DIABETIC RETINOPATHY CARE

Diabetic Retinopathy Care
Diabetes is a condition which impairs the body’s ability to use and store sugar. India is considered the diabetes capital of the world with over 20% of the world’s diabetic population.
Diabetic Retinopathy is the leading cause of blindness among diabetics.
At Aaradhya Netralaya, we understand the complications caused by diabetes and thoroughly examine all our diabetic patients before determining the treatment to be offered.

Our approach includes:
•Meticulous examinations of the interior of the eye using an Ophthalmoscope and 20D retinal lens.
•Making a detailed diagram of the retina with colour coding
•Using the fundus camera to capture serial photographs to understand the condition of the blood vessels.
•Performing Fundus Fluorescein Angiography and Optical Coherence Tomography to assess the stage of diabetic retinopathy.
Ultrasonography of the eye, if necessary

Some diabetics never show any sign of disease in the eye. But in many cases ,the disease progresses until massive bleeding ,scarring or retinal detachment has occurred making recovery of sight impossible.
Diabetic retinopathy increases with the duration of diabetes and almost all those who have been suffering from diabetes for over 30 years will be affected by Diabetic retinopathy.
Juvenile diabetics will be more prone to developing Diabetic Retinopathy at an early ago.

Stage of Diabetic Retinopathy
1. Non-proliferative Diabetic Retinopathy
This is the first stage of Diabetic Retinopathy.
During this stage hardly any symptoms are visible.
Though retinal swelling may be present.
At this stage ,the tiny retinal capillaries become semi-permeable eventually leading to leakage of fluid or blood into the eye.
2. Macular oedema

The macular is central part of the retina responsible for sharp and direct vision.
The centre of the macula begins to swell due to leakage of fluid from retinal capillaries resulting in blurred vision .
Macular oedema can often overlap with the other stages. Early detection of macular oedema will help ensure the most effective treatment.

3. Proliferative Diabetic Retinopathy

This is the final stage of Diabetic Retinopathy, where the blood vessel of the retina break and there is blood and fluid leakage into the eyes. Proliferative Diabetic Retinopathy leads to scar tissue development, retinal detachment and blindness.

Diagnosis of Diabetic Retinopathy
A comprehensive medical eye examination by an ophthalmologist is the best protection against the progress of Diabetes Retinopathy.
It is advisable that all diabetics, even those who do not have refractive errors ,go in for regular eye check-ups. This is especially true for pregnant women who have diabetes they need to have their eyes examined every trimester.
· Treating Diabetic Retinopathy
Diabetic Retinopathy is a treatable disease if diagnosis is made early.

Management Modalities include:
a. Metabolic Control: Strict control of blood sugar is mandatory. Additionally, control of BP lipid levels treatment of renal disease of present is also important
b. Photocoagulation: is the laser treatment offered to seal off the abnormal blood vessels and protect the central vision.

c. Laser rays are directed into the eye and focused to a tiny spot on the retina. Laser rays are directed into the eye and focused to a tiny spot on the retina .
The heat seals off the abnormal blood vessels. We make use of Hi –tech Green Lasers for the treatment. It is an outpatient procedure where each session takes about ten minutes.
The number of sessions required depends in the amount of damage the eye has undergone.
There may be a loss of some peripheral vision(side vision) and night and colour vision may reduce. But the benefits of laser treatment far out weight the risks.
Laser treatment aims at saving the existent sight and not in helping to regain sharp sight as before.
d. Intraocular Injections: of steroids and anti-VEGF agents may be used in addition to the above mentioned therapies.(Avastin , Lucentis,Ozurdex). FDA has approved Lucentis for Macular oedema.

 e. Advanced Vitreoretinal surgical procedures: Including vitreotomy , membrance peeling , endolaser and gas /oil injection are needed to treat late stages of diabetic retinopathy.

Patients who have undergone laser treatment should fallow certain instructions like:
· Don’t strain, bend suddenly, or lift heavy weights for at least four weeks after treatment
· Sleep with your head rasied using pillows
· Control coughing and sneezing with the appropriate medication.

Diabetic retinopathy and pregnancy
Pregnancy can increase the progression of diabetic retinopathy. Hence pregnant women with diabetes should have an eye examination every three months. Controlling blood sugar after the progression of diabetic retinopathy has less effect than controlling it in the initial years of the disease

Symptoms
In the early stages there are no warning signs: the treatment works best in this stage if detected by a routine retinal examination.
In relatively advanced stages, the vision worsens gradually or suddenly, making reading or driving difficult.
Bleeding in the eye can lead to black sports or floaters or total blockage of vision . Persons with advanced diabetic retinopathy may find it difficult to:
• Recognize faces from a distance Read fine newsprint, bills, or low contrast text
• Write in a straight line
• Tolerate bright light or see in dim light
• Move about independently outdoors after dusk
• Tell the time from a wristwatch or read the print on an insulin syring.