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 Diabetic Retinopathy Treatment |
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What is Diabetic Retinopathy ? |
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Diabetes is a disease that affects the small blood vessels of all the organs of the body. With progression, it inevitably involves the microvascular architecture i.e. the blood supply to the retina (sensory part of the eye) also. This manifestation of diabetes is called diabetic retinopathy.
In simple words, it is a disease of the blood vessels of the retina arising from diabetes. |
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What causes diabetic retinopathy & who is at risk? |
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The root cause is a long history of diabetes.
- Statistics indicate that among younger patients with diabetes, up to 8% of individuals will have this disease after 3 years of diagnosis and 25% at 5 years, 60% at 10 years, and 80% of diabetics will have this eye problem by 15 years.
- .In older Type-2 diabetics, up to 21% of patients have diabetic retinopathy at the time of the first detection of diabetes, and most develop some degree of retinopathy over time.
Uncontrolled diabetes, High blood pressure, High cholesterol, Kidney disease and Low hemoglobin worsen diabetic retinopathy. |
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What are the symptoms & signs of diabetic retinopathy? |
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1. It may remain asymptomatic for a long time.
2. However once the macula, i.e. the central part of the retina, develops a swelling, there would be noticeable deterioration in eyesight.
3. If there is bleeding within and in front of the retina, floaters (black spots or lines moving in front of the eye )would be seen or vision may be drastically reduced.
4. If the central retina gets detached, the vision loss becomes severe and chances of recovery even after surgery dip. |
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How diabetic retinopathy it diagnosed? |
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It can be diagnosed by a simple dilated eye examination to observe the retina in detail. If significant changes are found then investigations like Fluorescein Angiography and Optical Coherence Tomography may be done.
Fluorescein Angiography: This involves taking photographs of the retina after injecting a dye in a vein in the patient's arm. Once the dye reaches the eye, it helps to clarify the type and extent of disease, including detail of abnormal vessels and leakage.
Optical Coherence Tomography: In this test, photographs of the retina are taken to show its microscopic detail. This can help detect any early thickening of the retina or any areas of leakage. The type and amount of thickening can be delineated and an assessment of any pull on the retina can also be made. It also makes for an excellent tool to follow up after treatment to assess the effect of the treatment done and any need for repeating the treatment. |
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What is the treatment of diabetic retinopathy? |
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The gold standard of therapy is LASER photocoagulation.
LASER can help to prevent bleeding in the eye and also to decrease the swelling of the retina. However, it cannot usually restore vision already lost due to the retinal damage. It therefore has to be appropriately timed.
Other options now available are injecting drugs like steroids, AVASTIN and LUCENTIS into the eye. They also aim to reduce the swelling in the retina and aid in drying up of abnormal blood vessels. These have proved to be quite effective and are even known to have improved vision in some cases. A major drawback is that the effect of these drugs is limited, thus necessitating many patients to need these shots on a regular basis.
A combination therapy of LASER and injections is also increasingly being favored. |
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What are the surgical options? |
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Advanced microsurgery into play in cases with a non-resolving bleed in the eye or Retinal Detachment.This involves highly complex Vitreo-Retinal surgical procedures.
With the advent of highly advanced technology in medicine, some amount of visual recovery can be achieved in a large number of advanced cases. |
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| Cases that present early and are adequately lasered are generally able to maintain good vision. Keeping a strict control on blood sugar levels amongst diabetic patients is vital to slow the progression of this disease. A combination of injectable drugs and laser can provide improved outcomes in even moderately advanced cases. The results may not be very good in advanced cases even after surgery, however the attempt here is to retain at least some useful vision. |
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What are the possible complications? |
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Complications of diabetic retinopathy could be a non-resolving swelling of the retina, bleeding into the eye and Retinal detachment.
Complications of LASER are minimal. In some cases the swelling of the retina might increase initially, but it also normalizes in most patients.
Complications of AVASTIN per se are also minimal, but the main risk is that of infection while injecting the drug. The procedure is therefore routinely performed the injection in our operation theatre, taking all aseptic precautions.
Complications of steroid injection could similarly be infection, rise in eye pressure (glaucoma) and cataract.
Complications of surgery could be repeat bleeding into the eye or damage to the retina. |
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