Diabetic Retinopathy & Diabetic Macular Edema
What is Diabetic Retinopathy?
Diabetic retinopathy (DR) is a condition where the small blood vessels in the retina are damaged by the high blood sugar levels in patients with diabetes. The retina is the part of the eye responsible for detecting light signals, which the brain then interprets as vision. If left untreated, diabetic retinopathy can lead to blindness.
What is Diabetic Macular Edema?
Diabetic macular edema (DME) is a condition seen in diabetic patients where damaged blood vessels in the central part of the retina, called the macula, starts to leak fluid and lipids into the macula. This condition results in decline of central vision, and can ultimately lead to blindness if untreated.
What are the symptoms of diabetic retinopathy and diabetic macular edema?
There are usually no symptoms until advance stages of the disease. Symptoms can include blurred, double, or distorted central vision, floaters, partial or total loss of vision, or eye redness and pain.
Should I get my eyes checked if I have diabetes?
Yes, all patients with diabetes should have an eye examination, including a dilated eye examination, at least once a year. An optical coherence tomography (OCT) scan may be required to screen for diabetic macular edema. Patients who have diabetes are also at higher risk for glaucoma and cataracts, so regular eye examinations are important to detect these conditions before they affect vision irreversibly.
When is treatment for diabetic retinopathy required?
Prevention of diabetic retinopathy is the most important. By controlling the blood sugar levels and other associated conditions like high blood pressure and high cholesterol, you can slow down the development of diabetic retinopathy. However, some patients who have had diabetes for a long time may still develop diabetic retinopathy even with good blood sugar control.
You may need treatment for diabetic retinopathy if the macula is affected (Diabetic macular edema), or when abnormal blood vessels have formed (proliferative diabetic retinopathy). Early treatment is needed to prevent progression to more severe disease, such as bleeding inside the eye (vitreous haemorrhage), retinal detachment or severe glaucoma (neovascular glaucoma).
What treatments are available for diabetic retinopathy and diabetic macular edema?
Treatment options include:
Laser treatment (pan retinal photocoagulation).
Pan retinal photocoagulation is a non-surgical procedure which involves the use of laser to treat areas of the retina with poor blood supply, thereby limiting the growth of abnormal blood vessels. The procedure typically takes 10-20 minutes and is performed over 2 or 3 sessions to adequately treat the retina. Patients may feel slight pain during the procedure.
Eye injections (intravitreal anti vascular endothelial growth factor and steroids)
Injections of anti-vascular endothelial growth factors (anti-VEGF), is an effective treatment for diabetic retinopathy. Anti-VEGF helps to stop the growth of, and shrink abnormal blood vessels in the retina. It is also the gold standard treatment for diabetic macular edema, and helps to improve vision by removing the fluid in the macula and stopping further leakage. Intravitreal steroids are another effective treatment for diabetic macular edema.
Intravitreal injections are delivered with a fine needle into the eye, under topical anaesthesia. There is usually no pain associated with this procedure.
Surgery may be required in some patients with very advanced diabetic retinopathy, where there is bleeding inside the eye, or if the retina is detached due to scar tissue formation.