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Diabetes Health

Diabetic Retinopathy

Dr Padmaja Kumari Rani explains the effects of Diabetic Retinopathy to Sunila Kelkar.

Diabetic retinopathy (DR) is an important cause of visual impairment and blindness in people with Diabetes especially amongst those who fall within the working age group. Thus the morbidity and treatment costs of Diabetic Retinopathy results in significant economic burden to individuals and society as a whole.

Blindness and visual impairment related to Diabetic retinopathy also has significant impact on the quality of life of people with Diabetes.

People at a higher risk of developing Diabetic Retinopathy are those who have:

What is Diabetic Retinopathy?

Diabetic Retinopathy is a complication associated with Diabetes affecting small blood vessels of the retina. The retina is a light-sensitive layer at the back of the eye that covers about 65 percent of its interior surface. The optics of the eye creates an image of what is seen on the retina. This functions like the film in a single-lens reflex camera.

People at a higher risk of developing Diabetic Retinopathy are those who have:

  • had Diabetes for a long duration
  • poor blood sugar control
  • high blood pressure
  • lipid abnormalities
  • anaemia
  • smoke

How is vision affected by Diabetic Retinopathy?

A trained Ophthalmologist can screen for Diabetic Retinopathy either using Fundus photography or by a dilated fundus examination using indirect ophthalmoscopy.

Recent technological advances in fundus imaging led to a paradigm shift in the screening of Diabetic Retinopathy. These portable indigenous cameras can effectively screen for Diabetic Retinopathy at the primary eye care/ health care settings without the need of an expert. The physician should be the first point of contact for people with Diabetes. 90 per cent of Diabetic Retinopathy cases (early stages) only require management (hypertension control and lipid level regulation) under the guidance of Physician. Only 10 per cent of Diabetic retinopathy cases (sight threatening Diabetic Retinopathy) require referral to an Ophthalmologist. Hence visual acuity examination and fundus imaging (portable fundus camera) should be a part of the examination protocol at the physician’s clinic.

Management of Diabetic Retinopathy

Important modifiable risk factors include glycaemic (blood sugar) control, blood pressure, anaemia, renal parameters, serum lipid level control. Regular physical activity and cessation of smoking does have a positive influence in preventing progression of Diabetic Retinopathy. Regular physical activity in the form of brisk walking, yoga can have a beneficial effect in arresting the progression of Diabetic Retinopathy.

However one with severe form of Diabetic Retinopathy (which has resulted in bleeding in the eye) should be cautious in performing vigorous exercises requiring heavy breathing or lifting heavy weights which can increase pressure on the tiny fragile new blood vessels causing significant vitreous bleeding and resulting in impaired vision.

Medical management of Diabetic Retinopathy

Laser photo-coagulation is the gold standard therapy in the management of diabetic macular edema and proliferative (severe) form of Diabetic Retinopathy. Other important options of management include steroid / Anti VEGF injections into the vitreous cavity for the management of Diabetic Macular Edema and Proliferate Diabetic Retinopathy. These pharmacological advances create a significant impact with regards to visual gain in people with Diabetic Macular Edema.

Surgical Management of Diabetic Retinopathy

Recent advances in surgical techniques/ visualization systems have changed the scenario of surgical management of Diabetic Retinopathy. The current common indications for surgical management include non-clearing vitreous bleeding, tractional or combined retinal detachment involving macular area. Intravitreal Anti VEGF injections are used as important adjuvants in certain surgical cases of severe forms of Diabetic Retinopathy.

To conclude, good glycemic control, hypertension and lipid management along with annual Diabetic Retinopathy screening by fundus examination is essential for preventing blindness and visual impairment caused due to Diabetic Retinopathy.

Dr Padmaja Kumari Rani is a Consultant Doctor at the Smt Kanuri Santhamma centre for Vitreoretinal Diseases In L V Prasad Eye Institute in Hyderabad.

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