Prakash Netra Kendr (P.N.K.)

Vitreo Retina

Diabetic Retinopathy

What Is Retina?

The retina is the delicate light-sensitive layer on the back of our eyes, responsible for sensing light that enters our eyes and formation of images by direct communication with the brain. Damage to the retina is referred to as retinopathy.

How does Diabetes affect eyes?

Diabetes can affect sight by causing:-

Cataracts- Cataracts develop at an earlier age in people with diabetes.

Glaucoma- A person with diabetes is nearby twice as likely to get glaucoma as other adults.

Diabetic Retinopathy (DR) It results from changes in retinal blood vessels. When blood vessels in the retina are damaged they may grow into fragile, brush-like branches that leak blood and results in formation of scar tissue. This can blur or distort the vision and in advanced stages can lead to total blindness. Diabetic eye disease is a leading cause of blindness in India and worldwide. People with untreated diabetes are said to be 25 times more at risk for blindness than the general population. The longer a person has had diabetes, the higher the risk of developing diabetic retinopathy.

The new blood vessels grow along the retina and along the surface of the clear, 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, they cause severe vision loss and can even result in blindness.

What Are The Symptoms Of Diabetic Retinopathy?

  • Early stages may not produce any symptoms. Large number of eyes can progress to advanced stages without noticing any disturbance in vision.
  • Blurring of vision, distorted vision, difficulty in strong sunlight and reading problems are common complains by patients who develop swelling in the centre of the retina.
  • Sudden appearance of black floating objects or darkness is a common symptom experienced by patients with proliferative disease.

Why Early Detection and Treatment is important?

  • The best results from treatment of Diabetic Retinopathy are found in patients who present in early stages of disease and majority of visual loss in advanced Diabetic Retinopathy cannot be reversed . So best time to detect Diabetic Retinopathy is before it has produced any symptoms.
  • Patients who are detected at very early stage of Diabetic Retinopathy, and are under regular treatment are unlikely to go blind.
  • Early detection also motivates them to institute strict control of Diabetes and thus escape other complications like changes in the kidney and diabetic foot.

Can treatment regain vision loss?

For patients who have already lost vision from the disease, treatment usually does not regain the original vision. However, vision loss from complications such as bleeding into the eye, retinal detachments or cataracts can be regained.

How do we help Diabetics and Diabetic Retinopathy patients?

Diabetic Screening:

All Diabetic patients irrespective of visual symptoms are offered dilated retinal examinations at all visits at our institutes and also at regular intervals-

  • Annual Examination for patients with No Diabetic Retinopathy is recommended
  • Quarterly or 6 monthly examination for those with Diabetic Retinopathyis recommended depending on the stage of the disease.

Comprehensive diabetic care:

Along with eye care, controlling blood pressure, maintaining normal cholesterol levels and treating anemia can also prevent or significantly reduce progression of diabetic retinopathy. At EYE Q-Prakash Netra Kendr we always offer counseling for improving management of diabetes and encourage our diabetic retinopathy patients to seek Diabetolgist advice regularly. We insist on screening for nephropathy, neuropathy and Diabetic foot.

Our Team also gets involved in educating all Diabetic patients on;

Minimal Test required every 6 months at least

  1. FBS and PPS as advised by Physician.
  2. HbA1C (glycosylated hemoglobin)
  3. Lipid Profile
  4. Urine for Micro albuminuria

Body weight trends and goals- All Diabetics are encouraged to increase their physical activities and go for weight reduction Blood glucose control is the single most important risk factor for all complications. Strong emphasis isto make all efforts to keep it strictly controlled during all stages of diabetic retinopathy.

Blood Pressure control- Patients are made aware of the fact that uncontrolled hypertension also makes diabetic retinopathy worse.

Blood lipid control- The contribution of increased cholesterol and lipids in retinopathy is also explained to these patients.

Cardiovascular risk- Importance of regular cardiac screening is also stressed upon.Eyes- An annual Retina checkup to detect Retinopathy at the earliest stage is highlighted at each visit.

