Diabetic Retinopathy is progressive condition of the light sensitive layer, called the retina,
lining the back of the eye in patients with Diabetes Mellitus.
Elevated blood sugar levels damage small blood vessels that supply nourishment to the
retina. These blood vessels leak blood and other fluids into the retina causing swelling of the
retina and deterioration of vision. If untreated ,the visual deterioration can become
permanent and lead to blindness.
- Long duration of diabetes and poorly controlled blood sugar levels requiring insulin carry
higher risk for development of Diabetic Retinopathy.
- Presence of other complications of diabetes mellitus like diabetic nephropathy can lead to
rapid progress to advanced stages and worsening of vision.
- Male gender, pregnancy in diabetic women are among other risk factors.
The common types of refractive errors that occur in children are myopia (short sightedness), hyperopia (long sightedness) and Astigmatism.
Hyperopia (long sight)
Non-proliferative Diabetic Retinopathy (NPDR) is the early stage where the blood vessels
suffer damage and leak blood and other fluids into the retina.
Proliferative Diabetic Retinopathy (PDR) is the more advanced form of the disease. At this
stage, circulation problems cause the retina to become oxygen deprived. As a result new
fragile blood vessels can begin to grow in the retina and into the vitreous, the gel-like fluid
that fills the back of the eye. The new blood vessel may leak blood into the vitreous,
clouding vision. Other complications include detachment of the retina and the development
of glaucoma due to extremely high pressure in the eye. If left untreated, proliferative
diabetic retinopathy can cause severe vision loss and even blindness.
Clinical features and investigation
- Early stages of Diabetic Retinopathy often do not produce any symptoms.
- Leakage from the blood vessels into the central part of the retina leading to swelling of this part is called Diabetic Maculopathy. This causes blurring of vision or dark spot in the centre of vision.
- Advanced stages cause significant visual deterioration.
- Diabetic retinopathy can be diagnosed through a comprehensive eye examination.
- Investigations include blood sugar levels, HbA1C (which indicate levels of blood sugar control over 3 months), Hb (haemoglobin level).
- Eye investigations are Fundus Fluorescence Angiogram and Optical Coherence Tomography (OCT)
- Adequate control of blood sugar levels is the most important factor in limiting progression of disease.
- Treatment depends upon stage of the disease.
- Very early stages that do not produce significant swelling in the central retina do not require any treatment other than control of blood sugar and blood pressure.
- Diabetic Maculopathy and PDR are treated with laser or intra vitreal injections (injections given inside the eye)
- Advanced stages with retinal detachment or bleeding in the vitreous gel will require surgery.
Since early stages may not produce any symptoms, screening of diabetic patients helps identify those suffering from retinopathy. This is very important as early intervention is essential for preserving good vision.
A delay in diagnosis and treatment can cause permanent visual damage.