Diabetic Retinopathy

Depending on the severity of the disease, there are typically three stages of diabetic retinopathy:

1. Background retinopathy

At this stage, tiny bulges (microaneurysms) start forming in the blood vessels of the retina. These microaneurysms sometimes leak small amounts of blood. The eyesight is not affected at this stage, but the patient needs to take preventive measures to stop the progression of retinopathy. The bleeding might lead to swelling of the retina and macula (center portion of the retina).

Diabetic people can lose their vision due to macular edema (swelling of the macula). 

2. Pre-proliferative retinopathy

At this stage, the bleeding in the retina gets more severe and spreads to a larger area. The eyesight starts getting blurry at this stage. To prevent progression, the person has to visit the ophthalmologist every three months. 

3. Proliferative retinopathy

This is the most critical stage as new blood vessels and scar tissue start forming on the retina. This causes severe bleeding of the retina and might cause detachment of the retina. Diabetic people can lose their eyesight at this stage. Regular visits to the ophthalmologist can help in preventing the eyesight from getting worse.

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The symptoms of diabetic retinopathy may not be visible in the early stages but can be seen in the second and third stage. Some of the symptoms are:

• Constant blurry vision
• Blurry vision which clears out all of a sudden - only for a while
• Dark spots in the area of vision
• Seeing a number of floaters (shapes floating in front of the eyes)
• Colour blindness
• Faded or washed out vision
• Night blindness

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Diabetic retinopathy is the result of damage to the retina due to increased blood sugar levels of the body. Diabetic retinopathy can lead to vision loss in two ways:

• Fragile blood vessels leak blood into the retina, making the vision blurred. 
• Leaking of blood into the macula (central part of the retina), causing the macula to swell. A swelled up macula causes blurring of vision.

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The chances of diabetic retinopathy occurring reduce in the case of controlled diabetes. These are some measures which can help in preventing diabetic retinopathy:

• Keep the blood sugar levels, cholesterol levels and blood pressure under control. Check all these levels on a regular basis. 
• Regular visits to the diabetes specialist and an ophthalmologist. Visit the eye specialist immediately if you start seeing floaters or have a blurry vision. 
• Avoid food items with excess salt, fat and sugar.
• Maintain a healthy weight by eating a balanced diet rich in fiber and by exercising regularly.
• Quit smoking and alcohol consumption.

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Testing for diabetic retinopathy involves the proper examination of the retina and the macula. An eye specialist dilates the patient's pupil using medications, to look clearly into the retina. The following are the tests which are done to diagnose diabetic retinopathy:

• Visual acuity test: Usually, the first test is a visual acuity test, which is used to determine the clarity of central vision.
• Visual field test: This test is done to check the side (peripheral) vision.
• Eye muscles test: This test is done to see the functioning of the eye muscles.
• Tonometry: This test is done to check pressure buildup in the eyes.
• Retinal photography or tomography: This test is done to check the condition of the retinas.
• Fluorescein angiography: This test is done to evaluate the growth of abnormal blood vessels in the eyes.

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The treatment of diabetic retinopathy aims at restoring and saving the remaining eyesight of the patient. The most commonly used treatments are:

• Medications: Anti-VEGF medications like Avastin and Eylea can be given to reduce the swelling of the macula and slow down the rate of vision loss.
  VEGF stands for vascular endothelial growth factor, which is a protein that promotes the growth of new blood vessels. Anti-VEGF medicine blocks VEGF and slows down the growth of abnormal blood vessels in the eye.
• Eye surgery: Vitrectomy is one of the surgeries for diabetic retinopathy where the doctor removes the vitreous gel - the liquid that fills the space behind the lens of the eye - along with the blood accumulated on the retina. The procedure sometimes involves the removal of scar tissues present on the retina. This treatment helps in improving the eyesight of the diabetic patient.
• Laser surgery: Laser surgery is the most popular mode of treating eye conditions. It is painless and needs less time for recovery. In this treatment, a laser beam is projected on to the retina through the pupil. The laser beam stops the leaking and growth of all the abnormal blood vessels present in the retina.
  This treatment would not improve the eyesight but can prevent the progression of the condition.

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