Diabetes, is a condition which impairs the body's ability to use and store sugar. India is considered the diabetes capital of the world with over 20% of the world's diabetic population.
Diabetic Retinopathy is the leading cause of blindness among diabetics. Some diabetics never show any sign of problems in the eye. But in many cases, the disease progresses until massive bleeding, scarring or retinal detachment has occurred making recovery of sight impossible. Diabetic retinopathy increases with the duration of diabetes and almost all those who have been suffering from diabetes for over 30 years will be affected by Diabetic Retinopathy. Juvenile diabetics will be more prone to developing Diabetic Retinopathy at an early age.
Most often, Diabetic Retinopathy shows no symptoms until the damage is severe. However, some of the symptoms include:
1. Blurred vision and gradual vision loss
2. Shadows or missing areas of vision
3. Difficulty in reading or seeing up close
In most cases, because of the lack of symptoms, Diabetic Retinopathy is diagnosed only in the later stages, where revival of sight becomes difficult. This is the reason why all diabetics should regularly go in for eye check-ups.
I. Non-proliferative Diabetic Retinopathy
This is the first stage of Diabetic Retinopathy. During this stage hardly any symptoms are visible, though retinal swelling may be present. At this stage, the tiny retinal capillaries become semi-permeable eventually leading to leakage of fluid or blood into the eye.
II. Macular Edema
The macula is central part of the retina responsible for sharp and direct vision. The center of the macula begins to swell due to leakage of fluid from retinal capillaries resulting in blurred vision. Macular Edema can often overlap with the other stages. Early detection of macular edema wiII help ensure the most effective treatment.
III. Proliferative Diabetic Retinopathy
This is the final stage of Diabetic Retinopathy, where the blood vessels of the retina break and there is blood and fluid leakage into the eyes. Proliferative Diabetic Retinopathy leads to scar tissue development, retinal detachment, and blindness.
A comprehensive medical eye examination by an ophthalmologist is the best protection against the progress of Diabetes Retinopathy. It is advisable that all diabetics, even those who do not have refractive errors, go in for regular eye check-ups. This is especially true for pregnant women who have diabetes- they need to have their eyes examined every trimester.
Our approach includes:
1. Meticulous examinations of the interior of the eye using an Ophthalmoscope and 20D retinal lens.
2. Making a detailed diagram of the retina with colour coding.
3. Using the Fundus camera to capture serial photographs to understand the condition of the blood vessels.
4. Performing Fundus Fluorescein Angiography and Optical Coherence Tomography to assess the stage of diabetic retinopathy
5. Ultrasonography of the eye, if necessary.
Diabetic Retinopathy is a treatable eye disease if diagnosis is made early.
Management modalities include:
a. Metabolic Control: Strict control of blood sugar is mandatory. Additionally, control of BP lipid levels treatment of renal disease of present is also important.
b. Photocoagulation: It is the laser treatment for eyes offered to seal off the abnormal blood vessels and protect the central vision. Laser rays are directed into the eye and focused to a tiny spot on the retina. The heat seals off the abnormal blood vessels. We make use of Hi-tech Green Lasers for the treatment. It is an outpatient procedure where each session takes about ten minutes. The number of sessions required depends in the amount of damage the eye has undergone.
There may be a loss of some peripheral vision (side vision) and night and colour vision may reduce. But the benefits of laser treatment far outweigh the risks.
Laser treatment aims at saving the existent sight and not in helping to regain sharp sight as before.
c. Intraocular injections: of steroids and anti - V&GF agents may be used in addition to the above mentioned therapies
d. Advanced Vitreoretinal surgical procedures: including vitreotomy, membrance peeling, endolaser and gas/oil injection are needed to treat late stages of diabetic retinopathy.
Patients who have undergone laser treatment should follow certain instructions like:
1. Don't strain, bend suddenly, or lift heavy weights for at least four weeks after this laser treatment
2. Sleep with your head raised using pillows
3. Control coughing and sneezing with the appropriate medication
1. Fundus Flourescein Angiography (U.S.A)
2. Optical Coherence Tomography (U.S.A)
3. Retinal Photograph by Fundus Camera
4. 90D Slit Lamp Biomicroscopy
5. Indirect Opthalmoscopy
6. Retinal Laser Photocoaglation by Argon Green Laser (U.S.A)
Dr. Rakesh Kumar
Netra Nidan Eye Hospital
A/37, Sachivalya Colony, In front of Kendriya Vidyalaya Gate no.2, Kankarbagh, Patna 800020.