macular edema. The three stages of NPDR are mild, moderate, and severe, which may progress to the other type, or fourth stage-vision threatening, proliferative diabetic retinopathy.
Proliferative diabetic retinopathy (PDR)
Proliferative diabetic retinopathy, or advanced retinopathy, is the stage of retinopathy in which new blood vessels begin to grow within the retina. These new blood vessels are usually abnormal and grow in the center of the eye. If proper treatment is not taken at this stage then vitreous haemorrhage (Blood in the eye), or even worse situation like tractional retinal detachment can happen.
What are the symptoms of diabetic retinopathy?
It’s uncommon to have symptoms during the early stages of this condition. The symptoms of diabetic retinopathy often don’t appear until major damage occurs inside of the eye. You can prevent unseen damage by keeping your blood sugar levels under good control and getting regular eye examinations by a retina specialist to monitor your eye health.
Symptoms:
- seeing floaters or dark spots
- blurred vision
- loss of vision
- difficulty distinguishing colors
What causes diabetic retinopathy?
High levels of sugar in the blood over long periods cause diabetic retinopathy. This excess sugar damages the blood vessels that supply the retina with blood. High blood pressure is also a risk factor for retinopathy.
The retina is a layer of tissue in the back of the eye. It’s responsible for changing images that the eye sees into nerve signals that the brain can understand. When blood vessels of the retina are damaged, they can become blocked, which cuts off some of the retina’s blood supply. This loss of blood flow can cause other, weaker blood vessels to grow. These new blood vessels can leak and collects blood inside the eye, eventually it creates traction-scar tissue that can cause a loss of vision.
The longer you have diabetes, the higher your chances of developing diabetic retinopathy become. Nearly everyone who has diabetes for more than 15 years will show some signs of retinopathy. Keeping your diabetes under control can help slow the progression.
How is diabetic retinopathy diagnosed?
It’s a hidden disorder, Retina specialist-Ophthalmologist can diagnose diabetic retinopathy using a dilated eye examination. This involves the use of eye drops that make the pupils open wide, allowing proper visualisation of the vitreous cavity, optic disc, macula and rest of the retina.
They may also perform a fluorescein angiography test (FFA). During this test, your doctor will inject a dye into your arm, allowing them to track how the blood flows in your eye. They’ll take pictures of the dye circulating inside of your eye to determine which vessels are blocked, leaking, or broken.
An optical coherence tomography (OCT) exam is an imaging test that uses light waves to produce images of the retina. These images allow your doctor to determine your retina’s thickness. OCT exams help determine how much fluid, if any, has accumulated in the retina.
Treatment of diabetic retinopathy?
Your doctor may want to perform regular eye exams to monitor eye health depending upon the severity of the diabetic retinopathy- examination should be carried out at either two/three/four/six/twelve monthly intervals. An endocrinologist can help to slow the progression of retinopathy by helping you optimally manage your diabetes.
In advanced diabetic retinopathy, the treatment depends on type and severity of retinopathy.
Laser Therapy: Photocoagulation surgery can help prevent vision loss. This type of surgery uses a laser to control or stop leakage by burning the vessels to seal them. The types of photocoagulation and other treatments include the following:
- Pan-Retinal Photocoagulation (PRP): Thermal laser therapy performed two or more times to ablate the abnormal growth factors limiting further damage that can cause blindness.
- Focal photocoagulation: involves using a laser to target a specific leaky vessel near the macula to keep macular edema from worsening.
Intravitreal Injections: Anti-VEGF or steroid injections to be administered inside the eye on the need basis to reduce the severity of the diabetic retinopathy and to reduce the macular edema, helps in regaining vision.
Surgery: Pars plana vitrectomy involves removing excessive blood, scar tissue and cloudy fluid from the vitreous fluid of the eye, so further damage to eye is prevented.