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Diabetic Retinopathy

What is Diabetic Retinopathy?

Both Type 1 and type 2 Diabetes are associated with high blood sugar levels and other metabolic derangements associated with damage to small capillary vessels of the body. Its effect on the retina is called Diabetic Retinopathy which can lead to blindness unless properly controlled or treated.

What happens in Diabetic Retinopathy?

Lack of blood flow in certain areas of the retina due to capillary damage leads to further changes in the vascular system like bleeding, small aneurysm formation, leakage of fluid called Exudation, and later abnormal New Vessel formation (Neovascularization). These new vessels may later bleed into the Vitreous (Vitreous Hemorrhage) and undergo fibrosis which leads to Detachment of the Retina and finally Blindness.

What are the risk Factors for Diabetic Retinopathy?

· Duration of Diabetes- higher risk with longer duration

· Poorly controlled blood sugar

· High Blood Pressure

· Pregnancy

· Smoking

· Anemia

What Are the Symptoms of Diabetic Retinopathy?

· Vision Drop (from minor losses to Blindness)

· Floaters (varying from Red to Black)

· Blurry areas in the field of vision (Scotomas)

· Eye Pain

What Are the types of Diabetic Retinopathy?

1/non-proliferative Diabetic Retinopathy – these spectra of stages are characterized by bleeding and fluid exudates in the retina. These may be asymptomatic as central vision might be normal.

When it affects the macula, it is called Diabetic Maculopathy which can be associated with a drop in sight.

2/Proliferative Diabetic Retinopathy- is characterized by new vessel formation in the retina which might lead to bleeding into vitreous (Vitreous Hemorrhage) and Detachment of the Retina due to contraction of these vessel bundles, culminating in blindness. New vessel formation around the Iris finally results in a painful blind eye.

How is Diabetic Retinopathy monitored?

Every Diabetic Retinopathy patient should undergo screening annually in the UK (Ref. UK National Diabetic Eye Screening Program-NDESP). There they will undergo dilated fundoscopy exams or fundoscopy photographs which will be reviewed by an ophthalmologist.

The patients with the advanced stages of the disease will be monitored by ophthalmologists and will undergo advanced testing including OCT scans and Retinal angiographies.

How is Diabetic Retinopathy treated?

The best way to manage is by Preventing Diabetic Retinopathy setting in by controlling metabolic factors including blood glucose levels, and blood pressure, and taking up regular exercise. Even after the onset of the condition, these measures help to prevent it from worsening and in some cases may even cause regression.

Ophthalmological management depends on the stage of the disease and the decision is made by an ophthalmologist.

The non-proliferative stagewhen the vision is not affected doesn’t need any ophthalmological intervention except when it is very severe or when patients have difficulty in accessing health care.

When the vision is affected in Diabetic Maculopathy it is treated with Focal Laser Treatment to the macula or Intravitreal injections of ANTI VEGF Agents or Steroids in a patient-specific manner to restore vision to a level as close to normal as possible.

Proliferative Diabetic Retinopathy is treated with either Pan Retinal Photocoagulation Laser Treatment or Intravitreal Injections of ANTI VEGF Agents into the eye with a view to preventing further vision loss and blindness.

Advanced Stages of Diabetic Retinopathy

These patients may need to undergo Vitrectomy Procedures for vision preservation or restoration and Surgical Glaucoma Procedures to Control Eye Pressure.

Diabetic Retinopathy in Pregnancy

Pregnant Diabetic women are at a higher risk of developing and advancing in Retinopathy and thus monitored frequently depending on the case basis. To minimize the effects on the developing baby they are treated differently, and they should seek guidance from an ophthalmologist.

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