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.
does Diabetes affect eyes?
Diabetes can affect sight by causing:-
Cataracts develop at an earlier age in people with diabetes.
A person with diabetes is nearby twice as likely to get glaucoma as other
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 vesselsgrow 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.
are the symptoms of Diabetic Retinopathy?
stages may not produce any symptoms. Large number of eyes can
progress to advanced stages without
noticing any disturbance in vision.
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.
appearance of black
floating objects or darkness is a common symptom experienced by patients
with proliferative disease.
Early Detection and Treatment is important?
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.
who are detected at very early stage of Diabetic Retinopathy, and are under
regular treatment are unlikely to go blind.
detection also motivates them to institute strict control of Diabetes and thus
escape other complications like
changes in the kidney and diabetic foot.
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.
do we help Diabetics and Diabetic Retinopathy patients?
All Diabetic patients irrespective of
visual symptoms are offered dilated retinal examinations at all visits at our
institutes and also at regular intervals-
D Annual Examination for patients with No
Diabetic Retinopathy is recommended
D Quarterly or 6 monthly examination for
those with Diabetic Retinopathyis recommended depending on the stage of the
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-PrakashNetraKendr 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
Our Team also gets involved in educating
all Diabetic patients on;
Minimal Test required every 6 months at
and PPS as advised by Physician.
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
Blood lipid control- The contribution of
increased cholesterol and lipids in retinopathy is also explained to these
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.
visit to an ophthalmologist, once you are diagnosed with diabetes
follow-ups as advised by retina specialist
blood sugar closely
normal blood pressure
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
Laser photocoagulation is most effective
method to arrest the progression of diabetic retinopathy. Laser greatly reduces
the chance of severe visual impairment.
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.
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.
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
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.
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
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,
insist on detailed investigations to evaluate all these risk factors.
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
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
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.
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 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
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:
a diet low in antioxidant vitamins and minerals is a significant risk factor
However, there are some risk factors
that unfortunately you can't do anything about, such as:
risk increases with advancing age; from less than 10% for people 43-54 years of
age to nearly 40% for people over 75 years
history: up to 3 times greater risk within families (parents and siblings)
women are more susceptible
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.
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 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:
your eye doctor regularly - do not miss any scheduled appointment
the specific vitamin supplements, if recommended by your eye doctor
you notice a change in your vision or your Amsler Grid test, contact your eye
smoking - ask for help if you need it
your diet - include more fresh fruits and vegetables, especially dark green
leafy vegetables like spinach
a healthy body weight
excessive exposure to direct sunlight - wear sunglasses and a wide-brimmed hat
to protect your eyes from UV light
high blood pressure under control
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
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.
The Eye is the Lamp of the Body. So if your Eye is healthy, your whole body will be full of Light