Vision Threatening Retinopathy

Introduction:

Vision-threatening retinopathy, or diabetic retinopathy, is a severe complication of diabetes that causes damage to the blood vessels of the retina. The retina is the light-sensitive layer of nerve tissue that receives and sends signals to the brain to see the image.

What Is Vision-Threatening Retinopathy?

Also called sight-threatening diabetic retinopathy, it is a complication associated with diabetes.

Retinopathy can develop in people with either type 1 or type 2 diabetes. It most commonly occurs in patients with uncontrolled diabetes. Retinopathy initially shows mild or no symptoms, leading to blindness. It usually takes a long time to reach the final stage of retinopathy, which causes blindness.

How Does Diabetes Affect the Retina?

The retina is the light-sensitive layer of the eye that converts light signals to an image. The optic nerve sends the signals to the brain, forming vision. The retina has a rich blood supply through a network of small blood vessels.

Uncontrolled blood sugar levels for a long time can damage blood vessels in the retina, limit the blood supply to the retina, and damage blood vessels.

Retinopathy can be divided into four stages:

1. Mild Nonproliferative Retinopathy: It is the early stage of retinopathy, where tiny swellings or bulges appear in the blood vessels of the retina. These swellings are called microaneurysms.

2. Moderate Nonproliferative Retinopathy: Second stage of retinopathy with swelling of blood vessels and obstruction of blood flow. The building up of blood and other fluids in the retina causes blurry vision.

3. Severe Non-proliferative Retinopathy: Third stage of retinopathy, in which more blood vessels to the retina are blocked causing decreased blood flow to retina. Due to lack of blood vessels the body starts growing new blood vessels. The newly formed blood vessels are thin and fragile causing retinal swelling, blurry vision, and dark spots and high chance of permanent vision loss.

4. Proliferative Diabetic Retinopathy: Final stage of retinopathy, where blood vessels grow into retina and cause retinal bleeding. Formation of scar tissue causes retinal detachment, by pulling the retina.

What Are the Symptoms of Diabetic Retinopathy?

Early stages of diabetic retinopathy show no or few symptoms.

• Blurry vision.

• Eye pain.

• Redness.

• Difficulty in seeing in darkness.

• Shapes floating in the field of vision.

• Worsening of vision.

• Change in colors.

• Loss of vision.

What Are the Risk Factors for Developing Retinopathy?

• Having diabetes for years.

• Uncontrolled blood sugar level.

• High cholesterol level.

• Smoking.

• Gestational diabetes.

What Is Diabetic Eye Screening?

A screening test to find eye problems associated with diabetes. Everyone having diabetes for more than ten years should do a diabetic eye screening once a year. People over 50 years with uncontrolled diabetes are at a higher risk of developing retinopathy. Early detection of retinopathy helps in proper treatment before reaching an advanced stage. The initial stages of retinopathy are mostly symptom-free, and screening is done to diagnose retinopathy. Treatment starts at an early stage, and progress is assessed. It can help prevent permanent vision loss.

How Is Retinopathy Diagnosed?

• Ophthalmologists use a unique lens to see the inside of the eye. Eye drops are used to widen the pupil for better examination.

• Optical coherence tomography ( OCT) is a non-invasive imaging test for detailed and close retina examination. This method allows one to measure the thickness of the retina.

• Fluorescent angiography helps to see the blood vessels of the retina. This technique uses a yellow dye called fluorescein. Fluorescein dye is injected into a vein (commonly in the arm), and the die travels through the blood vessels and shows if there is any blockage or fluid leakage.

• OCT angiography is a newer technique, and no dye is required. It is used to find out any blood vessel blockage and fluid leakage.

What Are the Treatment Options for Diabetic Retinopathy?

• Medical Control - Proper management of diabetes mellitus can control the increased blood sugar level. Taking the prescribed medicines for diabetes and on-time control of blood sugar levels can help restore vision, following a healthier diet as a nutritionist prescribes. Regulation of blood pressure can also help in controlling retinopathy. In turn, it makes the tiny blood vessels of the eyes healthier.

• Medicine - Anti-VEGF (vascular endothelial growth factor) medication. VEGF is a protein that promotes the growth of new blood vessels in the body. In certain situations, cells can produce too much VEGF, causing uncontrolled growth of blood vessels into the retina. This uncontrolled growth of blood vessels can lead to low vision or blindness. Anti - VEGF medication blocks the action of VEGF protein and stops the damage to blood vessels and slowing down vision loss or even improving eyesight. The primary anti-VEGF medicines are Avastin, Lucentis, and Eyela. Steroid medications are given instead of anti-VEGF medicines.

• Steroid Implants - Tiny eye implants, called intravitreal implants, are injected into the eye using a unique applicator. This eye implant contains a steroid medicine called Dexamethasone. This eye implant helps slow Dexamethasone's slow release over a few months. The released steroid Dexamethasone helps reduce eye swelling and improve eyesight. The implant gets dissolved, and no need to remove it.

• Laser Surgery - In laser treatment doctor uses a medical laser to shrink the damaged blood vessels and prevent their re-growth.

• Vitrectomy - In advanced stages of retinopathy ophthalmologists might recommend surgery. In the surgery, the vitreous gel and blood from damaged blood vessels are removed from the eye. Scar tissue is also removed from the eye if present. This surgical procedure improves eyesight by allowing the light rays to focus on the retina.

What Are the Ways to Prevent Diabetic Retinopathy?

Diabetic retinopathy cannot be prevented, but reasonable control of blood sugar and blood pressure with early intervention to vision problems can help prevent complete vision loss.

• Diabetes management.

• Proper medication and use of insulin as advised by the doctor.

• Control of blood pressure and cholesterol level.

• Diabetic eye screening.

• Appointment with an ophthalmologist when there is a slight vision change.

• Early treatment for retinopathy.

• Maintaining a healthy lifestyle, eating a balanced diet, and regular exercise.

• Avoid alcohol consumption

• Quit smoking.

Conclusion:

Vision-threatening retinopathy is a severe complication of diabetes. Diabetic retinopathy causes damage to the blood vessels of the retina and eventually causes loss of vision. Diabetic retinopathy is best controlled by managing the blood sugar level. Proper screening tests and early treatment can slow down the process of retinopathy. Adequate management of diabetes can help improve vision.