What is diabetes mellitus?
Diabetes mellitus is a condition in which the pancreas, a gland in the abdomen, produces insufficient quantities of a hormone called insulin. Due to a deficiency of insulin, the body is unable to control the levels of sugar in the blood. Diabetes can affect the eye in several ways. Diabetic patients have a higher likelihood of developing cataract, glaucoma and damage to the retina.

What is diabetic retinopathy?
Retina is a light sensitive layer at the back of the eye on which the images are created and from here transmitted to the brain. This layer has a fine meshwork of very small blood vessels that get damaged in diabetes. This is called diabetic retinopathy. All diabetic patients are at risk of developing diabetic retinopathy. The longer the patient has diabetes and the more uncontrolled it is, the greater the risk.

In diabetic retinopathy the small blood vessels of the retina become weakened and develop small outpouchings called microaneurysms. These vessels also become more permeable, that is proteins and other substances readily leak out through the walls of the blood vessels. In the later stages, these blood vessels may get completely blocked. Due to the diseased vessels, the retina is deprived of adequate oxygen supply and this stimulates growth of new, abnormal vessels in the retina.

What are the symptoms?
Patients may remain free of symptoms in the early phases of the disease. A problem is first noted when the abnormal vessels bleed into the jelly of the eye called vitreous. This phenomenon is called vitreous haemorrhage. This presents as noticing black spots in the vision that are floating or as cobwebs. There may loss of vision that may be sudden or gradual. The bleeding into the vitreous leads to development of a scar that pulls on the retina causing it to detach from the eyeball (retinal detachment).

How is it diagnosed?
An eye specialist will need to do a thorough examination. All diabetic patients must visit the ophthalmologist once every year for an eye check-up to detect any abnormality in its early, treatable phase. The doctor may also perform a test called fluorescein angiography in which a dye is injected into a vein in the arm and photographs of the eye are taken using a special camera. This test helps to detect abnormal leakage of fluid in the eye, blockages in the blood vessels of the retina and presence of new abnormal blood vessels in the retina.

What is the treatment?
Several treatment modalities are available depending on the extent of damage. Laser photocoagulation is a technique in which the abnormal leakage of fluid can be reduced using laser. This also helps to regress the abnormal blood vessels in the retina, thereby reducing the chances of bleeding. This treatment does not improve ones vision, but helps to maintain it at that level and slows the progression of the fall in vision. In some case, the blood in the vitreous and the abnormal scar tissue may need to be removed by a procedure called vitrectomy. Newer techniques like vitreous microsurgery and endolaser show an improvement in 60-70% cases.
 

      Vision with Diabetic Retinopathy

  Laser Treatment

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