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Diabetic Retinopathy Care (D.R.)

Proliferative Diabetic Retinopathy
DR is a blinding disease involving Retina of Diabetic Patients .
About 30-35% of all diabetics have DR & about 6% have a sight threatening stage, which if diagnosed & treated preventively in time by Laser Photocoagulation, can reduce the risk of going blind from 50% to 2%.
The Retina gets affected by swelling, lack of nutrition, bleeding (hemorrhage)  and occasionally detachment.
The risk of  DR increases with 
1) duration of diabetes,  2) poor control of Diabetes

Presence of high blood pressure

Good control of Diabetes & Hypertension helps to reduce DR risk.
All diabetics must get their Retina checked for DR every year by an eye doctor who offers DR care.

Role of Special tests
Flourescein Angiography  is used selectively in some cases to guide treatment . A dye called Sodium Flourescein in injected in an arm vein & its circulation in the retinal blood vessels is assessed.

Flourescein Angiography

OCT: Optical Coherence Tomography  is selectively used to find if traction (pull) on the retina is the cause of reduced vision

OCT

Diabetic retinopathy does not usually impair sight until the development of long-term complications, including proliferative retinopathy, a condition in which abnormal new blood vessels may rupture and bleed inside the eye. When this advanced stage of retinopathy occurs, pan-retinal photocoagulation is usually recommended.
During this procedure, a special laser is used to make tiny burns that seal the retina and stop vessels from growing and leaking. Hundreds of tiny spots of laser are placed in the retina to reduce the risk of vitreous hemorrhage and retinal detachment. Targeted laser applications can treat specific areas in the central vision that are leaking. The laser is used to destroy all of the dead areas of retina where blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to decrease or disappear.

Expectations :
The goal of pan-retinal photocoagulation is to prevent the development of new vessels over the retina and elsewhere. There is no improvement in vision after the laser treatment. Vision may decrease due to swelling of the retina, after the laser treatment but  returns to its previous in few days. Recurrences of proliferative retinopathy may occur even after an initial satisfactory response to treatment.

This procedure sacrifices peripheral vision in order to save as much of the central vision as possible and to save the eye itself. Night vision may be diminished. After pan-retinal photocoagulation, in a small number of patients some blur will continue forever.

Treatment

LASER

Timely LASER treatment can stabilize the vision, slow the progression of the disease but can not cure it completely.
Once blinding complications occur, LASER can not restore lost vision
LASER treatment is done in stages & may need to be repeated as & when needed.

Surgical : In advanced stage of the disease complicated by large or recurrent bleeding in the eye, a surgery called VITRECTOMY is required.

Injection : They are given within the eye in the vitreous cavity . Anti VEGF ( Macugen, lucentis, Avastin,) injection is a newer modality  of  nature’s response to decreased nutrition by diseased blood vessels. Science is yet to understand the exact role, the correct timing, dosage, frequency of administration and long term benefits of this treatment.

 Another type of injection , Triamcenolone , is used to reduce non resolving retinal swelling (Macular Oedema). However its use can be complicated by formation of cataract, rise in eye pressure or infection within the eye.

Diabetic Retinopathy services at NETRA

Screening diabetic people for DR at specially subsidized rates.
Identifying sight threatening stage of the disease & treating these eyes with LASER to reduce risk of blindness.

* Giving the Injection treatment when required.

Phacoemulsification
Glaucoma Management
Diabetic Retinopathy Care
Retinal Detachment Surgery
Cornea Grafting
Refractive Surgery
Oculoplastic Surgery
Squint Correction
Contact Lenses
From Doctor's Desk
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