Vitreo-retina Services | Sunayana Eye Hospital

Diabetic Retinopathy is a disorder of the retina which affects most of the people with Diabetes Mellitus leading to visual
disturbance, at times total blindness.
Diabetic Mellitus is a condition where the blood sugar levels are above the normal range due to absence or deficiency of insulin in our body.

There are two types:

	IDDM ( Insulin Dependent Diabetic Mellitus)
	NIDDM ( Non-insulin Dependent Diabetic Mellitus)

Diabetes Retinopathy is known to be more common in IDDM. It affects the small capillaries of the retina thereby damaging the
nerve cells leading to vision problem. The wall of the capillaries become weak and starts leaking plasma fluid and fat leading to retinal oedema. Ballooning of capillaries i.e. Aneurysms is a common feature. The part of retina deprived of blood supply starts developing new abnormal vessels which break frequently causing retinal and pre retinal haemorrhages. If it happens in the
central part of retina it is called as Maculopathy which disturbs the vision to a greater extant.

Usually, Diabetes Mellitus does not affect the eye in the initial period (approx. 5-6 years) for majority of the people. But, if the
person is not careful in controlling his sugar levels, Diabetic Retinopathy can develop within few years of onset of Diabetes
Mellitus. After 10years of Diabetes, in spite of good control, Diabetic retinopathy can still manifest in majority of the individuals.
This is very impartment to know as one should always keep control of their diabetes from the time it is diagnosed.

Stages of Diabetic Retinopathy and Treatment


Normal Fundus		Diabetic Maculopathy

There are four stages of Diabetic Retinopathy. They are

	Non-proliferative Diabetic Retinopathy (NPDR)
	Pre- proliferative Diabetic Retinopathy (PPDR)
	Proliferative Diabetic Retinopathy (PDR)
	Stage of complication

In non-proliferative and pre-proliferative Diabetic Retinopathy small retinal haemorrhages ( Dot and Blot) are commonly seen. Usually vision is not affected. These are reversible changes.
The Diabetic individual should have regular follow ups and Laser therapy is usually not required in these stages. But, if the
central area of the Retina ( Macula) is affected by

	Fat collection
	Fluid collection
	Vascular blocks etc.
Then laser therapy is indicated.

At times a test called FLOURESCIN ANGIOGRAPHY is done to know the status of the central retina before Laser treatment.

In Proliferative Diabetic Retinopathy, new fragile, abnormal blood vessels start growing on the optic nerve head and the rest
of the retina. Laser treatment should be done immediately or else sight threatening problems arise.

In the stage of complications,

Sudden onset of blindness can occur due to

	Vitreous haemorrhages
	Retinal haemorrhages
	Traction retinal detachment
	Venous and arteriolar occulusions.
Even in this stage the surgical treatments like Vitrectomy, Membrane peeling, Endo laser, diathermy and other hi-tech procedures are done. Complete visual recovery is difficult.

Points to be remembered:

	All diabetics should have a regular checkup and follow up to detect signs of Diabetic Retinopathy at an early stage
	ARGON or DIODE LASER TREATMENT is effective in stabilizing the vision and preventing further worsening of Diabetic Retinopathy

	All said and done, the visual loss that has occurred after onset of Diabetic Retinopathy is difficult to be restored to normal with any of advanced treatment and hi-tech technologies.

	Proper control of diabetes is very important by means of proper diet, exercise, regular usage of medicines and periodic eye checkups.

Apart from this, Diabetes can give rise to other eye problems like early Cataract formation, Optic neuritis and ocular nerve palsy resulting in double vision.

Retinal Detachment

Separation of light sensitive layer of retina from the pigmentary layer is termed as retinal detachment.

Retinal Detachment

People at Risk

Myopia (shortsightedness)

Peripheferal Retinal Hole Leading to Detachment

	Diabetics
	People having history of eye injury

Retinal Detachment

Symptoms

Veil like vision

Vision in Retinal Detachment

	Floaters
	Flashes of light

Treatment offered at Sunayana:

	Treatment should be done on emergency basis.
	Pneumo retinopexy in case of small breaks with local RD, by injecting expandable air bubble it can be re attached.
	In total RD scleral buckling, cryo pexy, internal procedures like vitrectomy, endo laser and silicon oil injection will be done.

Buckling Procedure

Whatever said and done prevention is better than cure in these situations. Yearly checkup with dilatation is helpful in detecting the problem at an early stage.

ARMD

	It is a retinal disorder affecting central area of the retina in aged people. {60-70}
	It leads to distortion of vision, loss of central vision{central scotoma}
	After cataract surgery, if vision is not improving even with change of spectacles, ARMD has to be ruled out


ARMD Dry Type		ARMD Wet Type

Why it occurs?

	Weakening of the central retinal cells
	Reduction in the blood supply
	Retinal cell damage by free oxygen radicals
	For a 60 years old person, retina behaves like a 90 year old.


ARMD - Amsler Grid		Visual Distortion In ARMD

Diagnosing ARMD. {Dry and Wet}

	Visual acuity testing
	Amsler chart
	FFA, ICG
	OCT

Treatment

	Anti-oxidants
	Lasers-TTT and PDT
	Anti VEGF injections
	Sub Macular Surgery

Sunayana Eye Hospital having advanced Vitreo retina surgical facilities, offers latest treatment for the above conditions by specialists of international standard.

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