Diabetic retinopathy also known as diabetic eye disease, is a medical term used to describe the condition of damage to the retina and eventual blindness (if not treated) as a result of Diabetes Mellitus.
SIGNS & SYMPTOMS OF DIABETIC RETINOPATHY
- In first stage called non-proliferative diabetic retinopathy (NPDR) there are no symptoms.
- Microaneurysms & blocked retinal blood vessels can be detected only through fundus photography & fluorescein angiography.
- Macular edema are formed during NPDR.
- Macular edema occurs when protein deposits collect under the macula of the eye, causing it to thicken & swell.
- Distortion in the central vision of eye in a person can occur.
- Formation of abnormal new blood cells in the second stage called proliferative diabetic retinopathy (PDR).
- Bursting & bleeding of new blood vessels.
- Specks or spots of blood floating in the eye which will go away on their on.
- A following burst of the vessels may occur again which will lead to greater amount of blood draining & present in the eye.
- Blurred vision
- Hematoma
- Hemorrhage
- Cotton wool spots.
COMPLICATIONS
- Severe bleeding within the eye/Hemorrhage
- Vitreous hemorrhage
- Detachment of the retina
- Glaucoma
- Blindness.
CAUSES & RISK FACTORS
- Diabetes Mellitus: Type I and Type II
- Duration of Diabetes
- High blood pressure
- High blood cholesterol
- Tobacco use.
DIAGNOSIS OF DIABETIC RETINOPATHY
- Visual acuity test for seeing how well a person can see from a distance.
- Ophthalmoscopy: Examination of the retina through a special magnifying glass for a narrow view of the retina.
- Fundus Photography: Photographing the retina of the eye & photo documentation.
- Fluorescein angiography: Utilizes a fluorescein dye which circulates in the vessels of the eye and differentiates any blocked or leaking vessel from the normal ones.
- Retinal vessel analysis detects abnormalities in the retinal vessels & walls of diabetic patients.
- Optical coherence tomography (OCT): An optical imaging modality which produces cross-sectional images of the retina (B-scans) which are used to measure the thickness of the retina.
TREATMENT OF DIABETIC RETINOPATHY
Drug treatment:
- Intravitreal triamcinolone acetonide: This is a long acting steroid drug that is injected in the vitreous cavity, producing results by a decrease in macular edema & a subsequent increase in the visual acuity.
- Intravitreal anti-VEGF: Good results and an increase in visual quality produced by injecting of anti-VEGF agents like, bevacizumab, aflibercept, ranibizumab.
- Topical NSAIDs.
Laser Photocogulation:
- Modified grid: A ‘C’ shaped area around the macula is treated with low intensity small burns. This helps in clearing the macular edema.
- Periretinal photocoagulation (PRP): Also called scatter laser treatment, applied to treat proliferative diabetic retinopathy (PDR).
Surgery:
- Vitrectomy:
a) Surgical removal of the vitreous humor from the eye.
b) Involving the removal of the cloudy vitreous humor & replacing it with a saline solution.
PREVENTION
- Treatment of underlying conditions like hypertension & high blood cholesterol.
- Early detection of damage to the retina by regular screening tests.
- Treatment & management of obstructive sleep apnea.
- Cessation of smoking & tobacco.
- Management of diabetes & blood sugar.