What Does Diabetic Retinopathy Look Like – Diabetics are at risk for vision damage. The retina (the sensitive lining at the back of the eye) needs a constant blood supply to function properly. It has a network of small blood vessels. When blood sugar control or insulin levels in the body are poor, the small blood vessels in the retina will be damaged. This condition is known as “diabetic retinopathy”.
Diabetic retinopathy develops over many years, which can vary from person to person depending on the severity of the diabetes, the level of blood sugar control, and other risk factors such as high blood pressure or cholesterol levels.
Diabetic retinopathy is the leading cause of blindness in the world. Therefore, early screening and prompt treatment are often recommended.
There are two major vision-threatening complications of diabetic retinopathy, diabetic macular edema (DMO) and proliferative diabetic retinopathy (PDR).
Routine eye examinations are very important for all people with diabetes so that signs of diabetic retinopathy can be detected as early as possible. Treatment is most effective in stabilizing the condition
Another important consideration is optimal control of blood sugar levels and other risk factors, as diabetic retinopathy often accumulates over time.
If you have diabetes and are experiencing vision loss, you should immediately see a retina specialist for an eye examination. These tests often include:
You may need a further test called “fluorescein angiography”. In this test, dye is injected into a vein in your arm, then pictures are taken as the dye passes through the blood vessels in the eye. This test allows a retina specialist to identify leaky blood vessels in the eye and plan your treatment.
In diabetic macular edema, the damaged blood vessels can leak fluid onto the retina, which can accumulate in the macula (the middle and most sensitive part of the retina). This causes swelling of the retinal tissue and blurring of central vision when reading or driving.
The treatment of diabetic macular edema has evolved over the last few years. Main treatment methods:
This involves placing a small laser treatment into the area of the vessel leak. This helps slow leakage in the retina and reduces fluid in the macula. Depending on the severity of the vessel damage, the laser response varies. Laser treatment is often done if the leak is far from the center of vision.
This involves injecting medication into the eye, which is called an intra-vitreal injection. This treatment is often done if the leak involves the center of vision. Intraocular injection is the fastest and safest method.
Sri will discuss treatment options with you and advise on the best option for your condition.
Proliferative diabetic retinopathy is an advanced stage of diabetic eye disease. When the blood vessels in the retina are badly damaged by diabetes, the retina becomes starved of blood. In response, abnormal blood vessels develop on the surface of the retina. These abnormal blood vessels are weak and can easily bleed into the back of the eye, causing a condition called “vitreous hemorrhage”.
They can cause scarring and proliferation, leading to a condition called “traction retinal detachment.”
Proliferative diabetic retinopathy is primarily treated with a laser treatment called panretinal photocoagulation. Some advanced cases of proliferative diabetic retinopathy require surgical vitrectomy or a combination of both.
At the same time, it is important to achieve optimal control of blood sugar, blood pressure and cholesterol levels.
This laser treatment is called pan-retinal photocoagulation (PRP). In this treatment, a laser is applied to the outer retina. Laser is done in 2-3 sessions depending on the condition of the eye. The goal of laser treatment is to shrink the abnormal blood vessels and remove them. This helps prevent severe vision loss. Laser treatment will not only improve your vision but can also prevent long-term complications from diabetes.
If left untreated, proliferative diabetic retinopathy can lead to vision-threatening complications such as eye bleeding or the need for retinal detachment surgery.
The laser is performed using an eye examination machine attached to a laser system in an outpatient eye clinic. Initially, dilating drops are applied followed by a few numbing drops. A retina specialist places contact lenses in your eye to stabilize the eye for the laser. Laser sessions usually take about 10 minutes.
Mr. will discuss with you in detail about the laser procedure, its possible benefits and risks, and post-laser care.
Vitreous bleeding is bleeding in the vitreous (the gel at the back of the eye). In advanced diabetes, abnormal blood vessels form on the surface of the retina which is called “neovascularization”. These abnormal blood vessels are fragile and bleed easily into the gel cavity of the eye.
If the bleeding is minor, a retina specialist may consider initial observation for several weeks. However, retina specialists may consider vitrectomy surgery if:
Surgery to remove bleeding from the back of the eye is called a “vitrectomy”. This involves removing the gel from inside the eye using a small instrument. This is usually combined with removing scar tissue at the back of the eye, known as a “delamination”, and treating the outer retina with laser therapy.
Vitrectomy surgery is performed as a day surgery under local anesthesia (small injections of anesthetic solution around the eye). Your eye will be numb and you won’t feel any pain, although you may feel a sensation of pressure during the operation.
Sri will discuss the procedure with you in detail and will be able to advise you on the surgery, the potential benefits and the possible risks.
In advanced diabetes, retinal proliferation can lead to scar tissue, which, if left untreated, continues to grow on the surface of the retina and “pull” it from the underlying layers. This pulling force leads to detachment of the retina from the layers beneath it which is called “retinal detachment”.
In the early stages of traction retinal detachment, fast laser treatment can stop the spread. However, if the proliferation is large or involves the center of vision, surgery is indicated.
The operation, called a “vitrectomy,” involves removing the gel inside the eye using very small instruments and carefully dissecting fibrous scar tissue from the surface of the retina. Lasers are often performed concurrently at the end of surgery to reduce the risk of vascular recurrence.
Every diabetic tractional retinal detachment is different and the surgical plan is customized for each case. The specific risks and benefits of this procedure will be discussed with each patient individually.
Traction is carefully removed with fine incisions and laser treatment is applied to the retina to prevent further bleeding. Diabetic retinopathy is a common complication of diabetes that can occur in patients with type I and type II diabetes. Disease duration and poor glycemic control are directly related to the development of this condition. This causes the blood vessels in your retina to swell in the first place, eventually leading to blood vessel blockage.
This can over time cause floaters or black spots on vision, dark areas in the visual field, and complete loss of vision.
Anyone with diabetes can develop diabetic retinopathy. The main cause of diabetic retinopathy is damage to the network of blood vessels that supply nutrients to the retina. Due to high blood glucose levels, vessels become weak, damaged or grow abnormally and restrict blood flow to the retina.
Your eye doctor can diagnose diabetic retinopathy during a comprehensive dilated eye examination. A comprehensive diabetic eye exam includes:
Careful management of systemic diabetes is the best way to slow the development and progression of the condition. When the condition progresses to the point where the risk of bleeding into the eye is high, the patient is offered laser treatment to reduce the risk of sudden vision loss. This procedure does not improve vision but prevents further damage.
In some cases there is accumulation of fluid in the central area of the retina; Treatment for a condition called macular edema involves injections given into the eye. These injections help control and remove fluid that causes increased visual acuity.
Surgery for diabetic retinopathy is a vitrectomy. Vitrectomy is performed when laser treatment is ineffective or when the condition is so advanced that laser alone cannot stabilize the clinical condition. In this procedure, with the patient under local anesthesia, we remove the cloudy vitreous gel from inside the eyeball. It is then replaced with a clear liquid or gas. Any scar tissue or vitreous blood dragging on the retina is also removed.
An important and modifiable risk factor in the development of diabetic retinopathy is controlling sugar levels. This
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