Diabetic Retinopathy Overview

“At present, confirmed diabetes patients in India are 67 million, with another 30 million in pre-diabetes group. By 2030, India will have the largest number of patients in the world.”

Diabetes by its very nature affects the small and medium sized blood vessels of the body. This would significantly affect the Eye, Heart, Kidney ad the Peripheral Nerves.

Typically diabetes causes earlier onset Cataracts, makes a patient more prone to glaucoma but the real damage is to the retina- this ailment is referred to as diabetic retinopathy. The Retina has a large number of small and medium sized blood vessels that crisscross it. It is these that get affected by the disease.
In the earliest stages of the disease, the blood vessels become more congested and small outpouchings called micro-aneurysms appear. Small bleeding points may also be noted. This first stage of retinopathy rarely causes vision loss.

Subsequently, the blood vessels become more and more “leaky”. Blood, serum and small amounts of lipids leak out of these arterioles making the retina more boggy and fluid filled. This is referred to as edema. . On Clinical examination, small haemorrhages and exudates (exuded lipids) are seen. If the central retina is not affected, the vision at this stage may remain only mildly affected. Involvement of the central retina however can lead to a more serious loss of vision.
In the next stage, these blood vessels begin to shut down, leaving areas of the retina without blood supply or reduced blood supply at best. By now the patient has significant loss of vision.

In the last stages of diabetic retinopathy, new and abnormal blood vessels begin to form. These grow like weeds and invade almost all areas of the eye, leading to intractable glaucoma and tractional retinal detachments. By this stage vision loss is profound and usually beyond complete recovery.

The only way to prevent or at least slow down the progression of this terrifying and relentless ailment is good control of diabetes and regular eye exams by a qualified retinologist with sufficient experience in the field. Clinical Examination is often supplemented by investigations like OCT and Fluorscein Angiography which are essential towards diagnosis and further management.

Management of diabetic retinopathy is done in the hands of an expert and may need several sittings of laser or in more advanced cases, injections. Vision maintenance is the objective of treatment and good control of disease goes a long way in achieving this goal.