Healthy living With Dr. Nanchak Nimzing
Pone No: 08036787758, 09052597025
Diabetic Retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina (the light sensitive tissue at the back of the eye). A healthy retina is necessary for good vision.
What are the stages of diabetic retinopathy?
Diabetic retinopathy has four stages:
1.Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.
2.Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
3.Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
4.Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye.
By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.
Who is at risk for diabetic retinopathy?
All people with diabetes – both type 1 and type 2 – are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye examination at least once a year. It is worthy of note that between 40 to 45 percent of people diagnosed with diabetes have some stage of diabetic retinopathy. If a person is diagnosed to have diabetic retinopathy, their doctor can recommend treatment to help prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye examination as soon as possible. In this condition their doctor may recommend additional examinations during pregnancy.
How does diabetic retinopathy cause vision loss?
Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:
1. Fragile, abnormal blood vessels can develop and leak blood into the centre of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.
2. Fluid can leak into the centre of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.
Does diabetic retinopathy have any symptoms?
Diabetic retinopathy often has no early warning signs. If diabetes is diagnosed then the patient must have a comprehensive dilated eye examination at least once a year.
What are the symptoms of proliferative retinopathy if bleeding occurs?
At first, the sufferer will see a few specks of blood, or spots, “floating” in their vision. If such occur, then they should see their eye care professional as soon as possible. Treatment may be needed before more serious bleeding occurs. Heamorrhages tend to happen more than once, often during sleep.
Sometimes, without treatment, the spots clear, and vision will improve. However, bleeding can reoccur and cause severely blurred vision. It is important that the eyes are examined by an eye care professional at the very first sign of blurred vision, before more bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.
How are macular edema and diabetic retinopathy detected?
Macular edema and diabetic retinopathy are detected during a comprehensive eye examination that includes:
• Visual acuity test. This eye chart test measures how well the subject can see at various distances.
• Dilated eye examination. Drops are placed in the eyes to widen, or dilate, the pupils. The eye care professional uses a special magnifying lens to examine the retina and optic nerve for signs of damage and other eye problems. After the examination, close-up vision may remain blurred for several hours.
• Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to the eye for this test.
The eye care professional checks the retina for early signs of the disease, including:
• Leaking blood vessels.
• Retinal swelling (macular edema)
• Pale, fatty deposits on the retina
• Signs of leaking blood vessels
• Damaged nerve tissue
• Any changes to the blood vessels.
If the eye care professional believes that treatment is needed for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into the bloodstream. Pictures are taken as the dye passes through the blood vessels in the retina. The test allows the eye care professional to identify any leaking blood vessels and to recommend treatment.
How is macular edema treated?
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. In a small number of cases, if vision is lost, it can be improved. If vision loss is apparent then a professional eye examination is necessary.
How is Diabetic Retinopathy treated?
During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macula edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
Proliferative retinopathy can also be treated with laser surgery. This procedure is called scatter laser treatment.
What is a vitrectomy?
If there is a lot of blood in the center of the eye (in the vitreous gel), a vitrectomy to restore sight may be needed. If this is needed in both eyes, each eye is treated separately and several weeks apart.
What can be done if there is already some lost vision from diabetic retinopathy?
If the subject has lost some sight from diabetic retinopathy, then it is necessary for the patient to consult their eye care professional about low vision services and devices that may help them make the most of their remaining vision.
How can one’s vision be protected?
Every one diagnosed with diabetes should have a comprehensive dilated eye examination at least once per year. If diabetic retinopathy has already been observed then the examination should take place more frequently. In cases of early diabetic retinopathy the risk of blindness can be reduced by 95% with timely treatment and the appropriate care and follow up. Always remember that the key to diabetes is management and control and not waiting until drastic action is necessary.
Studies have shown that good control of blood sugar levels will slow the onset and progression of retinopathy. Not just retinopathy, diabetics who kept their blood sugar levels as close to normal as possible also had less kidney and nerve disease. Good control also reduces the potential need for sight-saving laser surgery. Remember also that there is a linkage between elevated blood pressure, cholesterol, and vision loss so control of both of these will also reduce the risk to sight.
Let us just sum up what we have learned on the subject of diabetic retinopathy:
• Proliferative retinopathy can develop without symptoms. At this advanced stage there is the high risk of vision loss.
• Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
• A diabetic can develop both proliferative retinopathy and macula edema and still see perfectly. However, the risk of vision loss is very high.
I make no apology for going into some detail on the subject of diabetic retinopathy. Sight is the most precious of our senses and if diabetes is allowed to progress uncontrolled then it is important to understand the consequences to one’s sight.