Diabetic Retinopathy

What is diabetic retinopathy?

People with diabetes can develop complications that affect their vision. A person with diabetes is at risk for developing diabetic retinopathy, among other ophthalmic disorders. Diabetic retinopathy is the leading cause of blindness in young and middle-aged adults today. The longer a person has diabetes and those their blood sugar control, the greater is their chance of developing diabetic retinopathy.

The retina is the light sensitive portion at the back of the eye that is responsible for converting light impulses (going into the eyes) into the images that we see. Normally, these retinal blood vessels are watertight, allowing continuous oxygen supply to the retina tissues; but in patients with longstanding diabetes, leaking and bleeding can develop. If this goes untreated, oxygen supply to the retina is compromised and as a result, even more abnormal vessels are formed at the back of the eye, causing more bleeding, and eventually the scarring and detachment of the retina.

Diabetic Retinopathy is more common in people who have poor medical control of their diabetes. Good control of diabetes is important to preserve vision. The result managing diabetes will is not dramatic or even noticeable over the short term.

However, the odds of preserving your vision over the long term are greatly improved by good medical control not only of blood sugar level, but also of high blood pressure, serum cholesterol and kidney diseases, if these are also present.

There are two types of diabetic retinopathy

• non-proliferative diabetic retinopathy

• proliferative diabetic retinopathy

NPDR, also known as background retinopathy, is an early stage of diabetic retinopathy and occurs when the tiny blood vessels of the retina are damaged and begin to bleed or leak fluid into the retina, resulting in swelling (diabetic macular edema) and the formation of deposits known as exudates. Many people with diabetes develop mild NPDR often without any visual symptoms.

PDR carries the greatest risk of loss of vision and typically develops in eyes with advanced NPDR. PDR occurs when blood vessels on the retina or optic nerve become blocked, consequently starving the retina of necessary nutrients. In response, the retina grows more blood vessels (neovascularization). Unfortunately, these new vessels are abnormal and cannot replenish the retina with normal blood flow.

Signs and symptoms of Diabetic Retinopathy

Generally, people with mild retinopathy do not have any visual loss.

People with more advanced retinopathy, however, may experience a broader range of symptoms. They may:

• see dark floaters

• Sudden frequent flashes of light

• experience loss of central or peripheral vision

• experience visual distortions or blurriness

• experience temporary or permanent vision loss

Who are at risk/what are the risk factors?

Long standing diabetics of at least 10 years. Diabetics with persistently uncontrolled blood sugar. Diabetics with complications of Diabetic nephropathy

How is Diabetic Retinopathy diagnosed?

A dilated eye exam is the only way to detect changes inside the eye before loss of vision begins. People with diabetes should have an eye examination at least once a year. More frequent exams may be necessary after diabetic retinopathy is diagnosed.

What are the current treatment options for person with diabetic retinopathy?

Treatment options for diabetic retinopathy will depend on the severity of the diagnosis. In very mild stages, your doctor might just advise you to keep your blood sugar and blood pressure under strict control.

In case swelling of the central portion of the retina develops, treatment can range from laser photocoagulation to injection of medications to control the swelling. Laser therapy is an option where focal areas of leakage, called microneurysms, are treated directly with the laser in an effort to cauterize and close the leaking spots. If the swelling is more extensive, your doctor might give you the option of injecting medications into your eye that can stop and reverse the swelling process.

When there is already growth of new abnormal blood vessels or “neovascularisation”, your doctor might advise you to undergo more extensive laser treatment where the treatment is aimed at inducing involution of these abnormal new vessels and preventing visual loss from complications of PDR. The extent of treatment is dependent on the severity of the PDR.

More advanced stages of Diabetic Retinopathy may require surgery to clear out the bleeding or the scar formation inside the eye. Vitreoretinal surgery is also indicated in very severe cases where the retina has already detached due to extensive scar tissue formation.

What are the possible complications of Diabetic Retinopathy?

PDR may lead to any one of the following:

1. Vitreous hemorrhage – proliferating retinal blood vessels growth into the vitreous cavity and bleed. Both the hemorrhage and resultant scar tissue may interfere with vision.

2. Retinal detachment – scar tissue in the vitreous and on the retina may pull on the retina, causing it to detach.

3. Neovascular glaucoma – abnormal blood vessel growth on the iris blocks the flow of fluid out of the eye, causing the pressure to increase and damaging the optic nerve.

Can diabetic retinopathy be prevented?

Yes. The most effective overall strategy for diabetic retinopathy is to prevent it as much as possible. Strict control of blood sugar levels will significantly reduce the long-term loss of vision from retinopathy. With improved diagnosis and treatment, only a small percentage of people with retinopathy develop serious vision problems.

What are the related services available at TMC?

At TMC, our board-certified Ophthalmologists are very capable of doing the basic retinal screening to rule out Diabetic Retinopathy. For cases requiring more specialized attention, our retina service, which is staffed by some of the most respected names in the field, can advise you on what the best option is for you.

Our Eye Center is equipped with top-of-the-line machines are the Zeiss Visupac Flourescein Angiography and Fundus Camera, as well as the Zeiss Cirrus Optical Coherence Tomography, both of which are considered some of the best in retinal diagnostics not only locally but also internationally.

For patients needing laser treatment, the center is equipped with the most advanced laser photocaogualtion machine in the region, the OptiMedic Patern Scan Laser Photocoagulator, which can perform retinal laser in significantly less time and noticeably less discomfort for the patient.

Our very modern operating rooms are likewise equipped with the most complete and advanced Vitreorentinal Surgery equipments including the LEICA F40 Operating Microscope with Oculus BIOM Accurus Vitrectomy System.

References:
a.    Bascom Palmer Website: https://bascompalmer.org/ July 26, 2009
b.    Clinical Ophthalmology, A Clinical Approach 5th Ed. Jack Kanski, 2003
c.    Dr. Michael Munoz, Department of Ophthalmology The Medical City Hospital
d.    Dr. Sherman Valero Department of Ophthalmology The Medical City Hospital

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For further inquiries or if you want to seek consult, please call:

EYE CENTER
Tel No. (632) 988-1000 / (632) 988-7000 ext 6252

CENTER FOR PATIENT PARTNERSHIP
Tel No. (632) 988-1000 / (632) 988-7000 ext. 6444