Diabetes is a common condition which affects many organs in the body, including the eyes. For this reason, anyone diagnosed with diabetes should keep up to date with regular eye checks.
Diabetes affects mainly the small blood vessels of the eye, especially those found in the retina. When the vessels become damaged due to diabetes, this can lead to a condition known Diabetic Retinopathy, which can lead to reduced vision. The damage is brought about by high and fluctuating levels of blood sugar.
The process of retinopathy starts from leakage of fluid, protein, fat and blood from the damaged capillaries, which in turn accumulate in the retina disrupting its function. It has a particular tendency to occur at the macula, which is the part of the retina that is responsible for central vision. A sign of Diabetic Retinopathy is reduced vision. However, a significant number of patients may not experience any visual symptoms until the later, more severe stages of the condition. This is why regular eye reviews are important, as early detection is key to slowing down the progression of damage.
At a more advanced stage of Diabetic Retinopathy, growth of abnormal new vessels in the retina may bleed and promote formation of scar tissue which can stretch, distort or at times detach the retina. Patients may experience a sudden increase in floaters or a loss of vision in one or both eyes.
The chances of developing Diabetic Retinopathy increases with the time in which a patient has had the condition, as well as how well the patient is able to control their blood sugar levels. Other co-existing medical conditions such as high blood pressure, high cholesterol levels, obesity and smoking can also play a role in the development and severity of Diabetic Retinopathy.
Diabetic retinopathy can be treated quite effectively as long as it is diagnosed and treated early.
Keeping you blood sugar levels stable and at an appropriate level through diet, exercise, and medication, as decided by your healthcare professional, is the best way for you to reduce the risk of developing Diabetic Retinopathy.
Anti - Vascular Endothelial Growth Factor (Anti-VEGF) treatment is a relatively modern form of Diabetic Eye Disease treatment, but has become an increasingly common form of treatment due to its success rate of slowing the progression of Diabetic Eye Disease. Anti-VEGF is injected into the eye by an ophthalmologist to reduce swelling in the retina and suppress new vessel growth. These are similar drugs to those used in the treatment of Wet Macular Degeneration. Anti-VEGF injections are very effective in improving and stabilising vision, however, usually need to be administered 4 to 8 weekly, for approximately 2-3 years, depending on the severity of disease and response to treatment.
Treatment is given under sterile conditions with local anaesthetic in the clinic.
Laser treatment was previously a very common treatment for diabetic eye disease, especially for diabetic maculopathy, prior to the discovery of Anti-VEGF treatment. Whilst it is still used to treat some macular disease, it is mostly used in treating Proliferative Diabetic Retinopathy. The laser is applied through a special contact lens in an outpatient setting and the patient can go home after having the treatment. The treatment is sometimes slightly uncomfortable for some people.
During the treatment, areas of the retina are treated with a tiny laser if there is significant leakage of fluid, especially at or near the macula, or if there are areas where the retina is affected severely by poor circulation causing ischemia. The aim of treatment is to help prevent further visual loss from further leakage and to promote reabsorption of fluid from the retina, hence reducing the stimulus to new vessel growth.
In cases where new blood vessels are already present, the aim of laser therapy is to cause the new vessels to regress and prevent any further vessels from developing. Repeated treatments are usually needed. If diabetic retinopathy is too advanced before laser treatment is undertaken, it may fail to significantly improve the patient’s visual prognosis. Once again, this underlines the importance of regular screening to detect diabetic retinopathy early and begin early treatment for the most successful outcome. Multiple treatments may be required so successfully manage the retinopathy.
Surgical treatment may be required for very advanced cases of the condition where there has been severe bleeding in the eye, scar formation or retinal detachment. Surgery however is normally reserved as an attempt to rescue desperate cases of advanced diabetic retinopathy from blindness.