Helpful tips:

  • Annual visit to an ophthalmologist, once you are diagnosed with diabetes
  • Regular follow-ups as advised by retina specialist
  • Monitor blood sugar closely
  • Maintain normal blood pressure
  • Quit smoking
  • Controlling cholesterol
  • Regular exercise and balanced diet

Management of Diabetic Retinopathy:

While strict diabetes control, tight blood pressure and lipid control, Laser photocoagulation, and Vitreo-retinal surgery remain the standard management of diabetic retinopathy, the newer injections have offered a new dimension to the treatment of this blinding disease. The fact these anti-VEGS injections not only halt the disease but also have the potential to provide improvement in selected cases makes them an exciting proposition.

Laser Treatment:

Laser photocoagulation is most effective method to arrest the progression of diabetic retinopathy. Laser greatly reduces the chance of severe visual impairment.

How Does Laser help in arresting Diabetic Retinopathy progression?

The Laser works by sealing the source of leakage and thereby reducing the fluid collection in the retina. It also works by reducing the formation and release of a harmful chemical called "VEGF" from ischemic retina. When "VEGF" is not available to abnormal new blood vessels, they start regressing (dying out) and thus proliferative stage gets arrested.

How is Laser done? Is it painful?

All treatment is carried out in an outpatient clinic and you will not have to stay in hospital. Eye drops are used to enlarge the pupils so that the doctor can look into your eye. The eye is then numbed with drops and a small contact lens is put onto your eye to stop it blinking. The eyes need to be moved in certain directions but this can easily be done with the contact lens in place. The treatment for sealing blood vessels doesn't usually cause any discomfort. However the treatment for new blood vessels can be a bit uncomfortable so you may be given a pain-relieving tablet at the same time as the eye drops. Most patients tolerate the laser without major discomfort or pain. If the treatment does become painful, then don't be afraid to ask your doctor to stop and schedule an extra session.

Does laser treatment have any side effects?

The treatment for sealing blood vessels has few side effects, although you may lose a little central vision or notice the laser burns as small black spots. The laser treatment for new blood vessels is more complicated and there may be more side effects. It is quite common to lose some vision to the sides (peripheral vision), and this may mean that you may have difficulty in driving in future. Night and color vision may also be reduced.

Occasionally your central vision may not be as good as before so that reading fine print is not as easy. This is usually temporary but sometimes this doesn't improve. No treatment is possible without some side effects. But the risks of laser treatment are far less than the risks of not having treatment. Without treatment the eyes with new blood vessels will progress to blindness.

Intravitreal Injections:

The injections block the effect of harmful chemicals and processes present in eyes with diabetic retinopathy and help in reducing the swelling of central retina. They also stop the rapidly growing abnormal blood vessels in diabetic retinopathy. Patients with macular edema can now expect significant improvement in vision after these injections. Sometimes multiple injections are required to arrest the advanced forms of the disease. Some patients also require long term injections. Unlike laser, injections have very few side effects; however their effect is temporary and always requires supplementation with laser.

Sutureless vitreous surgery:

The retinopathy patients on advanced stages who present late or those who keep progressing despite all treatments are managed by surgery. The availability of 25G suture less techniques allows these patients to recover faster with lesser pain and less visits to eye hospital after surgery.


Retinal Vascular Occlusions (RVO)

Most frequent retinal condition after diabetic retinopathy, the disease normally affects people >40 years of age. The disease is similar to myocardial infarction commonly known as "heart attack" or a stroke, where sudden blocking of retinal vein or artery leads to bleeding and or swelling in the central portion of retina (clinically known as Macula).

What causes Retinal Vascular Occlusion?

The cause of RVO is multifactorial just like cardiac diseases - uncontrolled hypertension, diabetes, smoking, age-related arterial thickening and clotting, generalized disease of vessels and some infections are common risk factors. First examination of RVO patients, the specialist would insist on detailed investigations to evaluate all these risk factors.

What causes vision loss after Retinal Vein Occlusions?

The vision loss from RVOs results from 2 reasons- in the early stage there is collection of fluid in central portion of retina called Macular Edema. Later stages the abnormal new blood vessels start developing from damaged retina. These abnormal retinal blood vessels lead to leakage of blood in eye and ultimately these blood vessels contract and create retinal detachment and blindness.

How do we manage Retinal Vascular Occlusion?

The management of RVOs would include baseline tests like fundus photography (FFA) and OCT. Following this, patients maybe treated with serial injections to reduce retinal swelling and subsequently laser photocoagulation is done for ischemic (poor blood supply) retina to prevent future complications. Prompt treatment and regular follow up is essential to prevent severe vision loss. Controlling blood pressure and other risk factors are equally important and would prevent similar thing happening to the other eye.

