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Diabetic Retinopathy

What is diabetes-related retinopathy?

Diabetes-related retinopathy is an eye condition that weakens the blood vessels in your retina. Anyone with diabetes can develop this condition. Without treatment, it can lead to vision loss or blindness. But with right care, you can prevent vision loss and stop disease progression.

Types of diabetes-related retinopathy

Non-proliferative Retinopathy (NPDR) : Diabetes-related

Diabetes-related retinopathy is an eye condition that weakens the blood vessels in your retina. Anyone with diabetes can develop this condition. Without treatment, it can lead to vision loss or blindness. But with right care, you can prevent vision loss and stop disease progression.

Proliferative Retinopathy (PDR) : Diabetes-related

When the disease progresses, abnormal blood vessels grow in response to the ischemia. These abnormal vessels can leak blood into the gel-like substance (vitreous) that fills your eye and cause tractional changes to the surface of the retina, detaching it and resulting in severe vision loss in late stages.

Symptoms of diabetes - related retinopathy

In the early stages, most people experience no signs of diabetes-related retinopathy. You may not experience vision changes until the condition is severe. For some people, symptoms come and go.

Blurred or distorted vision

New colour blindness or seeing colours as faded

Poor night vision (night blindness)

Small dark spots (eye floaters) or streaks in your vision

Trouble reading or seeing faraway objects

Tips to prevent diabetes-related retinopathy:

Avoid smoking

Control your blood sugar

Exercise regularly

Have annual eye examinations

Keep your blood pressure within a healthy range

Take any medications exactly as prescribed

Management and Treatment

In the early stages of the disease, your retina surgeon may use a wait-and-see approach, especially in the setting of good vision. During this phase, you have regular eye exams but don’t need further treatment. Some people need eye exams every two to four months.

Laser treatment

Laser treatment is used to treat new blood vessels at the back of the eyes in the advanced stages of diabetic retinopathy. This is done because the new blood vessels tend to be very weak and often cause bleeding into the eye.

Treatment can help stabilise the changes in your eyes caused by your diabetes and stop your vision from getting any worse, although it will not usually improve your sight.

Laser treatment, focal or grid laser, is also indicated in some cases of fluid/ swelling in the centre of the eye (macula) to stabilise the maculopathy.

  • It involves shining a laser into your eyes – you’ll be given local anaesthetic drops to numb your eyes
  • Eye drops are used to widen your pupils, and special contact lenses are used to hold your eyelids open and focus the laser onto your retina
  • Normally, it takes around 10 to 20 minutes
  • It is usually carried out on an outpatient basis, which means you will not need to stay in hospital overnight
  • May require more than 1 visit to a laser treatment clinic
  • It is not usually painful, although you may feel a sharp pricking sensation when certain areas of your eye are being treated

Eye injection

In some cases of diabetic maculopathy, injections of a medicine called anti-VEGF may be given directly into your eyes to reduce the swelling in the centre of the eye (macular edema) and sometimes to prevent new blood vessels from forming at the back of the eyes.

The main medicines used are Bevacizumab (Avastin), Ranibizumab (Lucentis)  and Aflibercept (Eylea).

These can help prevent the problems in your eyes from getting worse and also improve your vision.

During treatment:

The skin around your eyes will be cleaned and covered with a sheet

  • Small clips will be used to keep your eyes open
  • You’ll be given local anaesthetic drops to numb your eyes
  • A very fine needle is carefully guided into your eyeball, and the injection is given
  • The injections are usually given once a month to begin with
  • Once your vision starts to stabilise, they’ll be stopped or given less frequently
  • Injections of steroid medication may sometimes be given instead of anti-VEGF injections or if the anti-VEGF injections do not help

Eye implant

If you cannot have anti-VEGF injections, or they have not worked for you, you may be offered an eye implant called an intravitreal implant (brand name Ozurdex) containing a steroid medicine called dexamethasone.

This is a tiny implant that’s injected into your eye using a special applicator. You’ll be given a local anaesthetic first to numb your eye. The implant slowly releases dexamethasone over a few months. This reduces swelling in your eye, and can help to improve your eyesight. The implant eventually dissolves, so it does not need to be removed.

Eye surgery

Surgery may be carried out to remove some of the vitreous humour from the eye. This is the transparent, jelly-like substance that fills the space behind the lens of the eye.

The operation, known as vitrectomy, may be needed if:

  • A large amount of blood has collected in your eye
  • There’s extensive membrane that’s likely to cause, or has already caused, retinal detachment

About the procedure

 

  • During the procedure, the surgeon will make a small incision in your eye before removing some of the vitreous humour, removing any membrane and using a laser to prevent a further deterioration in your vision.
  • Vitreoretinal surgery is usually carried out under local anaesthetic and sedation. This means you will not experience any pain or have any awareness of the surgery being performed.
  • After the procedure, you should be able to go home on the same day.
  • For the first few days, you may need to wear a patch over your eye. This is because activities such as reading and watching television can quickly tire your eye to begin with.
  • You will probably have blurred vision after the operation. This should improve gradually, although it may take several months for your vision to fully return to normal.
  • Your surgeon will advise you about any activities you should avoid during your recovery.

Possible risks of vitreoretinal surgery include:

  • Developing a cataract
  • Further bleeding into the eye
  • Retinal detachment
  • Fluid build-up in the cornea (outer layer at the front of the eye)
  • Infection in the eye

There’s also a small chance that you will need further retinal surgery afterwards. Your surgeon will explain the risks to you.

Tips to prevent diabetes-related retinopathy: Flaticon Icons
  • Avoid smoking
  • Control your blood sugar
  • Exercise regularly
  • Have annual eye exams
  • Keep your blood pressure within a healthy range
  • Take any medications exactly as prescribed
Outlook / Prognosis

With timely treatment, you can prevent vision loss and delay diabetes-related retinopathy progression. After diabetes-related retinopathy treatment, you will have the best chance of a positive outcome if you manage your diabetes and keep your blood sugar well-controlled.

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