Diabetic eye disease is a group of eye disorders affecting the eyes of those with Diabetes .Retina is the most crucial part which gets affected by Diabetes. Retina is the delicate, light sensitive lining of the back of the eye. Diabetic retinopathy is one of the foremost causes of blindness due to any Systemic Disease.
With the increase in the duration of diabetes, risk of developing diabetic retinopathy also increases. It is observed that about 80% of the people suffering from diabetes for more than fifteen years do have some damage present in the blood vessels of the retina. Severe and uncontrolled diabetes, fluctuating blood sugar levels, high blood pressure (Hypertension), high blood cholesterol and diabetic kidney are all conditions which predispose a diabetic to develop changes in the retina.
Pregnancy and high blood pressure may aggravate Diabetic retinopathy.
It is very important to know that the retina gets affected adversely when the blood sugar level comes down quickly. It is extremely important that diabetics do not panic when their blood sugar level goes up. Blood sugar level should be allowed to come down slowly.
In the early stages, it is called Background Diabetic Retinopathy. In this stage, retinal blood vessels start leaking causing the retina to swell. In some cases, the leaking fluid collects in the central part of the retina. This condition is called Diabetic Maculopathy. This can lead to difficulty in reading, distortion in vision and other activities involving close concentration.
The advanced stage is called Proliferative Retinopathy. This is the most serious stage of Diabetic retinopathy. In this condition, new branch like blood vessels start growing on the surface of the retina. These abnormal blood vessels can lead to various complications like bleeding in the eye, detachment of retina or glaucoma.
Proliferative Retinopathy affects up to 20% of all diabetics and can lead to very severe loss of sight resulting in blindness.
Regular eye check-up for Diabetic Retinopathy is a must for all diabetic patients. It is recommended that all diabetics should get their retina checked once every 6 months. It is quite common for a diabetic patient to have good vision without any realization of the changes happening in the retina. Early warning symptoms threatening and damaging the eyesight are rare in Diabetic retinopathy. These changes if left untreated could lead to sudden blindness due to bleeding.
Fundus Fluorescein Angiography or FFA, which is a specialized technique, is also used to get finer details of the retinal blood vessels. In FFA, a fluorescent dye is injected through a vein in the arm. As this dye travels through the bloodstream to reach the retinal blood vessels, photographs are taken in quick succession. These photographs capture the details of the dye leaking from the abnormal blood vessels. This helps in diagnosing the stage of diabetes and the subsequent managment.
OCT- an advanced retinal scan to detect retinal problems
Laser treatment or Laser Photocoagulation. It is the most common line of treatment in most sight threatening diabetic problems. It is very important to realize that laser treatment aims to save the existing sight level and not to make it better. Laser treatment is recommended to the patients who have swelling of the retina in the macular area or new blood vessel formation. Laser photocoagulation is used to seal the microanurysms that are leaking fluid into the retina. If new blood vessels are growing then more extensive laser treatment has to be carried out which is called the Pan Retinal Photocoagulation (PRP). PRP is carried out over two to three sittings spread over a few weeks. In most cases, laser treatment causes the new blood vessels to regress and the swelling to subside.
It is an outpatient procedure and does not involve stay in the hospital. It does not require an incision. It usually does not cause much discomfort. It can be repeated, if required. It prevents further loss of vision but does not restore the already lost vision.
An injection of Anti-VGF is given in to the eye in order to reduce the retinal swelling/ new blood vessels. In severe cases, injections may have to be repeated.
Sometimes the new blood vessels bleed into the gel like centre (vitreous) of the eye. This condition called vitreous hemorrhage & can lead to sudden loss of vision. If the vitreous hemorrhage is persistent , then a procedure called Vitrectomy is recommended. This is undertaken to remove the blood and scar tissue from the centre of the eye . Some Complicated diabetic retinal condition may require extensive surgeries known as Vitreoretinal surgery.