Medical Retina

The retina is a layer of tissue (Fine meshwork of nerve fibrils) in the back of your eye that senses light, forms image and sends it to your brain via optic nerve. In the center of this nerve tissue is the most sensitive part of retina, known as macula. It provides the sharp, central vision needed for reading, driving and seeing fine detail.

Diabetic Retinopathy :

Diabetic retinopathy is a complication of uncontrolled, long standing diabetes that affects eyes. It is caused by damage to the blood vessel wall and narrowing / occlusion of blood vessels of retina, that occurs with uncontrolled blood sugar level.

Early symptoms include floaters, blurriness, dark areas of vision and difficulty perceiving colours. Blindness can occur.

Mild cases may be treated with careful strict diabetes management. Advanced cases may require treatment in the forma of laser, intravitreal injections or surgery.

There are two main stages of Diabetic Eye Disease.

NPDR (non-proliferative diabetic retinopathy)

This is the early stage of diabetic eye disease. Many people with diabetes have it. Very early stages of NPDR, patient may not find any defect in the vision.

With longstanding uncontrolled sugars with NPDR, tiny blood vessels leak, they cause swelling in the retina. Sometimes fat (Choesterol) leakage also occurs, known as hard exudates. When the macula swells, it is called macular edema. This is the most common reason why people with diabetes lose their vision. If cholesterol deposits get collected in the macula, it may permanently affect the vision.

Also with NPDR, blood vessels in the retina can close off affecting blood supply to macula. This is called macular ischemia. When that happens, blood cannot reach the macula. This leads to permanent vision damage

• Mild Non Proliferative Diabetic Retinopathy
• Moderate Non Proliferative Diabetic Retinopathy
• Severe Non Proliferative diabetic Retinopathy
• Diabetic Macular Edema

PDR (Proliferative Diabetic Retinopathy)

PDR is the more advanced stage of diabetic eye disease. It happens when the blood supply of retina gets hampered due to blockage of blood vessels in long standing uncontrolled diabetes, (ischaemia sets in), that’s when body starts growing new tiny, fragile blood vessels in order to provide nutrition to this deprived ischaemic retina. However these tiny new vessels are abnormal blood vessels that can lead to bleeding or leakage anytime. This is called neovascularization. These fragile new vessels often bleed into the vitreous. That is known as vitreous hemorrhage. If they only bleed a little, you might see a few dark floaters. If they bleed a lot, it might completely block all vision.

These new blood vessels can form scar tissue. Scar tissue can cause problems with the macula or lead to a detached retina.

PDR is very serious, and can steal both your central and peripheral vision.

• Proliferative Diabetic Retinopathy
• Tractional Retinal Detachment

What are the symptoms Diabetic Retinopathy?

You can have diabetic retinopathy and not know it especially in the early stage. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, you will notice symptoms such as:

• Seeing an increasing number of floaters or black spots
• Having blurry vision, affected near vision
• Seeing blank or dark areas in your field of vision
• Having poor night vision
• Loss of vision

Diabetic retinopathy symptoms usually affect both eyes, there is possibility of asymmetric eye involvement.

Diabetic Retinopathy Diagnosis :

• Dilated Fundoscopy : Drops are instilled in the eye to dilate the pupils. This allows your ophthalmologist to look through a special lens to see the inside of your eye.
• Optical Coherence Tomography (OCT): This machine scans the retina and provides detailed images of its thickness. This helps your doctor find and measure swelling of your macula in case of diabetic macular edema.
• Fundus Fluroscein angiography (FFA): helps your doctor see what is happening with the blood vessels in your retina, if there is any leakage from abnormal new vessels. Fluorescein angiography uses a yellow dye called fluorescein, which is injected into a vein (usually in your arm). The dye travels through your blood vessels. A special camera takes photos of the retina as the dye travels throughout its blood vessels. This shows if any blood vessels are blocked or leaking fluid. It also shows if any abnormal blood vessels are growing. OCT angiography is a newer technique and does not need dye to look at the blood vessels.

TREATMENT :

Medical Control

Controlling your blood sugar and blood pressure can reduce progression vision loss. Carefully follow the diet your nutritionist has recommended. Take the medicine your diabetes doctor prescribed for you. Sometimes, good sugar control can even bring some of your vision back. Controlling your blood pressure keeps your eye’s blood vessels healthy.

Intravitreal Injections

These are called anti VEGF injections. These include Accentrix, Razumab, Zaltrap, Eylea, etc. Anti-VEGF medication helps to reduce swelling of the macula, slowing vision loss and perhaps improving vision. This drug is given by injections (shots) in the eye. Steroid medicine is another option to reduce macular swelling. This is also given as injections in the eye. Your doctor will recommend how many medication injections you will need over time.

Vitrectomy Surgery

If you have advanced PDR, with vitreous hemorrhage (bleeding inside the eye) or tractional retinal detachment, your ophthalmologist may recommend surgery called vitrectomy. Your ophthalmologist removes vitreous gel and blood from leaking vessels in the back of your eye and settle the retina in case of detachment. This allows light rays to focus properly on the retina again.

5 Ways to Prevent Vision Loss from Diabetic Retinopathy

• See your ophthalmologist regularly every 6 months for dialated retina examination (Fundoscopy). Diabetic retinopathy may be found before you even notice any vision problems. Early diagnosis is vital to prevent permanent vision loss.
• If you have diabetes, talk with your primary care doctor about controlling your blood sugar. High blood sugar damages retinal blood vessels. That causes vision loss.
• Do you have high blood pressure or kidney problems. Ask your doctor about ways to manage and treat these problems.
• If you notice vision changes in one or both eyes, call your ophthalmologist right away.
• Get treatment for diabetic retinopathy as soon as possible. This is the best way to prevent vision loss.