Diabetic Retinopathy

People with diabetes are at risk of diabetic retinopathy because small blood vessels in the retina may become diseased and damaged. The longer a person has diabetes, the greater the risk of diabetic retinopathy. Available treatments can slow or prevent further vision loss.

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About

Diabetic retinopathy is the term used to describe changes in the retina due to the microvascular changes seen in diabetes. The retina is the innermost layer of the eye which converts the light into biochemical signals which are subsequently transmitted to the brain. In diabetes mellitus, the body is unable to metabolize sugar in the body. The high blood sugar levels cause microvascular changes, where tiny blood vessels that either become blocked or leaky. The tiny blood vessels that distribute blood and oxygen to the eye can also be affected. The result in the retina is leakage of fluid and protein, bleeding and retinal detachment if not managed properly.

The extent of these changes determines the type of diabetic retinopathy that you have. Nearly half of type 1 diabetics and a quarter of type 2 diabetics develop some sort of diabetic retinopathy. However, not everyone who has diabetes develops diabetic eye problems. Even if you do, you will most likely have a mild form of retinopathy which may never progress to a sight-threatening condition, provided you keep your diabetes well-controlled.

Symptoms

Diabetic visual impairment from occurs mainly due to diabetic maculopathy and proliferative diabetic retinopathy. However, diabetes is also associated with other eye diseases that can also cause blindness. These include cataract, glaucoma and retinal vascular occlusions.

Treatments

Good control of diabetes and blood pressure is essential in reducing your risk of sight loss from diabetes. Regular screening eye tests are an important part of any prevention strategy to detect and prevent sight loss from diabetes. The earlier you have treatment, the better the chance of good vision in the long run. If you have diabetes and are pregnant or if you have gestational diabetes mellitus, you will need to have more frequent retinal screening during pregnancy and after your baby is born.

Laser is an important therapy modality for sight-threatening diabetic retinopathy. Retinal laser treatment is the first line treatment for diabetic macular edema and proliferative diabetic retinopathy. Laser for macular edema is localized to the macular area. The aim of laser is to seal off any leaking retinal blood vessels and to reduce the swelling of the macula. Laser for proliferative diabetic retinopathy is more extensive. The aim is to burn the ischemic retinal cells in the retinal periphery to stop them from producing chemicals that stimulate the growth of the abnormal new blood vessels. This type of laser is performed when the abnormal new blood vessels are detected.

Intravitreal injections are the injections of medications into the vitreous cavity of the eyeball. Intravitreal injections with steroid or anti-VEGF agents are relatively new but have been very successful in treating diabetic macular edema. However, you may require repeated injections because the effect of each injection may only last a few months.

Vitrectomy surgery is reserved for advanced retinopathy where the vision is severely affected. This procedure involves removing the vitreous gel from the vitreous cavity and replacing the gel with a clear solution. The aim of surgery is to remove the blood and scar tissue that has developed within the eye. This is a very specialized and complicated operation and may require you to follow some stringent positioning instructions after surgery.

Further information on Diabetic Retinopathy can be found here:

Vision Eye & Health: http://www.vision-and-eye-health.com/diabetic-retinopathy.html

RANZCO: https://ranzco.edu/find-out-more-about/diabetic-retinopathy

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