Overview Diabetic retinopathy is an eye complication that may occur in patients with diabetes. This is due to the harmful effects caused to the tissues at the back of the eye, known as the Retina. These effects may not cause any symptoms at first but may lead to serious sight-threatening problems during the late stages. These problems occur more often in people suffering from diabetes for a long period or due to poor control of blood sugar levels. Symptoms Some common symptoms that may occur are blurred vision fluctuating vision string-like or web-like floaters loss of vision dark spots in the vision Therefore, it is advised that a regular eye check-up, including a retina examination, be done on annual basis. This check-up must first be undertaken at diagnosis of diabetes, and annually or as frequently advised. Causes Due to high blood sugar levels in the bloodstream, the blood vessels carrying this blood get damaged. Over time, the loss of finer blood vessels leads to poor blood supply to various tissues. As a result, the eye attempts to produce new blood vessels, which are often fragile and develop improperly. When these new vessels have not yet formed, the disease is called as Non-Proliferative Diabetic Retinopathy (NPDR). These may be divided into various stages like mild, moderate, severe and very severe depending on the intensity of damages already incurred When the new vessels have started forming, they are abnormally leaky and tend to bleed. This stage is called Proliferative Diabetic Retinopathy (PDR). This advanced stage requires urgent therapy and management as it may lead to vision loss and lead blindness. This is also referred to as Advanced Diabetic Eye Disease (ADED). Sometimes retinal blood vessel damage leads to a buildup of fluid (edema) in the central portion (macula) of the retina, known as Diabetic Macular Edema (DME). If macular edema decreases vision, treatment is required to prevent permanent vision loss. The treatment is usually in the form of an injection given directly inside the back of the eye or in form of laser therapy, called focal/grid laser. When there is bleeding occurs due to PDR, the blood can disperse in the jelly-like fluid in the back of the eye (Vitreous) which is known as Vitreous haemorrhage (VH). This warrants urgent therapy in the form of in-the-eye injections, laser therapy or surgery, or most often a combination of these options. When these stages are not treated, or due to poor blood sugar control, the disease may keep progressing. This can then lead to the formation of fibrous bands in the back of the eye which leads to a pull on the retina. This pull leads to the detachment of the retina from other eye structures leading to Retinal Detachment (RD). This often can lead to sudden vision loss and requires surgical correction. Lastly, when all these therapies fail, the proliferating new vessels keep bleeding and leaking fluid into the eye causing high pressures within the eye, called Glaucoma. Risk factors Anyone who has diabetes can develop diabetic retinopathy. The risk of developing the eye condition can increase as a result of: Having diabetes for a long time Poor control of your blood sugar level High blood pressure High cholesterol Diabetes-related other complications, such as Nerve related problems (Neuropathy), kidney related problems (Nephropathy) Pregnancy Tobacco use Associated heart-related illness Complications Diabetic Macular Edema: This is the swelling of the central part of the retina which is important for good vision. You may observe blurred vision or wavy vision, which can be confirmed by your retina specialist. This can be confirmed and measured with newer techniques such as Optical Coherence Tomography (OCT) and Fundus Fluorescein Angiography (FFA). This is treated with medicines injected directly into the back of the eye or using a grid/focal laser. Vitreous haemorrhage: When the new blood vessels bleed in the clear, jelly-like (Vitreous) fluid in the back of the eye, you may experience web-like or thread-like floaters. These may usually resolve on their own in a few days or weeks if mild, but when the bleed is severe, it may lead to total loss of vision. This can be corrected by surgical intervention. Laser therapy is also done to prevent further bleeding in the eye. Retinal detachment: This happens as a consequence of vitreous haemorrhage. A pull is caused by membranes formed due to blood leading to initially flashes of light, loss of part of the vision and later total loss of vision. Glaucoma: Due to leaking new vessels, bleeding, and new vessels growing in the front part of the eye, the pressure in the eye increases. This leads to damage in the Optic nerve, which carries signals to the brain. This can be corrected by medicines, or at times surgery to lower the increased pressures. Blindness: When the above-mentioned conditions are not managed in time, or due to poor control of blood sugars, these situations can often end up in blindness. Prevention Diabetic Retinopathy can be prevented by firstly good control of blood sugar levels. But, after years of diabetes, the disease may still trouble most patients. Its effects can be reduced by practising the following few steps: A healthy routine includes walking and aerobic exercises for 20-30 mins each day. Better dietary changes to control blood sugar levels. Regular monitoring of blood sugar levels and noting it down in a diary to help recall better. This simple step goes a long way in ensuring good control over blood sugar levels. Regular blood testing of glycosylated haemoglobin (HbA1c) levels. This gives an idea as to the average blood sugar in the system and the overall health status of the patient. If maintained under 6.5%, most complications are prevented. Keep a check on blood pressure and lipid profile. These cause simultaneous harm to the eyes and body. Also, regular checkups must include kidney function testing and electrocardiography (ECG) to understand health status in a better manner. Regular eye check-ups, especially annually including a fundus/retina screening must be done by an eye doctor. The frequency of check-ups should be more if the control of blood sugar is poor or there are existing eye problems. This is because diabetic retinopathy may not be noticeable to the patients until late. One should get checked immediately if one experiences any visual disturbances. Take control of your blood sugars for your eye, before it takes away the most precious gift of life, Sight! Visit your nearest COMET Eye Hospital today Think EYE, Think COMET
