Eye is the window to most systemic diseases. Diabetes mellitus is the most common disease affecting the current population between the ages of 30-65. Regular eye examinations help detect sight threatening and life threatening complications.
What is diabetic retinopathy?
It is a condition which occurs in the nerve layer of the eye called retina due to abnormalities in the tiny blood vessels called capillaries.
It is characterized by:
Micro aneurysms: These are the earliest clinical abnormality detected. They appear as small red dots. T
Hemorrhages: These most characteristically occur in the deeper layers of the retina. They appear round, regular and are described as ‘blot’.
Hard exudate: These are tiny specks to patches of confluent yellowish material deposited in the retina, close to the macular area (center point of vision). They result due to leakage of plasma from abnormally permeable capillaries.
Soft exudate: These are also referred to as “cotton wool” spots. They indicate nerve fiber layer infarcts or advancing arterial occlusions.
Neovascularisation: New blood vessels arise from the existing blood vessels on the optic nerve or the retina. These new vessels grow in response to capillary closure and decrease blood supply in the retina. They are fragile, leaky and often rupture causing hemorrhage, which may be within the layers of the retina, or into the vitreous cavity. The products leaking from these vessels, promotes the growth of fibrous tissue, which on contraction brings about retinal detachment and loss of vision.
Venous changes: Veins show sausage like dilation.
Based on the prognosis for vision, diabetic retinopathy is classified clinically as mild, moderate and severe depending on the extent of involvement of retina by the above mentioned features.
How can a diabetic detect, prevent and manage diabetic retinopathy?
- There is good evidence that good metabolic control in the early years following the development of the diabetes reduces the chance of developing retinopathy. Usually 5 years is the time for the appearance of these changes, but it may vary between individuals.
- Control should be assessed by reviewing HbA1c ( levels between 6-6.5 is desirable)
- Control high blood pressure
- Stop smoking
- Limit alcohol intake
- Exercise regularly
Note: Rapid lowering of blood sugar levels may result in worsening of retinopathy, which may require laser photo coagulation.
Early diagnosis and effective treatment is the key to preservation of vision.
- All diabetics must undergo a dilated eye examination by an ophthalmologist at the time of diagnosis of diabetes and then on:
- Yearly once if no changes are present.
- Once every six months if early changes are present
- Once every 3 months if changes are very close to the macula (sight threatening)
What is done if sight threatening changes are detected?
- Laser photo coagulation offers effective treatment if given at an early stage when patient is symptomless.
Note: Most often early diabetic changes are symptomless and detected only on dilated eye examination. Unless the macula is affected or there is a vitreous/ retinal hemorrhage which causes sudden drop in vision; diabetics rarely have an eye examination.
What is laser photo coagulation?
- Laser photo coagulation destroys the areas of retinal ischemia (less blood supply), which is a precursor of new blood vessels.
- It seals the leaking micro aneurysms
- Directly obliterates the new blood vessels.
Laser photo coagulation is an outpatient procedure and the person can resume his/her activities following the procedure (Exception: if vitreous hemorrhage is present and photo coagulation has been done, bed rest is often advised).
Are there any surgeries for diabetic retinopathy?
Advanced diabetic retinopathy where the hemorrhage does not clear within 6 months or there is extensive growth of fibrous tissue or retinal detachment needs surgical intervention.
What are the other possible problems seen in the eye?
- Fluctuating refraction (power of the eye): Raise in blood sugar levels results in short sightedness and low levels result in long sightedness.
- Cataract: Early development or hastening the progress of existing cataract is often seen.
- Glaucoma: Rise in intraocular pressure.
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