Diabetic retinopathy

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Causes
Types
Risk Factors
Symptoms
Diagnosis
Treatment
Prevention

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Diabetic retinopathy is a common diabetic eye diseasewhich is caused due to some changes in the blood vessels of the retina. The retina is a light-sensitive tissue that is present is the eye and is necessary for normal vision. In some cases of diabetic retinopathy, the blood vessels usually swell and leak out the fluid. While in other cases, there is an abnormal growth of new blood vessels on the surface of the retina. This condition usually affects both eyes and longer the person is suffering from diabetes, the more likely they will be affected with diabetic retinopathy.

Dr Haresh Asnani, a retina specialist from Advanced Eye Hospital and Institute, Navi Mumbai tells us about its symptoms, causes, prevention and more.

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Causes

Diabetic retinopathy is damage to the retina (innermost layer of the eye) caused by prolonged and inadequate blood glucose control. The small blood vessels in the retina are damaged and weakened.

The early symptom of eye problem related to diabetes is blurred vision and double vision. It can also cause a severe, permanent loss of vision. It also increases the risk of developing cataracts and glaucoma.

Here are 7 warning signs all diabetics need to watch out for.

Types

Diabetic retinopathy is usually classified into two main categories – Non-proliferative diabetic retinopathy (NPDR) and Proliferative diabetic retinopathy (PDR).

Non-proliferative diabetic retinopathy (NPDR): In diabetic retinopathy retina receives less blood supply, a condition called hypoxia. Because of hypoxia the earliest changes seen are swelling and blood clots on the retina. These changes are called non-proliferative or background diabetic retinopathy.

In advanced diabetic retinopathy there is increased blood clots and swelling affecting the patient’s vision.

Proliferative diabetic retinopathy (PDR): The patient’s vision can get affected in the earliest stages of retinal maculopathy. If untreated, these conditions can progress into proliferative diabetic retinopathy, a condition in which there is bleeding from the retina (vitreous or pre-retinal haemorrhage) and blood vessels growing from the surface of retina invade the front part of the eye. This can be a very dangerous and fast progressing condition which requires surgical intervention in most of the cases.

If not treated, it leads to end stage of diabetic retinopathy which is known as neo-vascular glaucoma. In this condition the intraocular (eye) pressure goes up due to blood vessels invading front part of the eye resulting in painful blind eye.

Risk Factors

People suffering from type1 diabetes and type2 diabetes are at higher risk of suffering from diabetic retinopathy. The only way to reduce your risk and prevent diabetic retinopathy is to control your blood sugar levels.

Symptoms

One may not observe any noticeable symptoms during the initial stage of the disease. But over time your condition may get worse as the retina gets damaged which ultimately leads to loss of vision. Usually during the later stage of the disease, one may observe symptoms such as -

Blurred vision

Difficulty with color perception and night vision

Fluctuating vision

As retinopathy advances or diabetic maculopathy starts, a patient’s vision goes down. When there is bleeding from the retina, patients experience floaters i.e. a shower of black spots in front of the eye. When the proliferative stage starts, the blood vessels pull the retina leading to retinal tears and sudden loss of vision.

There is a certain amount of pressure in the eye which maintains the eyeball in its shape and also plays a role in blood circulation in the eye. The normal intraocular pressure is 17-20 mm Hg. If it goes above that it starts pressing on the optic nerve and retinal nerve fibre layer and cause gradual loss of vision. End stage diabetic retinopathy results in unbearable pain due to rise in intraocular pressure.

Read about 9 interesting things your eyes reveal about your health.

Diagnosis

According to Dr Asnani, 'Diagnosis of diabetic retinopathy has to be done at the earliest stage possible. After being screened for diabetes, the patient should have a baseline retina check-up.' The tests done are -

Optical coherence tomography (OCT): It shows thickness in the centre of retina.

Fluorescein angiography: It helps to determine the circulation of the retina.

Here's why early detection of diabetes is good for your eyes.

Treatment

The common treatment options for diabetic retinopathy are -

Injections: Intravitreal steroid injections or anti-vascular endothelial growth factor injections are given to control diabetic maculopathy. In early stages of

Laser treatment: In early stages of retinopathy when there is ischemia (lack of blood) of retina, laser treatment is used. In later

Surgery: In later stages surgical procedure called vitrectomy (removing the blood clot filled vitreous from the centre of the eye) is done and then the retina is treated with laser. Then a gas or silicon oil is injected as a substitute to the vitreous into centre of the eye.

In some cases where there is excessive bleeding in the retina, injections are combined with surgery .

Here are 3 reasons you’re unable to keep diabetes under control.

Prevention

The single most important thing you can do to prevent long-term complications of diabetes is controlling your blood sugar. In addition to this, there are few factors that help in reducing your risk of developing complications of diabetes. These are -