Diabetes is the single most important cause for death and disability worldwide. It affects almost all organs in the body. It is estimated tat presently 19.4 million individuals are affected by this deadly disease and it is likely to go up to 57.2 million by 2025. With this statistics, every 5th diabetic in the world will be an Indian by 2025.
Diabetic retinopathy is essentially a disease process, which affects the blood vessels of the retina. It is also an indicator of the status of the blood vessels elsewhere in the body e.g. Kidney, heart, etc.
What happens to the retina in diabetes?
The pathological change in diabetes leads to the lack of blood supply or ischemia of the retina and hypoxia of retinal tissues. Long standing hypoxia leads to new vessels formation. These new vessels are fragile and bleed very easily. Excessive bleeding in the eye leaks to vitreous hemorrhage and loss of vision.
In some areas there is the swelling of the vessel wall and leakage of the fluid leading to retinal edema. Involvement of macula, the central portion of the retina leads to severe drop on vision. Scar tissue can also grow from ruptured blood vessels which will contract and pull the retina, detaching it with resultant loss of vision.
Major causes of irreversible blindness in old age.
Longer the duration of diabetes greater is the severity of retinopathy.
Hypertension, Renal disease, Hyperlipidemia, Obesity, Smoking, Anemia has an adverse on Diabetic Retinopathy.
Stages of Diabetic Retinopathy
Stage 1:Non Proliferative Diabetic Retinopathy – Mild, Moderate and severe.
Stage 2:Proliferative Diabetic Retinopathy – Early & High risk
Advanced Diabetic Retinopathy
Bleeding in diabetic retinopathy causes formation of scar tissue. This pulls the retina and causes retinal detachment which leads to permanent loss of vision.
A special photographic process known as Fundus Fluorescein Angiography (FFA), which involves injection of dye through the vein in the arm into the blood stream. Continuous photographs of the retina are taken for detecting leakage or poor blood flow in the vascular system of the retina.
Laser photocoagulation is the mainstay in the management of diabetic retinopathy. Focal, Grid and Pan Retinal Photocoagulation (PRP) are the different type’s pf laser applications in diabetic Retinopathy.
In advanced diabetic eye disease comprising of vitreous haemorrhage, tractional retinal detachment, requires surgical intervention (vitrectomy) and endo laser photocoagulation.
Precautions to be taken:
Good control of diabetes by medication,diet and exercise.
Control of associated disorders like hypertension, renal disease, hyper lipidemic status is a must.
Diabetic retinopathy patients with hypertension, renal disease or pregnancy should have regular ophthalmic checkup every 6 months.
Diabetic retinopathy patients who have undergone Laser should have regular ophthalmic checkup every 3 months.
All diabetics should have a mandatory eye checkup once in a year.