Diabetic Retinopathy

WHAT IS THE MEANING OF DIABETIC EYE DISEASES?
Diabetic eye diseases are the ophthalmic problems that may occur as the complication of the diabetes.
The problems that may occur in diabetic eye disease:

  • Diabetic retinopathy: The damage emerging in the blood vessels located in retina.
  • Cataract: Blurry vision and the loss of transperacy of the lens of the eye. Cataract emerges at earlier ages for patients having diabetes.
  • Glaucoma: High eye pressure and the resulting loss of vision by damaging the visual nerve. Diabetic patient has the risk of getting glaucoma twice as the other people.

WHAT IS DIABETIC RETINOPATHY?
Today diabetic retinopathy is the main reason of amaurosis. Retina emerges as a result of the changes in blood vessels. Retina is a light-sensitive layer and it has to be healthy for maintaining visual function. In diabetic retinopathy different types of damage occur. The structure of blood vessels start to malfunction, causing the emergence of small bubbles and the leakage of the fluid inside vessel to the tissues around. In the progressing levels new unfavored vessel knops emerge and this leads a sudden intraocular hemorrhage.
In diabetir retinopathy loss of vision is not seen at the initial stage; it develops within time. That’s why there is a possibility of diabetic retinopathy for the people not having a visual weakness, thus it is required make frequent ophthalmic examinations. Diabetes generally effects both eyes.

What are the stages of diabetic retinopathy?

  • Light non-proliferative diabetic retinopathy: In this early stage bubbles called microaneurysm emerge.
  • Middle non-proliferative diabetic retinopathy: Bubbles in retina vessels increase and occulsions emerge in veins.
  • Heavy non-proliferative diabetic retinopathy: Atherosclerosis and hemorrhages increase, the lack of oxygen in retina becomes clear.
  • Proliferative diabetic retinopathy: Lack of oxygen and innutrition in retina becomes more dominant and the process of the emergence of new unhealthy vessels in retina by sending danger signals to the brain. These new vessels are extremely fragile, which means they can cause hemorrhage and sudden vision loss at any moment.

How does diabetic retinopathy cause visual loss?
Diabetic retinopathy causes visual loss in two different ways:

  • Fluid leaking from the weakening vessels swarm in the visual center called macula and the hydrocele called macular edema emerges. This situation gradually decreases the vision.
  • In the proliferative stage sudden hemorrhages may occur by unhealthy, weak new vessel formations, causing sudden visual loss.

retinopathy-image1

In the left picture the vision a healthy person, and in the right picture the vision of a person with proliferative diabetic retinopathy takes place.

Who has the risk of diabetic retinopathy?

All people having Type 1 and Type 2 diabetes have the risk of diabetic retinopathy. Every diabetic patient has to pass through a detailed process of retinal scanning by the enlargement of the pupils, at least once a year. The more time the patient possesses diabetes, the more the risk of diabetic retinopathy develops.
Pregnancy poses another risk for the women with diabetes. During pregnancy the detailed retinal examination’s frequency should be increased.

What should I do to keep my vision?

If you have diabetes, you should have a detailed retinal examination at least once a year. Diabetic retinopathy is a sneaky disease. Proliferative diabetic retinopathy may develop in a diabetic patient, without making any visual harm throughout years. Whether you have a problem in your vision or not, your doctor may recommend you a treatment for diabetic retinopathy. Early diagnosis and the treatment on the right time can hinder the visual loss greatly.
If there is a development of diabetic retinopathy, retinal examniations should be made more frequently. In the case of advanced (proliferative) diabetic retinopathy, the risk of visual loss can be prevented 95% if the treatment is made on the right time.
The development and progression of diabetic retinopathy is hindered or slowed down greatly by regulating the blood sugar. Besides that it hinders or slows down the kidney and nerve damage.

What Are the Symptoms of Diabetic Retinopathy?

Diabetic retinopathy is a sneaky disease. In the early stages of the disease, there is no symptom, also diabetic retinopathy is a painless disease. One should not wait for the emergence of symptoms and should get under a retinal scan once a year. In the visual center called macula where, if the effusion called macular edema emerges, the visual blurriness will start. In the proliferative level if the unfavored new and ill vascularity starts these vessels may have a sudden hemorrhage and the vision may be lost at once.

What Are the Symptoms of Proliferative Retinopathy In a Case of Hemorrhage?

