Diabetic Retinopathy

Scientific Presentation on Cataract
Surgery @ ASCRS 2016
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 Diabetes is a disease characterized by increased sugar level in blood either because of inadequate secretion of insulin or improper processing of if by the body.

Other problems that may develop are

Cataracts -- cloudiness of the eye lens
Glaucoma -- increased pressure in the eye that can lead to blindness
Macular edema -- blurry vision due to fluid leaking into the area of the retina that provides sharp central vision
Retinal detachment -- scarring that may cause part of the retina to pull away from the back of your eyeball.

Here are two types of Diabetic Retinopathy

  1. Non-Proliferative Diabetic Retinopathy (NPDR)
  2. Proliferative Diabetic Retinopathy (PDR)
NPDR, also known as background retinopathy, is an early stage of diabetic retinopathy and occurs when the tiny blood vessels of the retina are damaged and begin to bleed or leak fluid into the retina resulting in swelling (diabetic macular edema) and the formation of deposits known as exudates. Many people with diabetes develop mild NPDR often without any visual symptoms.
PDR carries the greatest risk of loss of vision and typically develops in eyes with advanced NPDR. PDR occurs when small blood vessels on the retina or optic nerve become blocked consequently starving the retina of necessary nutrients. In response, the retina grows more blood vessels (neovascularization). Unfortunately these new vessels are abnormal and cannot replenish the retina with normal blood flow. 

PDR may lead to any one of the following 
Vitreous hemorrhage - proliferating retinal blood vessels grow into the vitreous cavity and break down. Both the hemorrhaging and resultant scar tissue may interfere with vision. 
Traditional retinal detachment - scar tissue in the vitreous and on the retina cause the retina to detach. 
Tractional and rhegmatogenous retinal detachment - scar tissue creates a hole or tear in the retina causing it to detach. 
Neovascular glaucoma - abnormal blood vessel growth on the iris blocks the flow of fluid out of the eye causing the pressure to increase and damaging the optic nerve.

Symptoms of Diabetic Retinopathy Include

  • Blurred vision and slow vision loss over time
  • Floaters
  • Shadows or missing areas of vision
  • Trouble seeing at night
Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.

How is Diabetic Retinopathy treated?

Laser treatment
Laser photocoagulation involves the focusing of a powerful beam of laser light on the damaged retina to seal leaking retinal blood vessels and stop abnormal blood vessel (neovascularization) growth.
Vitrectomy – In the event of the patient presenting with very advanced diabetic retinopathy, a surgical procedure known as vitrectomy is recommended. Blood-filled vitreous gel of the eye is replaced with a clear solution to aid in restoring vision. Sometimes the retina may also be detached and then the surgery involves reattaching the retina as well.

How to prevent visual loss in Diabetes?

Prevention of diabetic retinopathy and accompanying visual loss is a team effort involving the patient and our diabetic eye specialist. Early detection of diabetic retinopathy is the best protection against loss of vision. All diabetics must have their retinas examined at least once a year.