Diabetic Retinopathy, a complication of diabetes, is caused by changes in the blood vessels of retina, the light sensing nerve layer at the back of the eye. These damaged blood vessels leak fluid, lipid and blood which get deposited in the retina. As a result, the images which the retina sends to the brain become blurred, distorted or partially blocked.
Diabetic Retinopathy is the leading cause of blindness among adults in our country. The risk of developing diabetic retinopathy increases with the age of diabetes. About 80% of population with diabetes of more than fifteen years, will have some damage to the blood vessels of their retina. Besides, uncontrolled diabetes, fluctuating blood sugar levels, hypertension (high blood pressure), high blood cholesterol, anemia, effect of diabetes on kidneys and pregnancy aggravate Diabetic Retinopathy.
Normal Retina
Type 1, NPDR
CSME
Type 2, PDR
Treatment for diabetic retinopathy involves a multi-faceted approach tailored to the individual’s condition. Maintaining optimal blood sugar levels through medication, diet, and exercise is fundamental. Regular eye examinations are crucial for early detection, allowing timely intervention. In advanced cases, treatments such as intravitreal injections or laser therapy may be recommended to address swelling and abnormal blood vessel growth. Surgical options, like vitrectomy, become relevant in severe cases with significant bleeding or retinal detachment.
If the cavity of eye is filled by blood, the retina can not be lasered until the blood settles or clears. Procedure called Vitrectomy (PPV) is required if Vitreous Hemorrhage persists. Vitrectomy is a microsurgical procedure, performed in the operating room, to remove the blood. This is a sophisticated procedure performed by trained surgeons.
The most significant development in treatment of diabetic retinopathy is LASER. It seals or photo-coagulates the leaking blood vessels by heating effect. Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Laser does not require an incision and may be performed in the ophthalmologist’s office or an outpatient clinic. The patient sits on a chair and keeps his chin over the machine. A contact lens is placed over the eye to keep it open and to permit the surgeon to see the retina. During this procedure, a beam of laser light (green or red) is focused on the damaged retina. Small bursts of the laser beam are delivered to the diseased retina, which absorbs this energy.
Depending on the severity of the disease process, one to three or more sessions/sittings of the laser at one week intervals may be required. The laser shrinks abnormal blood vessels and prevents bleeding into the eyes.
Photo-coagulation may lead to temporary blurring of vision for some days. Laser offers no protection against development of new changes of diabetic retinopathy due to fluctuating blood sugar. Laser is not a substitute for adequate control of diabetes. It may take three to six months for laser to have full effect. If required, laser treatment can be repeated. The laser treatment prevents further loss of vision. It is therefore important to note, that the ideal time to start the treatment is when the vision is still normal.
Besides control of diabetes, management of any associated condition like hypertension, high cholesterol levels, anemia and nephropathy (effects of diabetes on kidneys) is very important to prevent aggravation of diabetic retinopathy. Steroid injections given in the outer layer of eye ball prevent leakage of fluid for 6-8 weeks. Latest advances in the treatment of diabetic retinopathy has been the introduction of anti-VEGF therapy. Bevacizumab (Avastin) is one of such drugs which is injected directly into the eyeball and has shown promising results in management of Diabetic Macular Edema and Diabetic Vitreous Hemorrhage. Lipid or cholesterol lowering drugs (Atorvastatin) also help in reducing the Diabetic Retinopathy.
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Who is at risk for diabetic retinopathy?
Individuals with diabetes, particularly those with poorly controlled blood sugar, are at risk. The risk increases with the duration of diabetes.
Can diabetic retinopathy be prevented?
While not always preventable, strict blood sugar control, regular eye exams, and a healthy lifestyle can help prevent or slow its progression.
What are the treatment options for diabetic retinopathy?
Treatment options include laser therapy, anti-VEGF injections, and surgery, depending on the stage of diabetic retinopathy.
How often should people with diabetes have eye exams?
People with diabetes should have a comprehensive eye exam at least annually. More frequent exams may be recommended if diabetic retinopathy is present.
What lifestyle changes can help prevent diabetic retinopathy?
Maintaining a healthy lifestyle, including a balanced diet, regular exercise, avoiding smoking, and managing diabetes, can contribute to prevention and overall well-being.
Can diabetic retinopathy be managed solely with medication?
Medications are not a primary treatment for diabetic retinopathy. Management involves controlling diabetes, regular eye exams, and, if needed, specific treatments like laser therapy or injections.
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