Diabetic Retinopathy WHAT IS DIABETIES? Diabetes is a fairly common disease that interferes with the body's ability to us and store sugar. Diabetes can start in childhood but usually begins later in life. Diabetes causes damage to the tiny blood vessels inside the human eye. This leads to adverse effect on the vision. This can also lead to Cataract and Glaucoma. WHAT IS DIA it ETIC RETINOPATHY? Diabetes can cause many health problems especially when it is severe and not in control. One of the serious conditions caused by diabetes is called Diabetic Retinopathy. Diabetic Retinopathy is one of the foremost causes of blindness. Diabetic Retinopathy is a disease affecting the Retina of the eye. Retina is the delicate, light sensitive lining ofthe back ofthe eye. Diabetic Retinopathy can weaken and cause changes in the small retinal blood vessels. These blood vessels may then begin to leak or swell or develop brush like branches. This deterioration of the retinal blood vessels causes hindrance in the supply of oxygen and nutrients needed by the retina to remain healthy. Early stages of this condition may cause symptoms like blurred vision. As the disease progresses, one may notice cloudiness of vision, black spots, floaters or even sudden loss of vision. But usually Diabetic Retinopathy does not produce visual symptoms strong enough to get noticed. Who gets Diabetic Retinopathy? As the name suggests, only the diabetics suffer from diabetic retinopathy. With the increase in the duration of diabetes, risk of developing diabetic retinopathy also increases. It is observed that about 80% of the people suffering from diabetes for more than fifteen years do have some damage present in the blood vessels of the retina. Severe and uncontrolled diabetes, fluctuating blood sugar levels, high blood pressure (hypertension), high blood cholesterol and diabetic kidney are all conditions which predispose a diabetic to develop changes in the retina Pregnancy and high blood pressure may aggravate Diabetic Retinopathy. It is very important to know that the retina gets affected adversely when the blood sugar level comes down quickly. It is extremely important that diabetics do not panic when their blood sugar level goes up. Blood sugar level should be allowed to come down slowly. Wide fluctuations in the blood sugar levels should be avoided at any cost. Diabetic Retinopathy occurs at a younger age in juvenile diabetics. These are diabetics who have been diagnosed with the condition during their childhood or teenage years. What are the stages of Diabetic Retinopathy? There are two main stages of Diabetic Retinopathy. In the early stages, it is called Background Retinopathy. In this stage, retinal blood vessels start leaking causing the retina to swell. It does not cause major symptoms. In some cases, the leaking fluid collects in the central part of the retina. This condition is called Diabetic Maculopathy. This can lead to difficulty in reading, distortion in vision and other activities involving close concentration. The advanced stage is called Proliferative Retinopathy. This is the most serious stage or form of Diabetic Retinopathy. In this condition, new branch like blood vessels start growing on the surface of the retina. These abnormal blood vessels can lead to various complications, which could further lead to a detached retina or glaucoma. Proliferative Retinopathy affects upto 20% of all diabetics and can lead to very severe loss of sight resulting in blindness. What is the procedure for detection of Diabetic Retinopathy? Diabetic Retinopathy, even in a serious form can be present without any symptoms. Regular eye check-up for Diabetic Retinopathy is a must for all diabetic patients. Normally an Ophthalmoscope is used for the purpose of examining the inner parts of the eye. Fundus Fluorescein Angiography or FFA, which is a specialized technique, is also used to get finer details of the retinal blood vessels. In FFA, a fluorescent dye is injected through a vein in the arm. As this dye travels through the bloodstream to reach the retinal blood vessels, photographs are taken in quick succession. These photographs capture the details of the dye leaking from the abnormal blood vessels. This helps in diagnosing the stage of diabetic retinopathy present. Besides diagnosis, FFA forms an important basis for the treatment. What is the importance of early detection and treatment in Diabetic Retinopathy? Most of the visual loss from Diabetic Retinopathy can be prevented, provided it is diagnosed early. But once the damage has occurred, the effects are usually irreversible. Early warning symptoms threatening and damaging the eyesight are rare in Diabetic Retinopathy. It is quite common for a diabetic patient to have good vision without any realization of the changes happening in the retina. These changes if left untreated could lead to sudden blindness due to bleeding. Thus, it is extremely important for every diabetic patient to undergo regular check up of the eye in order to detect the presence and extent of Diabetic Retinopathy. What is the treatment for Diabetic Retinopathy? Laser treatment or Laser Photocoagulation is the most common line of action in most sight threatening diabetic problems. It is very important to realize that laser treatment aims to save the existing sight level and not to make it better. Laser is a beam of high intensity light, which can be focused with extreme precision so as to reach the retina. Laser treatment is recommended to the patients who have swelling of the retina in the macular area or new blood vessel formation. Laser photocoagulation is used to seal the microanurysms that are leaking fluid into the retina. This is called the Focal or Grid laser photocoagulation and is done in a single sitting. If new blood vessels are growing then more extensive laser treatment has to be carried out which is called the Pan Retinal Photocoagulation (PRP). PRP is carried out over two to three sittings spread over a few weeks. In most cases, laser treatment causes the new blood vessels to regress and the swelling to subside. Laser treatment usually takes three to four months to be fully effective • What is Vitrectomy? Sometimes the new blood vessels bleed into the gel like centre (vitreous) of the eye. This condition called vitreous haemorrhage can lead to sudden loss of vision. If the vitreous haemorrhage is persistent, then a procedure called Vitrectomy is recommended. This is a microsurgical procedure, which is undertaken to remove rove the blood and scar tissue from the centre of the eye. A II rge majority of the patients notice imp ment in their , eyesight after Vitrectomy. Some facts about laser treatment: It is an outpatient procedure and does not involve stay in the hospital. It does not require an incision. It seals or photocoagulates the leaking retinal blood vessels. It usually does not cause much discomfort. However the treatment to remove new blood vessels can at times be a bit uncomfortable. • It can be repeated, if required. It prevents further loss of vision but does not restore the already lost vision. About us : We at Greenss Medical centre are committed to fight the dreaded diabetes by educating, treating and supporting the patients, who are suffering from this disease. We conduct regular educative and awareness camps and seminars to' helps people to know their current status. It's our aim to spread the message that any person who. Above the age of 40 years If any of the parents had diabetes Or in any general chek up was found to have diabetes. Should br careful and go for the following tests. Blood check up of sugar fasting & PP Sugar Hb A1C - (a blood test) Urine test for sugar Meet an eye doctor for eye retina check up At, Greenss Medical Centre (GMC) we have a dedicated medical retina specialist who looks after your diabetic retina status with most advanced equipments available with us. We examine you with advanced photo slit lamp and dedicated retinal fundus camera to record you high resolution photographs for study. We have the facility of FFA (Fundus Fluoro Angiography) to do a real time test for your eyes and if needed, we have most advanced Diode Greens Laser from Iriclex USA to do laser photo couagulation for the eyes. We have in house pathology to check your blood samples and a physician from medicine department to look after the other comorbidities of diabetes. We want you to be fully AWARE and INFORMED about Diabetes Mellitus. Issued in public interest for information and by no means taken as granted for treatment. Do take you doctor's advice always.