Diabetic Retinopathy

• Mild non proliferative diabetic retinopathy –

  swelling in small areas of the blood vessels in the retina.

• Moderate non proliferative diabetic retinopathy –

  some of the blood vessels in the retina will become blocked leading to hemorrhages

• Severe non proliferative diabetic retinopathy –

  more blocked blood vessels, which lead to areas of the retina no longer receiving adequate blood flow

• Proliferative diabetic retinopathy –

  new blood vessels will begin to grow in the retina, but they are fragile and abnormal, hence they can leak blood which will lead to vision loss and possibly blindness.

• Diabetic maculopathy –

  blood vessels become leaky in the macula which is the central area of the retina which gives us the best vision

Diabetic Retinopathy Diagnosis

Visual acuity testing:

This measures a person’s vision.

Tonometry:

This test measures pressure inside the eye.

Pupil dilation:

Drops placed on the eye’s surface widen the pupil, allowing a physician to examine the retina and optic nerve.

Comprehensive dilated eye exam:

It allows the doctor to check the retina for:

• Changes to blood vessels or leaking blood vessels

• Fatty deposits

• Swelling of the macula (Diabetic macular edema)

• Changes in the lens

• Damage to nerve tissue

Optical coherence tomography (OCT):

It uses light waves to produce images of the retina to assess the amount of fluid.

Fundus fluorescein angiography (FFA):

During this test, your doctor will inject a dye into your arm, allowing them to track how the blood flows in your eye. They’ll take pictures of the dye circulating inside of your eye to determine which vessels are blocked, leaking, or broken.

Treatment Modalities

The goal of any treatment is to slow or stop the progression of the disease. In the early stages of non-proliferative diabetic retinopathy, regular monitoring may be the only treatment. Diet and exercise and controlling blood sugar levels can help control the progression of the disease.

Laser : If the disease advances, the blood vessels can leak blood and fluid into the retina, leading to macular edema. Laser treatment can stop this leakage. Focal laser photocoagulation involves using a laser to target a specific leaky vessel in the macula to keep macular edema from worsening. Widespread blood vessel growth in the retina, which occurs in proliferative diabetic retinopathy, can be treated by creating a pattern of scattered laser burns across the retina. This causes abnormal blood vessels to shrink and disappear.

Medical management: Injection of anti VEGF medication into the eye may help to reduce swelling of the macula, slowing vision loss and perhaps improving vision. Steroid injection into the eye is another option to reduce macular swelling. 

Surgical management: Vitrectomy involves removing scar tissue and blood from the vitreous fluid of the eye.