Procedure of Diabetic Retinopathy

Diabetic retinopathy is a common complication of diabetes that affects the eyes and can lead to vision impairment or even blindness if left untreated. It occurs when high blood sugar levels damage the small blood vessels in the retina the light-sensitive tissue at the back of the eye. As one of the leading causes of blindness among adults, early detection and timely treatment of diabetic retinopathy are crucial.

With diabetes becoming increasingly common across the globe, especially in countries like India where lifestyle diseases are on the rise, awareness about diabetic retinopathy is more important than ever. According to the World Health Organization (WHO), diabetic retinopathy is the leading cause of vision impairment among working age adults. Fortunately, modern diagnostic tools and treatment options have made it possible to detect the condition early and manage it effectively.

What is Diabetic Retinopathy?

Diabetic retinopathy is a progressive eye disease that affects people with type 1 or type 2 diabetes. Over time, uncontrolled blood sugar levels can cause the retinal blood vessels to swell, leak fluid, or close off completely, preventing blood from reaching the retina. In more advanced stages, abnormal blood vessels may grow on the surface of the retina, leading to severe vision problems. The condition is typically divided into two main stages: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

When Should You Get Screened?

Anyone diagnosed with diabetes should undergo regular eye screening. The American Diabetes Association recommends that

1. Individuals with type 1 diabetes have their first eye exam within five years of diagnosis.

2. Those with type 2 diabetes should have a comprehensive dilated eye exam at the time of diagnosis.

Pregnant women with diabetes should also have an eye exam in the first trimester, as pregnancy can worsen diabetic retinopathy.

Procedure of Diabetic Retinopathy

1. Diagnosis of Diabetic Retinopathy :- The first step in the procedure is diagnosing the condition, typically performed by an ophthalmologist or retina specialist. The process includes

   Comprehensive Eye Exam :- A detailed eye examination is conducted, which may include

   • Visual acuity test to measure how well you see at various distances.

   • Dilated eye exam, where special drops are used to widen your pupils, allowing the doctor to examine the retina and optic nerve thoroughly.

   • Tonometry, which measures intraocular pressure.

   Retinal Imaging :- Several imaging techniques help in confirming and staging the disease

   • Fundus photography captures high resolution images of the retina.

   • Optical Coherence Tomography (OCT) provides cross-sectional images of the retina, detecting fluid accumulation or swelling.

   • Fluorescein Angiography involves injecting a dye into a vein in your arm and capturing images as the dye flows through retinal blood vessels, identifying any leaks or abnormal vessels.

2. Monitoring and Early Management :- In the early stages, especially in non proliferative diabetic retinopathy, treatment may not be immediately necessary. The focus is usually on tight blood sugar, blood pressure, and cholesterol control to slow the progression of the disease. Patients are monitored through regular follow-ups and retinal imaging, typically every 6 to 12 months, depending on the severity.

   Lifestyle changes such as maintaining a healthy diet, regular exercise, quitting smoking, and adhering to prescribed medications also play a vital role in managing early-stage diabetic retinopathy.

3. Treatment of Advanced Diabetic Retinopathy :- When diabetic retinopathy progresses to moderate or severe stages, particularly in proliferative diabetic retinopathy or if diabetic macular edema (DME) is present, medical intervention becomes essential. The treatment options include

   • Intravitreal Injections :- Anti-VEGF (vascular endothelial growth factor) medications like ranibizumab (Lucentis), bevacizumab (Avastin), or aflibercept (Eylea) are injected directly into the eye. These drugs reduce fluid leakage, inhibit the growth of abnormal blood vessels, and can significantly improve vision in cases of macular edema.

     Sometimes, steroids are used instead, especially when anti-VEGF is not effective.

     These injections are usually given in a sterile clinical setting, and the procedure takes only a few minutes. Most patients require a series of monthly injections initially, followed by a maintenance schedule based on their response.

   • Laser Photocoagulation :- Laser treatment is one of the oldest and most effective methods for treating diabetic retinopathy. It uses high energy light beams to seal or destroy abnormal blood vessels and reduce retinal swelling.

     Laser treatment is usually performed in an outpatient setting and may cause mild discomfort or blurred vision for a few hours after the procedure.

   • Vitrectomy Surgery :- In very advanced cases, especially when there is significant bleeding into the vitreous (vitreous hemorrhage), retinal detachment, or scar tissue formation, vitrectomy surgery is recommended. This procedure involves removing the cloudy vitreous gel and replacing it with a clear solution to allow light to focus properly on the retina.

     Vitrectomy is a surgical procedure performed under local or general anesthesia, typically requiring a short hospital stay. Recovery may take several weeks, and patients are advised to follow strict postoperative care.

What to Expect After Treatment?

The success of diabetic retinopathy treatment depends on the stage of the disease and the patient’s overall health. While treatments can prevent further vision loss and even restore some vision, they do not cure the disease. Ongoing management of diabetes and routine eye checkups are crucial to prevent recurrence.

After treatment, patients should

1. Continue regular follow ups as advised by their retina specialist.

2. Monitor their blood glucose and blood pressure levels.

3. Report any changes in vision such as floaters, blurriness, or dark spots immediately.

Preventing Diabetic Retinopathy

While not all cases can be prevented, diabetic retinopathy can often be delayed or minimized by

1. Maintaining optimal blood sugar levels (HbA1c below 7%).

2. Controlling blood pressure and cholesterol levels.

3. Following a diabetic-friendly diet.

4. Avoiding smoking and limiting alcohol intake.

5. Attending regular eye screening appointments.

Early detection remains the cornerstone of diabetic retinopathy management, and with modern treatment options, many patients can maintain good vision throughout their lives.

Conclusion

Understanding the procedure of diabetic retinopathy from diagnosis to treatment empowers patients to take timely action and prevent irreversible damage to their eyesight. Thanks to advancements in medical technology, treatments such as anti-VEGF injections, laser therapy, and vitrectomy offer effective solutions for preserving vision.