Exploring Fundamentals Of Diabetic Retinopathy
What Is Diabetic Retinopathy?
- Introduction: –Diabetic retinopathy is a disease of retina caused by high blood sugar levels.
That is why every diabetic patient should have a yearly retinal evaluation.
2. Types of Diabetic Retinopathy :-
a) Non-proliferative diabetic retinopathy: – Can be reversed and treated to get back good vision.
b) Proliferative diabetic retinopathy:– It is Advanced, should be treated to retain vision.
What are the risk factors for Diabetic Retinopathy?
- Diabetes duration
- Elevated blood sugar levels
The retina is the light-sensitive inner layer of the eye. The layer is made of numerous blood vessels and photosensitive receptor cells spread across the eye. The constant blood supply in neurons enables the retina to function properly.
Diabetes is a condition in which the blood sugar levels in the blood are elevated. High blood sugar causes damage to the blood vessels in the eye, leading to leakage and capillary occlusion. As a result of bleeding, the vessels fail to supply adequate oxygen to the retina, and the cells eventually start dying. This condition is called retinal ischemia.
Vision loss due to diabetic retinopathy starts with diminishing central vision, a condition caused by macular edema or swelling of the central retina called macula. The macula is responsible for best vision in any person
- Spots or falling dark strings (floaters)
- Blurr vision
- Dim vision
- Dark patches
- Vision loss
- Fluctuating vision
- Reduction in field of vision
- Distorted vision or wavy vision or metamorphopsia
Primary prevention involves control of glucose and blood pressure. Adequate blood sugar control and periodic eye examination is essential.
Diabetic retinopathy causes irreversible vision loss. Hence, taking prior precautions is a wise step.
For screening, you need to visit an ophthalmologist. First, the ophthalmologist will ask for details about blood sugar control – Fasting, postprandial and Hba1c, as well as blood pressure levels and serum lipid profile.
Slit lamp examination and dilated fundus examination would be performed. Careful examination for the presence of any abnormal blood vessels on the iris and retina as well as cataract (associated with diabetes). Intraocular pressure (IOP) is checked. Dilated Retinal examination should include a macular examination (contact lens or non-contact lens) to look for microaneurysms, hemorrhage, hard exudates, cotton wool spots, retinal swelling (DME).
Finally, the doctor will ask for the following tests if required for further diagnosis and management.
- Fluorescein Angiography
- Optical Coherence Tomography (OCT)
Screening tests are an effective tool in diagnosing diabetic retinopathy in the initial stages and halting their progression to advanced stages
Fluorescein angiography (FA) may be used to determine the degree of ischemia or the presence of retinal vascular abnormalities and to assess the flow of blood in retinal blood vessels.
Optical coherence tomography (OCT) is useful to determine the presence and location of macular edema as well as retinal thickness measurements. The OCT can be sequentially obtained to determine whether the macular edema is responding to therapy.
Preventing diabetes is the best way to prevent diabetic retinopathy.
Hemoglobin A1c is a measure of the degree of glycemic control over the past 3 months. A goal of 5.5 % – 6.0 % is ideal, although difficult to achieve in some patients. Generally, HbA1c ≤ 7 is the goal.
If you have diabetes, then you can prevent it with the following guidelines:
- A strict and healthy diet including superfoods good for eye health
- Walking for 45 minutes every day
- Including superfoods that help in sugar level management. UseFood swaps to prevent sugar level increase.
- Regular diabetes as well as eye checkups.
- Pay attention to vision changes.
General management –
Systemic control of diabetes, hypertension, hyperlipidemia, hypercholesterolemia, nephropathy, and other diseases is extremely important.
Ocular management –
Treatment is usually needed in order to prevent loss of vision or to try to improve vision which includes
1. Photocoagulation – It includes a focal/grid/ pan-retinal laser treatment in which the blood vessels are burnt and sealed to stop fluid leakage.
2. Injection of drugs (anti-VEGF therapies or corticosteroids) – decrease the retinal swelling and regress the new abnormal blood vessels
3. Pars Plana Vitrectomy – It is a type of minimally invasive eye surgery which is indicated in the case of advanced disease with vitreous hemorrhage and retinal detachment.
Prevention is better than cure. Therefore it is important to visit the ophthalmologist regularly for a periodic eye examination for early diagnosis and management of diabetic retinopathy in order to prevent irreversible vision loss. Prognosis is better if treatment is done at the early stages of the disease. Hence, we advise all diabetics to visit Krishna eye center for comprehensive eye examination and diabetic retinopathy treatment in Mumbai.