Ntravitreal Injections:

The injections block the effect of harmful chemicals and processes present in RVOs and help in reducing the swelling of central retina. They also stop the rapidly growing abnormal blood vessels in the retina. Patients with Macular Edema can now expect significant improvement in vision after these injections. Sometimes multiple injections are required to arrest the advanced forms of the disease. Some patients also require long term injections. Unlike laser, injections have very few side effects; however their effect is temporary and always requires supplementation with laser.

Sutureless vitreous surgery:

The patients with advanced stages, who present late, with pulling on retina by new blood vesselsor retinal detachment, are managed by surgery. The availability of 25G Suture less techniques allows these patients to recover faster with lesser pain and less visits to eye hospital after surgery. The surgeons offer detailed counselling with realistic expectations.


AMD: The Facts:

AMD is a chronic, age-related, degenerative disease of the macula. The macula is a very small and specialized area in the center of the retina, which allows you to see find details directly in front of you, such as words in a book or images on television. So, while the entire retina lets you see that there is a book in front of you, the macula lets you see what is written in the book.

Am I At Risk?

There are a number of factors both within and outside of your control that can put you at increased risk for developing AMD. Knowing what they are can help you to make certain changes to your lifestyle that may reduce your risk.

The following are risk factors that you can do something about:

  • Smoking
  • Diet: a diet low in antioxidant vitamins and minerals is a significant risk factor
  • Excessive sunlight exposure
  • High blood pressure
  • Excessive weight/obesity

However, there are some risk factors that unfortunately you can't do anything about, such as:

  • Age: risk increases with advancing age; from less than 10% for people 43-54 years of age to nearly 40% for people over 75 years
  • Family history: up to 3 times greater risk within families (parents and siblings)
  • Gender: women are more susceptible
  • Race: Caucasians are at higher risk.

Obviously you can't change everything that puts you at risk but, wherever you can, consider making any lifestyle changes that will reduce your risk.

The Amsler Grid:

The Amsler Grid is a useful and simple tool for monitoring your central vision. It's a test that you can do at home. Regular use will alert you to any changes in your vision.

Treatment Options:

Laser photocoagulation:

With this treatment, your doctor will aim a high-energy laser at the areas where leaky blood vessels could affect central vision if not treated. This slows down the leakage of fluid and reduces the amount of fluid in the retina.

Photodynamic therapy (PDT):

PDT involves an intravenous drug and a cool laser to seal the leaking blood vessels. It works by sealing abnormal blood vessels in the back of the eye.

Anti-VEGF therapy:

Anti-VEGF stands for anti-vascular endothelial growth factor. VEGF is thought to be a trigger for abnormal leaking and growth of the blood vessels in the macula, which leads to edema. Anti-VEGF drugs are injected into your eye to help prevent this from happening.

It's your Vision-Hold On To It:

Your vision is precious, so do whatever is in your control to hold on to it. There are specific things you can do that may help to delay vision loss:

  • Visit your eye doctor regularly - do not miss any scheduled appointment
  • Take the specific vitamin supplements, if recommended by your eye doctor
  • If you notice a change in your vision or your Amsler Grid test, contact your eye doctor immediately
  • Stop smoking - ask for help if you need it
  • Improve your diet - include more fresh fruits and vegetables, especially dark green leafy vegetables like spinach
  • Maintain a healthy body weight
  • Avoid excessive exposure to direct sunlight - wear sunglasses and a wide-brimmed hat to protect your eyes from UV light
  • Keep high blood pressure under control
  • Be proactive about vision rehabilitation and the use of visual aids.

You have an important role to play in ensuring that vision loss is caught early and treated as soon as possible.

Living With Vision loss Due To AMD:

Vision loss due to AMD does not necessarily mean you will become blind; however, the disease can have a profound effect on your quality of life. A significant loss of central vision can severely impact your ability to function as before, making things you've always taken for granted such as reading, driving, and watching television, extremely difficult. It can also impact your ability to work. However, the vast majority of patients retain their independence even if, in some cases, this requires the help of visual aids and rehabilitation.

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The Eye is the Lamp of the Body. So if your Eye is healthy, your whole body will be full of Light

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