In the case of sudden hemorrhage the first symptom is the emergence of floaters. After a while the vision may shut down completely. If the floaters are seen, the patient should immediately pass through the detailed retinal scan and have the suitable treatment, otherwise the bleeding gets more intense and the vision may shut down completely. Most of the sudden hemorrhages emerge while sleeping in the small hours.
Sometimes, the bleeding may stop by itself and vision may recover again without a treatment. However it is a misleading situation and there is a high possibility of the iteration of hemorrhage. Therefore the patient should see his/her doctor before waiting fot the hemorrhage to pass. If not treated, diabetic retinopathy results in a severe visual loss. Whereas with the early treatment the visual gain increases.

How Is Diabetic Retinopathy and Macular Edema Determined?

A detailed retinal examination contains the tests written below:

  • Measure of visual acuity: Visual capacity is measured from a distance.
  • Retinal examination: Pupils are enlarged by various droppings. Detalied retinal examination is made by using various lenses.
  • Measure of eye pressure
  • Fluorescein angiography: In the detailed retinal examination, if deemed necessary, your doctor may recommend the shooting of fluorescein angiography.By injecting A colorant substance toyour arm vessels, retina photographs of your eyes are taken one after another. This way the visceral structure of the retina of the eye will be exposed. Treatment will be lead according to these results.
  • Optical coherence tomography: Recently a device called optical coherence tomography (OCT) is used for tracing and determining the macular edema. Without any penetration to the patient, the real-like incisions of the macular regions are obtained. Diod laser light beams are used for this purpose. OCT gives us detailed information about the macular edema.

HOW IS DIABETIC RETINOPATHY TREATED?
If there is no macular edema, especially in the earlier stages, there is no need for treatment. Blood sugar, blood pressure and cholesterol levels should be kept under control to prevent diabetic retinopathy to progress.
If the new unfavored vessels occured in retina (proliferative diabetic retinopathy) laser treatment should be applied to the whole retina (except the visual center). This treatment generally lasts for two or three sessions. This laser treatment should be made before the intraocular hemorrhage starts. In the existence of heavy hemorrhage the laser treatment is not possible.
If the hemorrhage is very intense, surgical cleaning of the hemorrhage called vitrectomy is required. With vitrectomy, the hemorrhage in the eye is cleaned completely and the required laser treatment is made within the same surgery.

How is Macular Edema Treated?
Diabetic macular edema is treated with laser. Generally a single session is enough but in persistent situations multiple sessions could be necessary. If there is macular edema in both eyes, firstly one of the eyes should be treated then the other one should be treated within a few weeks. To generalize, laser treatment prevents the risk of amaurosis (blindness) in an amount of 90% because of the diabetes. However, laser treatment does not frequently provide visual gain for the patients who already have a visual loss. Therefore early diagnosis and treatment is very important.
In recend years, new treatment methods are started to be used except for laser, for the diabetic macular edema. These new medicine called Anti-VEGF helps the recovery in diabetes – related retinopathy by preventing the emergence of unhealthy new vessels and the leakages from veins causing macular edema. These medicine are injected inside the eye, and they can be used together with the laser or by itself. Compared with lasers they provide a possibility of a visual gain. However it should be noted that anti-VEGF treatment is a surgical treatment and it requires an injection to the eye. Therefore, unavoidably, it brings some risks such as infection and retinal break. Thus, the environment of the operating room should be extremely sterilised and the surgery should be implemented by the experienced specialists. Also, in which conditions it should be done or how frequent it should be implemented ought to be decided by the specialists.

What is vitrectomy?
If there is an emergence of hemorrhage related with the intraocular daibetic retinopathy, vitrectomy surgery is implemented.
Vitrectomy can be implemented with the local or general anesthesia. The way of anesthesia is mutually decided by the doctor and the patient. In vitrectomy, little holes are opened to the eye wall and by using very tiny equipment these holes are penetrated and the fluid called vitreus and hemorrhage is cleared. Generally the laser treatment of retina is also completed in the same surgery. Protective eye drops are used for a period of a moth after the surgery.

It should be noted that diabetes is a systematic disease. Ophthalmic health is directly related with the cholesterol proportions, blood pressure, and most importantly, blood sugar.

Diabetic retinopathy is a sneaky disease. Retina can be exposed to heavy damage without a visual loss. Therefore frequent control, early diagnosis, the right treatment is extremely important.

It is not possible to treat diabetic retinopathy completely. The damage done by it is permanent. Implemented treatments can fix the complications led by diabetic retinopathy in a limited way. Therefore early diagnosis and treatment is very important.