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Diabetic Retinopathy
Diabetic retinopathy is retinopathy
(damage to the retina) caused by complications
of diabetes mellitus, which can eventually
lead to blindness. It is an ocular manifestation
of systemic disease which affects up to
80% of all patients who have had diabetes
for 10 years or more. With the increase
in diabetic cases every year, diabetic retinopathy
is now the sixth most common cause of blindness
in India. Despite these intimidating statistics,
research indicates that at least 90% of
these new cases could be reduced if there
was proper and vigilant treatment and monitoring
of the eyes citation.
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Are the eyes of all diabetics affected?
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Eyes of about 80% of the diabetic
patients are affected over time.
The longer the duration of diabetes
greater are the chances of developing
retinopathy.
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How can diabetes affect the eye?
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Diabetes causes retinopathy, early
droplet type of cataract and makes
one more prone to developing glaucoma.
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What is diabetic retinopathy?
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Diabetes in responsible for micro
vascular changes all over the body
leading to typical kidney or nerve
problems etc. Similar changes in
vessels of retina produce diabetic
retinopathy. In this condition,
the retinal blood vessels are affected
causing insufficient supply of oxygen
and nutrients needed by the retina
to remain healthy. There are bleeding
spots and deposits of fatty material
with swelling of the retina. Thus
the retina is unable to transmit
visual messages to the brain resulting
in low vision or blindness.
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How does diabetic retinopathy cause
low vision or blindness? |
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Diabetic Retinopathy can be either
Non-proliferative: When the blood
vessels leak, macular edema may
occur, thereby reducing vision.
Proliferative: When new,
weak blood vessels grow or proliferate,
bleeding into the vitreous may occur
and cause severe visual loss
In moderate cases, the visual loss
is due to swelling and bleeding
within the retina. But in many cases
vision is lost due to severe bleeding
inside the eye from the abnormal
blood vessels in the retina, leading
to blindness. In advanced cases
it may be because of tractional
retinal detachment
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What are the symptoms by which diabetic
retinopathy can be identified? |
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Usually diabetic retinopathy is symptomless.
Some may have normal vision till they develop
sudden blindness due to bleeding. As there
are no symptoms in early stages diabetic
retinopathy, it is essential that diabetic
patients undergo a routine check-up by an
eye specialist every six months.
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How is diabetic retinopathy diagnosed?
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- Retinal Examination:
- Fundus Fluorescein Angiography
(FFA): In FFA, photographs of
the Retina are taken, after
injecting a dye in the arm.
- Ocular Coherence Tomography
(OCT): This advanced imaging
modality allows scanning of
the retina.
This helps visualize and document
the swelling and deposits in the
retina and may also reveal the presence
of tractional bands.
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How is diabetic retinopathy treated? |
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Early diagnosis of Diabetes Mellitus
and effective control of blood sugar
through diet, exercise and medication
can help reduce your risk of developing
these eye problems associated with
Diabetes Mellitus.
The treatment of diabetic retinopathy
is decided on the basis of the stage
of the disease. In the very initial
stages, it just requires periodic
follow up to look for progression
of disease. The ophthalmologist
decides when to see a patient next
depending upon the severity of changes
in the retina.
Later when the disease is more advanced
he/she may decide to treat it with
one or more of the following options:
Laser Treatment : There are
well-defined criteria for laser
therapy. Laser therapy is done when
there is significant maculopathy,
or when there are significant new
blood vessels in the retina or iris.
Laser treatment is an OPD procedure.
After putting anesthetic/numbing
drops in the affected eye, the patient
is comfortably seated on a stool/chair
with chin and forehead stabilized.
A contact lens is then inserted
in the eye and laser beam is focused
onto the retina. The light is absorbed
by pigment layer of the retina,
where it is converted into heat.
Laser photocoagulation helps to
preserve vision by preventing new
blood vessel formation. It may also
help in reducing the swelling of
thickened retina in some cases and
prevent further deterioration of
vision.
Anti-VEGF agents (Lucentis, Avastin,
Macugen) : These agents are
being used in some selective cases
alone or in addition to laser treatment
or surgery.
Surgery : Vitrectomy surgery
and other additional procedures
may be required to manage the complications
of diabetic retinopathy, like vitreous
hemorrhage, retinal detachment,
severe macular edema, etc.
The vitreous is the clear, jelly-like
substance that fills the middle
of the eye. In some patients, there
may be bleeding into the vitreous
or the vitreous may pull the retina,
reducing vision severely. In such
instances a surgical procedure called
vitrectomy is performed. The Vitreous
is removed during vitrectomy surgery
and usually replace by a saltwater
solution.
The operation removes any blood
or debris (from infection or inflammation)
that may be blocking or blurring
light as it focuses on the retina.
Vitrectomy surgery removes scar
tissue that can displace, wrinkle,
or tear the retina. Vision is poor
if the retina is not in its normal
position
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