What is Diabetic Eye Disease?
Eye problems as a result of complications of diabetes are called diabetic eye diseases.
Problems with diabetic eye disease:
• Diabetic Retinopathy: Damaged veins on the retinal network layer.
• Cataract: The ocular lens gets blurred and loses the opacity. Cataract is seen at the early ages with the diabetes patients.
• Glaucoma: Increasing intraocular pressure and damaging the visual nerves. People with diabetes has the double risk of glaucoma.
What is Diabetic Retinopathy?
The structure of the veins is degenerated, and bubbles occur, lead to bleedings and leakage of the fluid from the veins to the surrounding tissues. On the later stages, new buds occur on the retina and leads to sudden intraocular bleeding.
The visual impairment develops at the later stages of diabetic retinopathy. Because of that a diabetes patient who doesn’t have any problem with the vision also should have regular examinations. Both eyes are mostly gets affected by diabetes and might lead to blindness
Stages of Diabetic Retinopathy
1) Light Non-proliferative diabetic retinopathy: In this early stage, microaneurysms - bubbles occur on retinal veins.
2) Mid Non - proliferative diabetic retinopathy: Vascular occlusions occur on the veins and bubbles on the retinal veins are increased.
3) Heavy Non-proliferative diabetic retinopathy: Lack of oxygen in the retina is present, vascular occlusions & bleedings increased.
4) Proliferative diabetic retinopathy: Lack of oxygen in the retina is increased, retina is unnourished and danger signals are sent to the brain after the appearance of unreliable new veins. These new veins are very fragile, carrying the risk of bleeding and sudden visual impairment.
Who Has the Risk of Diabetic Retinopathy?
Everyone who has the Type 1 and Type 2 Diabetes, has the risk of Diabetic Retinopathy. Every single diabetes patient should have a detailed retinal examination at least once a year with the pupils dilated. The risk of diabetic retinopathy increases directly related to the history of diabetes disease.
Pregnancy is also a risk for those who has diabetes. Retinal examinations should be performed often during the pregnancy.
What Are the Symptoms of Diabetic Retinopathy?
Diabetic retinopathy is an insidious disease. There are no obvious symptoms at the early stages, and it is a painless disease. Symptoms shouldn’t be waited to have an examination; it is recommended to have a check at least once a year. Blurry vision occurs as a result of accumulation of macular oedema at macula. At the later stages, if the undesirable and unhealthy veins occur, they might bleed suddenly, and visual impairment can immediately occur.
What are the Indications of Proliferative Retinopathy in the Case of Bleeding?
Seeing flying objects is the first and most common indication in case of sudden bleeding. The vision might be totally black after a while. In the case of seeing flying objects, it is recommended to have a detailed retina examination and have the necessary treatment. If not, bleeding increases and the loss of vision is expected. Sudden bleedings are mostly experienced early in the morning when sleeping. In some cases, the bleeding stops itself and the vision comes back. However, this is a misguiding situation and there is the high chance of relapse. An examination is a must in every case of bleeding
Diabetic retinopathy ends up with visual impairment if not treated. An early diagnoses & treatment can help you keep your vision.
Detailed Retinal Examinations and Tests of Diabetic Retinopathy
Visual Acuity Test: Is a test from a certain distance to examine Woll-alike stains how well the patient can see.
Retinal Check: Pupils are dilated with certain drops and a detailed examination of retina is performed with different kinds of lenses.
Fluorescein Angiography: A fluorescein angiography might be recommended by your physician during the retinal check if needed. A colorant is injected through the veins and retinal photography is performed from both eyes in order to generate a map of retinal veins. Treatment is given accordingly.
Optical Coherence Tomography: OCT device is used lately in order to detect the macular oedema and follow. Without any intervention, real-like sequences of the macular area are obtained via diode laser. OCT also gives us detailed intelligence about the macular oedema.
How is Diabetic Retinopathy Treated?
Especially in the early stages, there is no need for a treatment if there is no macular oedema. Blood sugar, blood pressure and cholesterol should be under control in order to prevent diabetic retinopathy progress.
Laser treatment should be applied to the whole retina in the case of proliferative diabetic retinopathy. This treatment is mostly 2 or 3 sessions. This treatment should be started before any intra ocular bleedings.
It is unfortunately not possible to perform this treatment in the presence of strong bleeding. Vitrectomy operation is suggested if the bleeding is very dense. Blood is completely cleaned with vitrectomy and laser is performed.
How Diabetic Macular Oedema is Treated?
Diabetic macular oedema is treated by laser. Mostly, one session is enough however on some occasions the treatment might be repeated. If there is macular oedema in both eyes one should be treated a few weeks after another.
Generally, diabetes related risk of visual impairment is prevented %90 percent with laser. However, the laser cannot help for the improvement of vision loss. Because of that, early diagnoses and treatment is important. Nowadays there are also alternative treatments to laser for the diabetes related macular oedema. Anti – VEGF medicines might help treating the macular oedema by preventing the formation of new unhealthy veins and preventing the leakages which leads to macular oedema.
These medications, which are injected in the eye can be used together with the laser or alone and might improve the vision. But it should be kept in mind that Anti – VEGF treatment is a surgical intervention and an injection inside the eye. So, there are the risks of infection, retinal tears. It should be performed in a sterile operating theatre by experienced surgeons
Treatment of the Bleeding Caused by Vitrectomy Surgery in Diabetic Retinopathy
Vitrectomy is performed if there is intraocular bleeding related to diabetic retinopathy. Vitrectomy can be performed under general or local anaesthesia which will be decided together with the patient. The vitreous gel and bleeding are cleaned with special thin devices which are entered through very tiny holes that are created on eye wall. The suctioned gel is replaced with a medical liquid called “balanced salt solution”. In the same surgery, retinal laser treatment is also mostly performed together. One month of protective eye drops are prescribed mostly.
Diabetes is a systemic disease. The health of the eye is directly related to blood sugar, arm tension and cholesterol. A total treatment of diabetic retinopathy is not possible. Some damages are permanent. The treatments might fix some of the complications that diabetic retinopathy may have caused.