Diabetic Retinopathy: How to Avoid and How to Cure

Special edition on World Sight Day

Every person in our country has heard about diabetes. Wondered, why?

Diabetes is a condition which develops over time and affects 425 millions of people in the world. In diabetes, a person has high blood glucose (sugar) levels. These raised blood glucoseif left untreated for a long time can lead to complications such as diabetic retinopathy (affects retina present in the eyes), diabetic nephropathy (affects kidneys), and diabetic neuropathy (affects nerves present in the peripheral parts of the body). That is why we are often told to keep our blood glucose levels in check.

Diabetic Retinopathy

It is mesmerising how our eyes work and coordinate to make us see how beautiful this world is. Retina is a part of the eyes that detects light and translates into signals that could be identified by the brain (optic signals). Now, these optic signals are sent to the brain where it does magical things and we visualise what is there we want to see.

In case of diabetes, blood vessels in the retina get damaged and a condition is developed known as “Diabetic Retinopathy.” Due to high blood glucose levels, the blood vessels present in the retina get ruptured which causes fluid to leak out of the vessels and causes complications such as blurred vision, and loss of vision.

Complications of Diabetic Retinopathy

Diabetic retinopathy may cause certain complications related to eyes that may hinder our day to day functions which include:

1. Dark spots or patches in vision
2. Strings or webs floating in vision (floaters)
3. Blurred vision
4. Changes in vision
5. Colours may appear washed out or faded (impaired colour vision)
6. Impaired night vision
7. Distorted vision
8. Loss of vision

Eye floaters lead to distorted vision

Screening of Diabetic Retinopathy

To detect the presence of diabetic retinopathy, certain eye screening exams are performed

1. Visual Acuity Testing: It is an eye test used to determine vision at certain distances.
2. Tonometry: This test is performed to measure pressure inside the eye i.e. intraocular pressure.
3. Pupil Dilation/ Fundoscopy: In this test, eye drops are used for dilation causing pupil to widen which allows your doctor a better view of eye for examination.
4. Optical Coherence Tomography (OCT): It is an imaging test that uses light waves to take cross-sectional pictures of your retina. It provides detailed images of the tissue in eye.
5. Fluorescein Angiogram: In this test, a fluorescent dye is injected into bloodstream. The dye highlights the blood vessels in the eye so they can be photographed.

Fundoscopy examination is a simple procedure that requires half hour of your time. Every person with diabetes shall get it at least once a year. In this examination, you will be administered an eye drop that will dilate your pupils (those pretty black thing in our eyes) to make our retina more visible. After about 15 minutes, your vision will become blurred and images of your retina will be captured by a camera and your procedure will be completed. This blurred vision may be present maximum upto 6 hours. The images captured will give the status of your eyes.

Stages of Diabetic Retinopathy

Stage I: Background retinopathy/ mild nonproliferative retinopathy (Mild NPDR)

In this stage, little balloon like figures starts emerging in the blood vessels of retina known as ‘microaneurysm’. These may burst and cause fluid leakage. In this stage, your sight is not affected and the condition is reversible with proper care.

Stage II: Pre proliferative retinopathy/ moderate nonproliferative retinopathy (Moderate NPDR)

In this stage, the blood vessels present in the retina swell and get more deformed. Complications arise and there is a high probability that your vision could be impaired. Here, you will be advised to get screening eye examinations every three to six months.

Stage III: Severe nonproliferative retinopathy (Severe NPDR)

This stage is characterised by blocked or ruptured vessels which leads to lack of blood supply in various regions of retina. This oxygen deprived region secretes some factors to form new blood vessels. In this stage, our body is fighting like a warrior to keep us from further damage. There is a high probability that your vision may be affected and you will be provided treatment to reverse this stage.

Stage IV: Proliferative diabetic retinopathy (PDR)

This is the last stage of diabetic retinopathy. The new blood vessels formed in the retina are fragile and can easily be damaged and bleed into the retina. The tissues that had these blood vessels also contract as a defence mechanism and leads to retinal detachment (peeling of retina from its place). This may lead to permanent loss of vision (blindness).

Prevention of Diabetic Retinopathy

It is always great to keep things in hand before they get worse. I am always up for, “Precaution is better than cure.” Following are the few things that may help in preventing the development of diabetic retinopathy:

1. Keep your blood glucose levels in range and constantly monitor them.
2. Maintain a healthy lifestyle and check your medicine intake.
3. Control in diet by including lots of green vegetables and foods rich in fiber.

4. Get into at least 30 minutes of physical activity every day.

5. Reduce smoking.

6. Monitor your blood pressure and cholesterol levels regularly.

7. Get regular screening test.

Treatment of Diabetic Retinopathy

There are modernised techniques available to cure diabetic retinopathy which includes:

1. Anti-VEGF Injection Therapy: The therapy can reverse abnormal blood vessel growth and decrease fluid in the retina. Most people require monthly anti-VEGF injections for the first six months of treatment. Thereafter, injections are needed less often.

2. Laser Surgery: Laser burns for diabetic retinopathy slow the leakage of fluid, reduce swelling in the retina. The procedure is usually completed in one session, but some people may need more than one treatment.

3.Corticosteroids: These drugs are either injected or implanted into the eye. It can be used alone or in combination with other drugs or laser surgery to treat diabetic retinopathy.

4. Panretinal laser surgery/Panretinal photocoagulation: Treatment involves tiny laser burns in areas of retina that is stretched away from its position. This procedure is used to treat proliferative diabetic retinopathy (PDR).

5.Vitrectomy: A surgical procedure used to treat diabetic retinopathy, usually requires a single overnight stay in the hospital.

On this World Sight Day, I wish you healthy eyes and a happy life! :)

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Sources:

1. https://www.nhs.uk/conditions/diabetic-eye-screening/ (Accessed on October 11, 2018)
2. https://emedicine.medscape.com/article/1225122-treatment (Accessed on October 11, 2018)
3. https://www.nhs.uk/conditions/diabetic-retinopathy/stages/ (Accessed on October 11, 2018)
4. https://www.health24.com/Medical/Tests-and-procedures/Fundoscopy-Client-20120721 (Accessed on October 11, 2018)
5. https://webeye.ophth.uiowa.edu/eyeforum/tutorials/diabetic-retinopathy-med-students/Diabetic-Retinopathy-medical-students.pdf (Accessed on October 11, 2018)