EYE CLINIC

DIABETIC RETINOPATHY | EYE CLINIC - EMMETROPIA

What is diabetic retinopathy?

 

Diabetic retinopathy is a complication of diabetes that affects the eyes. In the context of generalized vascular disease, it causes "leakage" of blood components into the surrounding tissues and leads to insufficient oxygen supply of this area.

The most important risk factor is the duration of diabetes. Retinal disease rarely occurs in the first five years after diagnosis.

Because diagnosis is often delayed, a drop in vision can be the initial warning. If the condition is not treated early, it can even lead to blindness. 80% of people with diabetes in a period of 10 to 15 years will develop damage to the vessels in the retina.

The condition can appear in anyone with type 1 or type 2 diabetes. The greater the problem with the diabetes and the patient's blood sugar control, the more likely is that diabetic retinopathy will develop.

 

Symptoms

 

In the early stages of diabetic retinopathy there are no symptoms. However, as the condition progresses, the symptoms of diabetic retinopathy will include:

 

• Spots that look like they are floating in front of the eye and affect the visual field ("flies" - floaters)
• Blurred vision
• Variations in vision within a small period of time
• Reduced color perception
• Dark or empty areas in the visual field
• Loss of vision

Diabetic retinopathy usually affects both eyes usually with varying severity.

 

Causes

 

Over time, the presence of excess blood sugar can lead to obstruction of the tiny blood vessels that feed the retina, interrupting the blood supply. The result is that the eye tries to develop new blood vessels (neovascularization).

However, these blood vessels do not have the same sturdy anatomy of the normal blood vessels, making them more likely to bleed.

 

Diabetic retinopathy is divided into two (major) stages

 

• Non-proliferative: At this stage the image of the back of the eye shows micro-aneurysms, micro-hemorrhages, exudates (pale yellow spots) and swelling of the retina. When the blood components leak into the tissues in the most central point of the retina (in the macula) then we have what is called “diabetic macular oedema” (DMO).

 

• Proliferative: Due to poor blood circulation in the retina, low oxygenation zones (ischemia) are created. By reacting to this condition, the eye creates new pathological (abnormal) vessels (new vessels) which are very sensitive and can bleed. The final stage of this proliferative stage includes vitreous hemorrhage, membrane scarring, retinal tractional detachment and neovascular glaucoma which is painful, difficult to treat and can quickly lead to permanent vision loss.

 

In addition to retinopathy, diabetic patients may have other eye problems. When the blood sugar level is not kept constant, it causes swelling of several tissues and can change the refractive power of the crystalline lens which leads to cloudy vision.

It is important to know that cataracts occur at a younger age in diabetics.

Gestational diabetes does not pose a risk of retinopathy, but such a pre-existing condition can develop more rapidly during pregnancy.

 

Risk factors

 

Anyone with diabetes can develop diabetic retinopathy. The risk of developing diabetic retinopathy can be increased by the following:

 

• Diabetes duration - the longer a person has diabetes, the greater the risk of developing diabetic retinopathy
• Incomplete control of blood sugar levels – uncontrolled diabetic patients
• High blood pressure
• High cholesterol
• Smoking
• Pregnancy

 

Complications

 

Diabetic retinopathy is an abnormal development of blood vessels in the retina. Complications of the condition can lead to serious vision problems such as:

 

• Vitreous Hemorrhage: Abnormal new blood vessels may bleed. If the bleeding is small, you will see only a few dark spots ("flies").

In more severe cases, the blood can fill the vitreous cavity and block your vision partially or completely.

 

Hemorrhage of the vitreous usually does not cause permanent loss of vision. Often, the blood clears on its own within few weeks or months. If the retina is not damaged, vision may return to pre-bleeding levels.

 

• Retinal detachment: Abnormal blood vessels associated with diabetic retinopathy cause scarring of the surrounding tissues by creating membranes that can pull and detach the retina. This can cause dark spots ("floaters") in vision, light flashes ("lightning", "flash") or severe vision loss (like a “black curtain”).

 

• Glaucoma: The new blood vessels can extent in the front of the eye and affect the normal flow of aqueous humor, causing an increase in pressure of the eye (glaucoma). The high intraocular pressure can damage the optic nerve which actually transmits images from the eyes to the brain.

