Diabetic Retinopathy
What is Diabetic Retinopathy?
India stands to become largest diabetic
population by 2010.Population of diabetic patients in India
is 34 million acording to various sources.
A person with diabetes is at risk for developing diabetic
retinopathy among other ophthalmic disorders. Diabetic
retinopathy is the leading cause of blindness in young and
middle-aged adults today. The longer a person has diabetes,
the greater their chance of developing diabetic retinopathy.
There are two types of diabetic retinopathy:
Non-Proliferative Diabetic Retinopathy (NPDR)
Proliferative Diabetic Retinopathy (PDR)
NPDR, also known as background retinopathy,
is an early stage of diabetic retinopathy and occurs when
the tiny blood vessels of the retina are damaged and begin
to bleed or leak fluid into the retina resulting in swelling
(diabetic macular edema) and the formation of deposits known
as exudates. Many people with diabetes develop mild NPDR
often without any visual symptoms.
PDR carries the greatest risk of loss of
vision and typically develops in eyes with advanced NPDR.
PDR occurs when small blood vessels on the retina or optic
nerve become blocked consequently starving the retina of
necessary nutrients. In response, the retina grows more
blood vessels (neovascularization). Unfortunately these new
vessels are abnormal and cannot replenish the retina with
normal blood flow.
PDR may lead to any one of the following
Vitreous hemorrhage - proliferating retinal blood vessels
grow into the vitreous cavity and break down. Both the
hemorrhaging and resultant scar tissue may interfere with
vision.
Traditional retinal detachment - scar tissue in the vitreous
and on the retina cause the retina to detach.
Tractional and rhegmatogenous retinal detachment - scar
tissue creates a hole or tear in the retina causing it to
detach.
Neovascular glaucoma - abnormal blood vessel growth on the
iris blocks the flow of fluid out of the eye causing the
pressure to increase and damaging the optic nerve.
What are the symptoms of diabetic
retinopathy?
Generally, people with mild NPDR do not have
any visual loss. A dilated eye exam is the only way to
detect changes inside the eye before loss of vision begins.
People with diabetes should have an eye examination at least
once a year. More frequent exams may be necessary after
diabetic retinopathy is diagnosed.
People with PDR experience a broader range of symptoms. They
may
see dark floaters
experience loss of central or peripheral vision
experience visual distortions or blurriness
experience temporary or permanent vision loss
How is diabetic retinopathy diagnosed ?
Diabetic retinopathy is diagnosed by
dilating the pupil and looking inside the eye with an
ophthalmoscope. If an ophthalmologist discovers diabetic
retinopathy, he or she may wish to order color photographs
of the retina through a test called fluorescein angiography.
During this test, a dye is injected into the arm and quickly
travels throughout the blood system. Once the dye reaches
the blood vessels of the retina, a photograph is taken of
the eye. The dye allows the ophthalmologist to detect
damaged blood vessels that are leaking dye.
Can diabetic retinopathy be prevented ?
The most effective overall strategy for
diabetic retinopathy is to prevent it as much as possible.
Strict control of blood sugar levels will significantly
reduce the long-term loss of vision from retinopathy. With
improved diagnosis and treatment, only a small percentage of
people with retinopathy develop serious vision problems.
What are the current treatment options for a person with
diabetic retinopathy ?
Because the earliest stages of diabetic retinopathy include
inflammation, intraocular corticosteroids have been utilized
with some success in selected patients. This form of
treatment includes the use of a long-acting corticosteroid (triamcinolone
acetonide) injected into the vitreous cavity by way of a
very tiny needle under topical (drops) anesthesia. This
treatment may reduce retinal swelling and improve visual
acuity in patients with diabetic macular edema. However,
visual recovery may be limited and the effect may last only
3 to 6 months after the treatment. Other newer modalities
like Anti vascular endothelial growth factor drugs(
Lucentis,Macugen and Avastin )have been proved to be quite
successful in reducing macular edema and new vessels
temporarily. However they do not work well all alone unless
combined with adequate photocoagulation.
What does Shree Ramkrishna Netralaya offer
patients with diabetic retinopathy?
Diabetic Eye Unit established at SRN
provides constant care for diabetic patients.It involves
routine screening of diabetics to detect retinopathy.If
detected early patients can be managed medically by FFA and
laser treatment,thereby preventing further decrease in
vision.
We have found very encouraging results with
use of Anti VEGF drugs like Avastin and Lucentis in cases of
macular oedema and PDR cases .
Patients presenting at a later stage with
decreased vision due to vitreous hemorrhage and tractional
retinal detachment require vitrectomy We have experienced VR
surgeon to perform vitreoretinal surgeries
Procedures at Shree Ramkrishna Netralaya
▪ Fundus fluorescein angiography (FFA)
with Fundus Camera (Carl Zeiss Meditech,Germany)
▪ PRP( Pan retinal photocoagulation) argon Green laser
(Iris Medical,USA)
▪ Grid laser
▪ Cryopexy
▪ A R M D Management
▪ PDT (Photo Dynamic Therapy)
▪ Anti VEGF Injections (Lucentis and Macugen
▪ Scleral buckling
▪ Vitrectomies
▪ Trauma Care
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