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DIABETIC RETINOPATHY (DR)

About Diabetic Retinopathy (DR)

  • Diabetic retinopathy (DR) is damage to the blood vessels in the retina, the light-sensitive tissue at the back of the eye.
  • DR is the most common diabetic eye disease and a leading cause of visual loss & blindness.
  • If a person has DR, they may not notice changes to their vision. But over time, DR can get worse and cause vision loss. DR usually affects both eyes.

 

Prevalence

  • It is estimated that in 2002, DR accounted for about five per cent of world blindness, representing almost five million blind people.
  • In Malaysia, diabetic eye disease is the most common cause of visual loss among adults of working age.
  • The longer a person has diabetes, the more likely they are to develop DR, particularly if the diabetes is poorly controlled. At diagnosis, less than five per cent will have retinopathy while the prevalence rises to 40-50 per cent after 10 years.

 

How Do You Go Blind from Diabetic Eye Disease?

  • Blood vessels damaged from DR can cause vision loss in two ways:
    • Fragile, abnormal blood vessels can develop in the retina and leak blood into the centre of the eye, leading to visual loss & even blindness.
    • Fluid can leak into the centre of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called DME. It can occur at any stage of DR, although it is more likely to occur as the disease progresses.

 

Symptoms

  • DR often has no early warning signs.
  • As the condition progresses, DR symptoms may include:
    • Spots or dark strings floating (floaters)
    • Blurred vision
    • Fluctuating vision
    • Dark or empty areas in your vision
    • Difficulty with colour perception

Figure 1: Normal vision and the same scene as viewed by a person with DR

Diagnosis

  • A comprehensive dilated eye exam is recommended at least once a year to detect the disease before it causes vision damage.
  • It enables the eye care professional to see more of the retina and look for signs of DR.
  • Optical coherence tomography (OCT)
  • It is a non-invasive exam that produces a cross-sectional image of the retina.
  • This method is helpful in identifying how much the retinal layers are distorted and whether macula swelling is increasing or decreasing following treatment with injections or laser.

 

Prevention

  • Persons with diabetes can reduce their risk of getting DR by doing the following:
    • Make a commitment to manage diabetes
  • Monitor blood sugar levels regularly
  • Keep blood pressure and cholesterol under control
  • Quit smoking
  • Pay attention to vision changes

 

Treatment

  • Early DR
    • If a patient has non-proliferative DR, they may not need treatment right away. However, their eye doctor will closely monitor their eyes to determine if they need treatment.
    • It may also be helpful to work with an endocrinologist to improve diabetes management.
  • Advanced DR
    • If a patient has proliferative DR, they will require treatment. These include:
      • Focal laser treatment for DME (photocoagulation)
        • Photocoagulation can stop or slow the leakage of blood and fluid in the eye.
        • The patient’s vision will be blurry for about a day after the procedure.
          • Scatter laser treatment / Pan retinal photocoagulation (PRP)
            • During the procedure, the areas of the retina away from the macula are treated with scattered laser burns, causing the abnormal new blood vessels to shrink and scar.
            • The patient’s vision will be blurry for about a day after the procedure.
            • Some loss of peripheral vision or night vision after the procedure is possible.
  • Anti-VEGF or steroid injections
  • Anti-VEGF and steroid drugs work by targeting vascular endothelial growth factor (VEGF), a protein involved in causing new blood vessel formation.
  • The drugs are injected into the eye at regular intervals and inhibit the growth of new blood vessels and reduce swelling at the macula.
  • Vitrectomy surgery
    • This procedure can be used to remove blood from the middle of the eye (vitreous) as well as any scar tissue that is tugging on the retina using delicate instruments.
    • Sometimes, a gas bubble must be placed in the cavity of the eye to help reattach the retina.