Rapid changes in lifestyle and increased awareness of the disease has resulted in a documented prevalence of about 33% of some degree or form of diabetes in the UAE. While medication can keep diabetes under control, if unchecked or left unsupervised diabetes can lead to many different forms of health complications. With correct treatment many people with diabetes can prevent or delay the onset of these complications. Diabetic retinopathy is one of the most important complications of uncontrolled diabetes mellitus.


What is Diabetic retinopathy?


Diabetic retinopathy is a diabetic complication that affects the eyes. It is caused by damage to the blood vessels of the light sensitive tissue at the back of the eye known as the retina.
Damage to the retinal blood vessels can cause partial vision loss or even blindness. In diabetes the high blood sugar levels damage the cells that line the blood vessels. As a result, the blood vessels may leak fluid or bleed into the retina and cause vision loss.
Who gets it?
Anyone with diabetes mellitus can develop diabetic retinopathy. The occurrence and severity of the diabetic retinopathy is directly linked to the degree of sugar control, duration of diabetic disease and the presence of other conditions such as hypertension and kidney disease. Diabetes mellitus may also predispose the patient to early cataract, glaucoma and other ocular complications.

Signs and symptoms:


The early stages of diabetic retinopathy are not obvious as the centre of the retina may not yet be affected. In later stages patients may have 
•    Blurred or fluctuating vision
•    Distortion of vision and presence of dark spots (floaters) in front of the eye 
•    Bleeding in the eye cavity (vitreous hemorrhage) which can lead to sudden loss of vision
•    Dark or empty areas in vision


Diagnosis:


Diabetic retinopathy if untreated can lead to permanent loss of vision. Hence it is essential to diagnose and treat the disease appropriately. Detailed evaluation involves the following steps.


Comprehensive eye examination to evaluate all parts of the eye from the front to the back. This involves visual acuity examination, intraocular pressure measurement and slit lamp examination. 


Additionally few eyedrops will be applied to dilate the eye. At Thumbay Hospital we utilise the latest fundus cameras to examine the retina in a process called as dilated fundus examination and fundus photography. Patients who have diabetic retinopathy involving the centre of the retina (macula) will also undergo the Optical Coherence Tomography (OCT ) scan.


In some patients a special photographic process will be used, in which a dye is injected into the blood circulation to better identify the stage of diabetic retinopathy and to guide treatment. This fundus fluorescein angiography (FFA) process creates a visual map of the retina aiding in treatment. 

Treatment:


The treatment of diabetic retinopathy depends upon the stage of the disease. In early stages control of blood pressure, blood sugar, cholesterol, hemoglobin and kidney function will help limit the signs of diabetic retinopathy. These measures are also necessary in the later stages of the disease when more advanced forms of treatment are required.


In patients with leakage of fluid and blood from damaged vessels, laser treatment is necessary.At Thumbay Hospital we use the latest green laser with multispot technology to deliver the laser energy. Laser sittings are usually painless and are performed in the OPD in multiple sittings. In patients with swelling in the macula and vision loss due to recurrent bleeding, injections may be required in the eye cavity.


Advanced cases with large amounts of bleeding inside the eye or tractional retinal detachment require complex Vitreoretinal microsurgery. Thumbay Hospital has advanced microsurgical suites with the latest small gauge instrumentation offering treatment in such cases.


Diabetic retinopathy is a disease which has the potential to cause permanent visual loss. Any patient diagnosed with diabetes mellitus should receive a detailed fundus evaluation at the time of diagnosis. Subsequent examinations should be conducted annually or more frequently depending upon the stage of the disease and degree of diabetic control. If diabetic retinopathy is diagnosed early and treated appropriately, the severity of the damage can be limited and vision can be restored. 

This article has been contributed by Dr Soman Sukumaran Nair who is an Ophthalmology specialist at Thumbay Hospital, Dubai.