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Diabetic Retinopathy

Diabetes and the Eye

An increasing incidence of diabetes mellitus poses a major health problem in India. The contributing factors are:
» An inappropriate diet, high in fat and carbohydrates
» Sedentary lifestyle

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.

» Diabetic retinopathy—damage to the blood vessels in the retina.
» Cataract—clouding of the eye's lens. Cataracts develop at an earlier age in people with diabetes.
» Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

Diabetes may affect both the young (type I) and the old (type II). The latter type is far more common. Regardless of the type of diabetes, many diabetics develop a complication called diabetic retinopathy, a change in the retinal blood vessels that leads to loss of vision

Diabetic Retinopathy: A Silent Killer

» Diabetics are twice as likely as non-diabetics to develop eye problems. The most common eye complication in diabetes is diabetic retinopathy; other complications are cataract and glaucoma. » Fifty percent of diabetics develop some degree of diabetic eye disease. » The risk of blindness is 25 times higher in diabetics than in non-diabetics. » Early detection and timely treatment of diabetic eye disease significantly reduces the risk of vision loss. » Diabetic retinopathy is often symptomless in the early stages. Since only an ophthalmologist can detect early signs of diabetic retinopathy, all diabetics should have their eyes examined at least once every year.

Diabetic retinopathy is gradual in onset and is related to the duration of diabetes. High blood glucose levels, high blood pressure and genetics influence the development and progression of diabetic retinopathy.

There are two main stages of diabetic retinopathy:

Non-proliferative: At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels. As the disease progresses, some blood vessels that nourish the retina are blocked. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to grow new blood vessels for nourishment. When the blood vessels leak, macular edema may occur, thereby reducing vision.

Proliferative: At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result. When new, weak blood vessels grow or proliferate, bleeding into the vitreous may occur and cause severe visual loss.

Treatment of diabetic retinopathy

Lasers are widely used in treating diabetic retinopathy. Lasers are formed by an intense and highly energetic beam of light. They can slow down or stop the progression of diabetic retinopathy and stabilise vision.

What is Laser?

Laser is an intense and highly energetic beam of light that emerges from a light source and is focused on the retina. Absorption by the retina will either seal or destroy the abnormal tissue.

Patterns of Laser treatment

Laser treatment reduces swelling by sealing the weak leaking vessels in the retina. It also regresses the new vessels hence prevents or stops bledding.

Laser treatment in diabetic retinopathy is of three types:

» Focal treatment
» Grid treatment
» Panretinal treatment

The laser experience

Laser treatment usually takes place in an out-patient setting. The patients are given topical anesthesia to prevent any discomfort. The patient is positioned before a slit lamp. The ophthalmologist guides the laser beam precisely on the target, with the aid of a slit lamp and a special contact lens. Absorption by the diseased tissue either reduces the retinal thickening or stops bleeding. Additional treatment may be required depending on the patient’s condition.

Laser

The clinic is equipped with multiple lasers with slit lamp delivery and indirect ophthalmoscope delivery systems. Both double frequency YAG and diode laser is available for treatment of diabetic retinopathy, retinal holes , tumors ,Retinopathy of Prematurity, retinal vascular diseases etc. In addition Transpupillary Thermotherapy and Photodynamic Therapy for treatment of tumours and sub retinal neovascular conditions are also available.

Laser treatment is usually performed as an outpatient procedure. The patient is given topical anesthesia to prevent any discomfort and is then positioned before a slit lamp. The ophthalmologist directs the laser beam precisely on the target with the aid of the slit lamp and a special contact lens. Absorption by the diseased tissue either seals or destroys the tissue. Additional treatment may be required according to the patient's condition.
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