Diabetic Retinopathy

Her sweet charms are second to none. She has spellbound 40 million Indians already. Beware of her sweetness, for she slowly and ever so silently ensnares you… and before you know it, she would have robbed you of your sight… like 5 million people every year. Who is this enchantress? She is Diabetes.

What is meant by Retina?

Retina is the light sensitive tissue that is present at the back of your eye. Light rays from the object are focused onto the retina, which are then converted into impulses by the retina and sent to the brain so that we can ‘see’ the object. The macula is the centre of the retina which is responsible for fine vision.

What is Diabetic Retinopathy?

Diabetic Retinopathy is the damage that is caused to the blood vessels of your retina because of diabetes.
You are more likely to develop diabetic retinopathy, the longer you have had diabetes (Type 1 or Type 2) and the more uncontrolled your diabetes is.

What causes Diabetic Retinopathy?

Diabetes causes unnaturally high amounts of sugars (glucose) to remain in your blood. This causes damage to your blood vessels including those that supply the retina.

There are two types of Diabetic Retinopathy:

1.Background or Non Proliferative Diabetic Retinopathy: This is the earliest stage. Here, damaged blood vessels in your retina leak fluid and blood into your eye.

This causes  changes in your eyes including:
• Retinal Hemorrhage: Blood leaks into your retina.
• Microaneurysms: Small buldges develop in your retinal blood vessels that leak fluid.
• Hard Exudates: Cholesterol or other fat deposits may leak into your retina.
• Macular Edema: Fluid leaking into your macula may cause it to swell. This affects its functioning.
• Macular Ischemia: Smaller blood vessels called capillaries close down reducing the blood supply to your macula. Without sufficient oxygen and nutrients, your macula cannot function properly and blurring of your vision occurs.

 

 

2. Proliferative / Advanced Diabetic Retinopathy: By this stage, many of your retinal blood vessels have closed and blood supply has been affected. Your retina attempts to make up for this damage by growing new blood vessels (hence the word proliferative). Unfortunately, these new blood vessels are abnormal and hence it causes further damage in the following ways:
• Traction Retinal Detachment: These new blood vessels are often found along with formation of scar tissue which crumples, pulls and detaches your retina. This wrinkling and detachment cause further vision loss.
• Vitreous Hemorrhage: These new blood vessels being delicate bleed into your vitreous (the gel in your eye). Depending on the quantity of the bleed, you may either see floaters     or have vision loss which is usually temporary.
• NeoVascular Glaucoma: Because of new blood vessels forming in your iris (coloured part of your eye) the normal outflow of fluid gets blocked. This causes pressure to increase     in the eye which leads to damage to your optic nerve.

Following are the risk factors:

Longer duration of diabetes
Uncontrolled high sugars
High cholesterol
High blood pressure
Smoking
Pregnancy

Do I have Diabetic Retinopathy? (Signs and Symptoms)

In the earlier stages of a diabetic retinopathy, you may not even have any symptoms at all. Gradually as the damage goes on occurring, you may notice:

Blurry vision
Fluctuations in Vision
Spots or strings floating in your field of vision
Difficulty in perceiving colours
Shadows or dark areas in your vision
Vision Loss

 

 

Usually both your eyes will get affected.

What are the complications of Diabetic Retinopathy?

Vitreous Hemorrhage
Retinal Detachment
Glaucoma
Blindness

What are the tests for Diabetic Retinopathy?

Diabetic Retinopathy is best diagnosed by an examination of your eyes which is done after dilating your eyes with drops.
Also, the following tests may be done:
Vision Test
Eye pressure testing
Fluorescein Angiography: This helps to see the damage to your blood vessels.
Optical Coherence Tomography: This helps to see the thickness of your retina and know if fluid has leaked into it.

What is the treatment for Diabetic Retinopathy?

It depends on the stage of your disease:
Early:
In the early stages, you may only require regular monitoring by your eye doctor along with strict control of your blood sugars.
Advanced:
Here, surgery is usually required.
• Focal laser treatment / Photocoagulation:
This is used to slow down or stop the leakage of fluid or blood into your eye. If your blurred vision was due to swelling of your macula, your vision might not become completely normal.
• Scatter Laser Treatment / Pan- retinal Photocoagulation:
Laser burns are used to shrink and scar the abnormal blood vessels. This is used for areas that are away from the macula. There are chances of you having diminished night or peripheral vision after this procedure.
• Vitrectomy: This is used to remove blood from the vitreous as well as scar tissues in your eye. The gel that is removed is replaced with a salt solution.
Surgery can be used to slow down the damage or halt its progress; however total cure is not possible. Hence, regular visits to your eye doctor for examinations cannot be substituted.

How can I prevent Diabetic Retinopathy?

• Keep a strict check over your diabetes. Regular exercises and blood sugar monitoring are a must.
• Get an HbA1C test done. This helps you know the average blood sugar levels over the last 3 months.
• Keep your blood pressure and cholesterol under control.
• Quit smoking
• Keep an eye on your vision so that you will be able to notice the slightest change.
• Visit your eye doctor regularly even if you do not experience any symptoms.