Diabetes has become a lifestyle-related epidemic in our country. It being a vascular disease manifests in blood vessels throughout our body. The eye is the only place where we can see these changes happening to our blood vessels in vivid detail. Hence, diabetic retinopathy has been given a lot of importance and screening for it is in vogue in all diabetics. This article looks at what symptoms patients with diabetic retinopathy experience and about when would be the best time to have a doctor examine the retina to screen for diabetic retinopathy.
Symptoms of Diabetic Retinopathy
The most common symptom of diabetic retinopathy is blurred vision. This can happen because of various vascular retinal changes caused by diabetes.
A sudden severe blackout over a matter of minutes to seconds can be due to vitreous hemorrhage.
A distorted image can be due to diabetic macular edema. It can also be due to secondary retinal vein occlusions.
A retinal detachment can happen in advanced proliferative diabetic retinopathy.
Other vision-threatening problems are ischemic optic neuropathy and severe dry eyes.
Importance of Screening for Diabetic Retinopathy
As diabetic retinopathy is a disease which can be prevented from worsening by screening, the screening of all patients with diabetes is of utmost importance. There are several known instances wherein an asymptomatic person would be diagnosed to have diabetes by merely performing retinal screening for diabetes. Patients already diagnosed with diabetes, whether on medication or not, will need to be screened for diabetic retinopathy as soon as possible, so as to not miss out on diabetic retinopathy and to prevent any future complications that might arise due to his/her retinopathy not being adequately managed.
The usual follow up schedule is yearly for mild to moderate cases, while severe cases will need three-monthly monitoring. The more severe the disease, the more frequent are the follow-ups required. Advanced cases will need to be reviewed every three months.
Screening is a hassle-free and non-invasive process requiring a dilated examination of the fundus. A few cases with high diabetic damage inside the eye will also need an estimation of their intraocular pressure, gonioscopy to check for blood vessels in their anterior chamber angles and slit lamp examination to look for bleeding vessels in their iris on every screening visit apart from fundus examination.
Importance of Controlling Diabetic Changes in the Retina
Since problems due to diabetic retinopathy are quite preventable when picked up at an early stage, the importance of regular screening and yearly follow-ups cannot be overemphasized. The retina is a nerve tissue, and just like any other nerve in our body, it has no regenerative potential. So, damage once done would be irreparable except in the very early stages of the disease in some patients.
The main dictum that applies in the treatment of diabetic retinopathy is the same as in the treatment of retinal disorders in general, and it is that we can never recover lost vision and treatment would only be aimed at minimizing the loss in visual potential. Hence, it makes all the sense in the world to screen for and prevent diabetic complications than to try to manage it later.
Medical Treatment of Diabetic Retinopathy
The mainstay of treatment of diabetes is oral/injectable antidiabetic medication, and the importance of diabetic control in the prevention of retinopathy cannot be overemphasized.
Retinopathy, in the proliferative stage, is usually treated with argon green laser, in a process called photocoagulation wherein the bleeding vessels are heat-sealed using lasers. This prevents bleeding into the eye and further loss of vision.
Ocular medication only becomes relevant in the case of neovascular glaucoma, a form of glaucoma resulting from the growth of new vessels over the anterior chamber angle causing a rise in the pressure inside the eye. The treatment for this involves the use of antiglaucoma medications such as Timolol maleate and/or Brimonidine, but even with these measures, patients with neovascular glaucoma rarely improve.
Surgery for Diabetic Retinopathy
Surgery for retinal disorders, in general, is only done as a palliative measure and will not result in any visual gains in general. These are usually required by diabetics with advanced disease and complications such as vitreous hemorrhage requiring vitrectomy or tractional retinal detachment due to proliferative diabetic retinopathy needing scleral buckling. The overall prognosis for such cases is poor. It is advisable to patients that they control their sugars well so as not to land up in such complications.
In general, diabetics with retinopathy can expect a wide and visual symptoms, but the symptoms which need a visit to an ophthalmologist are:
1. A sudden onset of blurring or diminution of vision.
2. Multiple floating objects in front of the eye.
3. Experiencing a sensation such as a falling of curtains followed by diminution of vision.
4. Pain in and around the eye with blurred or foggy vision.
Diabetic retinopathy is a preventable and treatable disease, provided patients have good compliance to follow-ups and present early on during the disease progression. Proper treatment with control of sugars can mitigate vision loss and support a healthy eye and good vision.Last reviewed at: 27.Sep.2018