Retina is like the film of the camera which sends the image to the brain for processing. A damaged retina can lead to significant visual disturbances many of which may become permanent if not treated in time.

Diabetic retinopathy is one of the leading causes of blindness in adults. It is caused by changes in the blood vessels of the retina, making them leaky, causing visual damage. Early detection can be done by Eye Angiography and OCT. Retina Lasers can retard the progress of disease and prevent permanent visual damage. Nidhi Eye And Multispeciality Hospital is one of the leading national referral centers for advanced retinal diagnostics and the surgeries are done by the best retinal surgeons in West U.P.

Exams and Tests

The tests that may be required in case of diabetic retinopathy for its complete evaluation and formulation of treatment strategy are:

• • Fundus Photography : To keep the record of the present status of the retina as well as for patient understanding of their problems via visual impact.
  • Optical Coherence Topography (OCT): This is a very important modality in cases who have selling in their retina (macula) or where subtle tractions over the retina are suspected.

It gives a 3-dimensional picture of the retina which helps in quantifying the thickness of swelling and the type of swelling which helps a long way in deciding the treatment protocol as well as helps in follow ups.

• Fundus Fluorescein Angiography : This test is used in the patients to rule out chances of bleeding inside the eyes and to see the areas of retina where there is a lack of blood supply. It helps us in evaluation of areas where lasers are required and in advanced cases it helps us to decide whether surgery can help a patient improve his/her vision.
• Complete Diabetic Profile : This is a set of blood and urine tests which we perform to understand you better, and to suggest and modify treatments according to your own needs.

 

Treatment

People with the earlier form (non-proliferative) of diabetic retinopathy may not need treatment. However, they should be closely followed by a retina specialist.
Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.
Several procedures or surgeries are the main treatment for diabetic retinopathy.

Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels.

A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may also be used to repair retinal detachment.

Drugs that prevent abnormal blood vessels from growing, and steroid drugs injected into the eyeball are possible new treatments for diabetic retinopathy.

Treatment depends largely on the type of diabetic retinopathy you have. Your treatment will also be affected by how severe your retinopathy is, and how it has responded to previous treatments.

Early Diabetic Retinopathy

If you have non-proliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine if you need treatment.
It may also be helpful to work with your diabetes doctor (endocrinologist) to find out if there are any additional steps you can take to improve your diabetes management. The good news is that when diabetic retinopathy is in the mild or moderate stage, good blood sugar control can usually slow the progression of diabetic retinopathy.

Advanced Diabetic Retinopathy

If you have proliferative diabetic retinopathy, you’ll need prompt surgical treatment. Sometimes surgery is also recommended for severe non-proliferative diabetic retinopathy. Depending on the specific problems with your retina, options may include:

Focal Laser Treatment

This laser treatment, also known as photocoagulation, can stop or slow the leakage of fluid in the eye. . It is an OPD procedure which is absolutely safe and you can go home immediately after the lasers. During the procedure, leaks from abnormal blood vessels are treated with laser burns. Focal laser treatment is usually done in a single session. Your vision will be blurry for about a day after the procedure. Sometimes you will be aware of small spots in your visual field that are related to the laser treatment. These usually disappear within weeks. If you had blurred vision from swelling of the central macula before surgery, however, you may not recover completely normal vision. But, in some cases, vision does improve.

Scatter Laser Treatment

This laser treatment, also known as pan-retinal photocoagulation, can shrink the abnormal blood vessels. It is an OPD procedure which is absolutely safe and you can go home immediately after the lasers. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar. Scatter laser treatment is usually done in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible in few patients.

Injections

These are injections of either steroid or anti-Vascular Endothelial Growth Factor (anti-VEGF) medications into the vitreous cavity of the eyeball. This is becoming an increasingly popular retinopathy treatment option for diabetic macular edema and proliferative diabetic retinopathy. In fact, intravitreal injections are now frequently being used in combination with retinal laser to enhance the retinopathy treatment effect.

Steroid such as triamcinolone and anti-VEGF drugs such as bevacizumab (Avastin) and ranibizumab (Lucentis) work in 2 ways. Firstly, they interfere with chemicals that encourage leakiness of the retinal blood vessels. This helps to stop further leakage of fluid and protein from the blood vessels at the macula. This reduces the amount of fluid in the macula (diabetic macular edema), restores the structural integrity of the macula, and therefore maintains your central vision.

Secondly, the anti-VEGF drugs also interfere with chemicals (produced by retinal cells damaged from the diabetes) that stimulate the growth of abnormal new blood vessels. By doing so, abnormal new blood vessels will stop growing and may even regress or disappear completely. The use of anti-VEGF in proliferative diabetic retinopathy treatment is becoming more widespread and more accepted. It is particularly useful in cases where vitreous hemorrhage has occurred. In these cases, the view of the retina may be too hazy and obscure for effective retinopathy treatment with laser to be performed.

Before the injection, you will be given dilating drops to enlarge your pupil, anesthetic eye drops to numb your eye and antibiotic drops to reduce the risk of infection. A clip will be used to keep your eyelids open. The injection itself takes no more than 5 minutes and shouldn’t be painful although you may feel a slight sting or scratch. Your eye may feel slightly sore after the anesthetic effect wears off.

After the injection, you may notice the following:

• Slight blurriness and swirls in your vision for a few days
• Redness, blood and irritation which settle after a few days
• Increased watering of the eye

Complications of intravitreal injections are uncommon and occur in less than 1% of the time. If a complication happens to you, treatments are usually available to fix any problems that arise from it. The main complications of this form of retinopathy treatment are raised eye pressure (potentially leading to glaucoma), cataract, retinal detachment and infection of the eyeball (infective endophthalmitis).

Vitrectomy This procedure can be used to remove blood from the middle of the eye (vitreous) as well as any scar tissue that’s tugging on the retina. Vitrectomy is performed as a day case in our centre. It can be performed either under local anesthesia (where you are awake) or under general anesthesia (where you are put to sleep). If you opt for local anesthesia, you will need an anesthetic injection (peribulbar) around the eye to numb it. Prior to that, you will be given dilating drops to enlarge your pupil and anesthetic eye drops to provide an initial numbing effect to your eye. The operation itself can take from 30 minutes to 3 hours, depending on the complexity of the surgery. If gas is inserted into your eye, you should not travel by air for at least 2 months when the gas would have dissipated away. If silicon oil is inserted into your eye, you will not have any travel restrictions. However, you will need to have a second operation to remove the silicon oil.

You should be able to go home after a short rest following surgery. Do not drive. Make sure there is someone with you for 24 hours after surgery. Your eye will feel uncomfortable, sore and itchy. It will also be sensitive to light and feel as though there is something in the eye. You will be given eye drops (antibiotic to prevent infection and steroid to reduce inflammation) to put in your eye after surgery. Be careful not to accidentally hit or press against the eye. It is best not to swim or engage in strenuous activities while you are still using the eye drops. It is alright to read or watch television.