How does diabetes affect the retina? 

Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma (Increase pressure inside the eye) , but the disease's affect on the retina is the main threat to vision. Most patients develop diabetic changes in the retina after approximately 10 years. But if the patient is not controlling his Diabetes changes could occur as early as 5 years or even less. 

Stages:

 

The earliest phase of the disease is known as background diabetic retinopathy. In this stage, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision.

                                                

 

Proliferative diabetic retinopathy; in this stage circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New, fragile, vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called neovascularization. Unfortunately, these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous, causing spots or floaters, along with decreased vision. 

In the latest stages of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and glaucoma.

How do you notice it?

 

There's really no specific way to know, but most importantly are;

-         Blurring of vision or deterioration of vision

-         Floaters and flashes of light

-         Sudden loss of vision

That's why it is recommended that Diabetic patients do routine visit for ophthalmologist for evaluating their Retina via dilated fundus examination. If everything is ok, fundus examination can be done on annual visits.

 

How do I treat it?

 

Treatment of Diabetic retinopathy requires both ophthalmologist and patient's cooperation. The most single effective treatment is controlling your blood sugar levels. And it is important to know that any surgical interference could lose its effect when the patient fails to lower his blood sugar to or near normal levels. Keep in mind that regular visits and early detection can save your vision.

 

1-     Laser Photocoagulation using argon laser can help to destroy the new fragile blood vessels. Argon laser leads to reduction in VEG-F (Vascular Endothelia Growth Factor) which is responsible for these abnormal vessels growth. Mostly, laser is applied to the peripheries of the retina. Laser can not be applied to the center of the retina or the macula.

2-     Intravitreal Injection; this popular technique provide the means of treating neovascularization located near the macula. Most widely used are Avastin and Leucentis. More detailed discussion about IV injections are found in Procedures/Intravitreal injection.

3-     Vitrectomy; commonly needed for diabetic patients who suffer a vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the eye). During a vitrectomy, the retina surgeon carefully removes blood and vitreous from the eye, and replaces it with clear salt solution (saline). At the same time, the surgeon may also gently cut strands of vitreous attached to the retina that create traction and could lead to retinal detachment or tears. But the need for this surgery has become less after the use of IV injections.

4-     Surgery For Retinal Detachment; Retinal detachment requires surgical treatment to reattach the retina to the back of the eye. The prognosis for visual recovery is dependent on the severity of the detachment.

5-     Controlling Diabetes. Helps progression and preventions.