 

• Blindness: Eventually, diabetic retinopathy, glaucoma, or both can lead to complete vision loss.

 

Prevention

 

Diabetic retinopathy cannot be prevented in all cases.

However, regular eye examinations, good blood sugar control and blood pressure. Early intervention when the first symptoms occur can help prevent severe vision loss.

If the patient has diabetes, the risk of developing diabetic retinopathy may be reduced by:

 

• Proper management of diabetes with your endocrinologist
• Frequent monitoring blood sugar levels
• HbA1c test every 3 months (This is a three-monthly blood test which shows the average daily blood glucose of the patient)
• Maintaining blood pressure and cholesterol under control
• Reduce or Stop Smoking
• Beware of changes in vision: The patients should contact the ophthalmologist immediately if they notice sudden changes in vision or if vision becomes blurred, sees spots (like "flies" - floaters, etc.).

Diabetes does not necessarily lead to vision loss. Active effort in the management of diabetes can significantly contribute to the prevention of complications.

 

Diagnosis

 

Diabetic retinopathy is diagnosed with a comprehensive ophthalmological examination in which the pupils of the eyes (mydriasis) will need to be dilated after the use of special eye drops. This dilation can cause blurred vision for a few hours.

During the examination the ophthalmologist will examine for the following:

 

• Visual acuity
• Abnormal blood vessels
• Swelling and minor retinal hemorrhage - with Fundoscopy and Optical Coherence Tomography scan (OCT)
• Development of new blood vessels and scar tissue
• Bleeding in the vitreous if any
• Retinal detachment if any
• Optic nerve abnormalities
• High intraocular pressure (glaucoma)
• Cataract if any

 

Treatment

 

Treatment, which largely depends on the type of diabetic retinopathy and the severity of the symptoms, aims to slow or stop the progression of the disease.

 

• Non-proliferative diabetic retinopathy: In these cases, treatment may not be needed immediately.

However, regular eye examinations are needed so that the ophthalmologist can determine when it may be necessary.

When diabetic retinopathy is mild or moderate, good blood sugar control in collaboration with the patient's endocrinologist may slow the progression.

 

• Productive diabetic retinopathy: In this case immediate treatment is needed. Depending on the specific problems in the retina, treatment options may include:

 

• Intravitreal injections / implants: The use of intravitreal injections / implants involves the use of anti-VEGF drugs (anti-angiogenic drugs) and / or cortisone preparations in the eye, which can help stop the growth of new blood vessels and reduce the increased inflammation. They are now being used more and more often with great safety.

 

• Photocoagulation (Argon Laser): This laser treatment can stop or slow down the progression of the disease.

Argon Laser treatment is usually done in one or two sessions and can be combined with the use of intravitreal injections.

If vision was blurred before, then treatment may not fully restore your vision to normal levels but reduces the chance of worsening the Diabetic Macular Oedema (DMO).

 

• Vitrectomy:  During the vitrectomy procedure, through small incisions to the eye we remove the vitreous along with the hemorrhage as well as the scar tissue that creates traction to the retina.

 

The above treatments often slow or stop the development of diabetic retinopathy but diabetes is a chronic disease and future retinal damage as well as vision loss cannot be excluded.

Even after the treatment for diabetic retinopathy, regular eye examinations are necessary as additional treatment may be needed at some point.

 

Why Emmetropia

 

At Emmetropia Eye Clinic, we are investing in new technology to ensure that all measurements, examinations, and finally treatments are performed accurately.

Our medical staff will inform you and advise you in detail on the best possible solution. Emmetropia is the only private ophthalmology clinic in Crete with dedicated department for posterior pole diseases like Diabetic retinopathy, macular problems etc.

In our Clinic we have state-of-the-art technology available to diagnose, monitor and treat any type of diabetic retinopathy. All modern methods of treatments such as Intravitreal injections, the top class Argon laser technology by IRIDEX™ as well as surgical equipment for performing vitrectomy with the latest generation of Bausch & Lomb(USA), StellarisPC ™ platform, the Leica M844 F40 high-resolution surgical microscope and HAAG-STREIT's excellent EIBOS-2 Wide angle viewing system guarantees the precision of our retinal procedures.