India stands to become largest diabetic population by 2010.Population of diabetic patients in India is 34 million acording to various sources. A person with diabetes is at risk for developing diabetic retinopathy among other ophthalmic disorders. Diabetic retinopathy is the leading cause of blindness in young and middle-aged adults today. The longer a person has diabetes, the greater their chance of developing diabetic retinopathy.
There are two types of diabetic retinopathy:
* Non-Proliferative Diabetic Retinopathy (NPDR)
* 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.
Generally, people with mild NPDR do not have any visual loss. A dilated eye exam is the only way to detect changes inside the eye before loss of vision begins. People with diabetes should have an eye examination at least once a year. More frequent exams may be necessary after diabetic retinopathy is diagnosed. People with PDR experience a broader range of symptoms. They may
See dark floaters
Experience loss of central or peripheral vision
Experience visual distortions or blurriness
Experience temporary or permanent vision loss
Diabetic retinopathy is diagnosed by dilating the pupil and looking inside the eye with an ophthalmoscope. If an ophthalmologist discovers diabetic retinopathy, he or she may wish to order color photographs of the retina through a test called fluorescein angiography. During this test, a dye is injected into the arm and quickly travels throughout the blood system. Once the dye reaches the blood vessels of the retina, a photograph is taken of the eye. The dye allows the ophthalmologist to detect damaged blood vessels that are leaking dye.
The most effective overall strategy for diabetic retinopathy is to prevent it as much as possible. Strict control of blood sugar levels will significantly reduce the long-term loss of vision from retinopathy. With improved diagnosis and treatment, only a small percentage of people with retinopathy develop serious vision problems.
Because the earliest stages of diabetic retinopathy include inflammation, intraocular corticosteroids have been utilized with some success in selected patients. This form of treatment includes the use of a long-acting corticosteroid (triamcinolone acetonide) injected into the vitreous cavity by way of a very tiny needle under topical (drops) anesthesia. This treatment may reduce retinal swelling and improve visual acuity in patients with diabetic macular edema. However, visual recovery may be limited and the effect may last only 3 to 6 months after the treatment. Other newer modalities like Anti vascular endothelial growth factor drugs( Lucentis, Macugen and Avastin )have been proved to be quite successful in reducing macular edema and new vessels temporarily. However they do not work well all alone unless combined with adequate photocoagulation.
Diabetic Eye Unit established at SRN provides constant care for diabetic patients. It involves routine screening of diabetics to detect retinopathy. If detected early patients can be managed medically by FFA and laser treatment, thereby preventing further decrease in vision. We have found very encouraging results with use of Anti VEGF drugs like Avastin and Lucentis in cases of macular oedema and PDR cases .
Patients presenting at a later stage with decreased vision due to vitreous hemorrhage and tractional retinal detachment require vitrectomy We have experienced VR surgeon to perform vitreoretinal sugeries
Fundus fluorescein angiography (FFA) with Fundus Camera (Carl Zeiss Meditech, Germany)
PRP( Pan retinal photocoagulation) argon Green laser (Iris Medical, USA)
A R M D Management
PDT (Photo Dynamic Therapy)
Anti VEGF Injections (Lucentis and Macugen