Diabetes is one of the systemic diseases affecting the eyes. First not noticable, changes in the blood vessels develop over the course of disease, affecting the eyes as well. Diabetic retinopathy is a chronic micro-vascular disorder of the retina. It affects vision and may lead to blindness.
What is diabetic retinopathy?
Photoreceptors in the retina are stimulated by light. The optic nerve carries the information to the vision processing part of the brain. As a result of diabetic metabolic changes, the tiny blood vessels in the retina become blocked and starve the retina of nutrients. This may then lead to leakage in the central retina or result in the growth of new vessels wich may bleed and casue thickening of the retina.
Diabetic retinopathy develops slowly, but after 10 to 15 years two thirds of diabetics suffer from vascular disorders affecting the retina. Typically, the disease develops more quickly in patients with type 1 diabetes (juvenile diabetes) than in those suffering from type 2 diabetes.
It is important to control diabetes with adequate medication and diet in order to delay the course of diabetic retinopathy.
What is the course of disease?
There are two stages of diabetic retinopathy: background retinopathy is the earliest stage in the development of retinopathy. It is characterised by the presence of small haemorrhages, abnormal blood vessels and fatty deposits.
Proliferative retinopathy is the more severe stage of the disease. The smallest vessels, called capillaries, are blocked and starve the retina of nutrients. In response to this, new vessels grow either in front of the retina on to the back surface of the vitreous gel, or occasionally on the iris. The new vessels are fragile and may bleed into the vitreous. This form of retinopathy may eventually lead to blindness.
What are the possible treatments?
So far, diabetic retinopathy cannot be cured, but different forms of treatment may control deterioration. In general, early diagnosed retinopathy followed by an early onset of treatment raises the chances of success.
Early diabetic control may slow down the rate of the progression of complications. If you suffer from diabetes, you can contribute a lot by living a healthy lifestyle. You should control your diet and weight, avoid smoking and alcohol and have your blood sugar levels and your blood pressure checked regularly.
If your ophthalmologist has already diagnosed damage in the retina during the retinal examination, laser treatment may slow down the course of the disease or stop it, reducing the danger of loosing eyesight.
Laser therapy is called photocoagulation. This procedure focuses a laser beam in small bursts onto the damaged retina. The laser treatment reduces the tissue hormones which caused the growth of the new blood vessels. Therefore, the new vessels shrink and this reduces the chance of haemorrhage. Laser treatment is only mildly painful and has to be repeated according to the severitiy of the disease. Treatment is usually performed on an outpatient basis, but in some cases your ophthalmologist may recommend staying overnight.
In some patients where there has been recurrent bleeding and the vitreous is clouded with old or fresh blood, a vitrectomy operation may be necessary. The exchange of the cloudy vitreous with a clear substance can help to restore some vision. Depending on the state of the retina, the quality of your vision may not be as good as it was previously. In some severe cases of diabetic retinopathy, success means stabilising vision and preventing it from getting worse.
Can I prevent diabetic retinopathy?
Early detection and treatment will benefit your eye sight. As there are no noticable symptoms in the early stages of the disease, diabetics should have their eyes checked by an ophthalmologist every year including a complete retinal examination. If diabetic retinopathay is diagnosed, these eye exams have to be repeated in shorter intervals. In most cases, the ophthalmologist will start treatment before the patient experiences visible deteriorations in eye sight.
Diabetic retinopathy is one of the most common causes for blindness in the western world, but it can be prevented in most cases. Please book an appointment at Prof. Findl's private practice for a thorough examination of your eyes!