A study conducted under the auspices of ORNATE India, a collaborative project between the U.K. and India, has uncovered a significant prevalence of vision-threatening diabetic retinopathy (VTDR) in India. The study estimates that approximately 4% of diabetics aged 40 and above in India are afflicted with VTDR.
Diabetic retinopathy is an eye condition triggered by consistently high or fluctuating blood sugar levels, commonly associated with diabetes. This ailment arises when the delicate blood vessels in the retina are compromised due to prolonged periods of elevated blood sugar. As a consequence, these vessels may experience weakening, bleeding, fluid leakage, or abnormal growth.
The bleeding or leakage from these vessels can lead to vision challenges, particularly within the retina, which plays a crucial role in converting light into signals for the brain to interpret. Additionally, the accumulated fluid may result in swelling in the macula, a vital region of the retina responsible for enhancing vision clarity.
Initially, symptoms may go unnoticed, but they have the potential to exacerbate over time.
Impact of Age on the Risk of Diabetic Retinopathy
As individuals grow older, the structure of their eyes undergoes natural changes. With advancing age, there is a decrease in the flow of blood rich in nutrients and oxygen to the eyes. Additionally, the healing process for any ocular damage tends to be slower compared to younger individuals. This age-related factor makes the eyes more susceptible to stress and inflammation.
These changes associated with aging can hinder the healing process and magnify the impact of complications arising from diabetes.
Apart from age, research indicates that individuals with diabetes who develop other related complications, such as nerve damage or kidney disease, face an elevated risk of developing diabetic retinopathy.
Diabetic Retinopathy Symptoms
In the early stages, diabetic retinopathy often manifests without noticeable symptoms. It is typically in the more advanced stages that symptoms become apparent.
This condition tends to impact both eyes. Some common signs and symptoms of diabetic retinopathy encompass:
Risk Factors for Diabetic Retinopathy
While anyone with diabetes faces a potential risk of developing diabetic retinopathy, certain factors can elevate this risk. This risk is notably higher if the individual:
When it comes to treating diabetic retinopathy, several factors come into play, including the severity of the condition and its response to prior interventions.
In the initial stages, a cautious approach may be taken, where a doctor closely monitors the individual’s eyes without immediate intervention, a strategy known as “watchful waiting.”
For certain cases, individuals may need to undergo comprehensive dilated eye exams as frequently as every 2 to 4 months.
However, in most instances of advanced diabetic retinopathy, surgical intervention becomes necessary. There are several treatment options available:
Injections into the Eye: Medications known as vascular endothelial growth factor (VEGF) inhibitors can be used to inhibit the growth of new blood vessels and improve vision. Most individuals receiving these injections will require them for at least three months. While some may eventually need them less frequently or not at all, others may continue to require them for vision protection.
Scatter Laser Surgery: Specifically designed for Proliferative Diabetic Retinopathy (PDR), this procedure uses lasers to burn the damaged blood vessels, causing them to shrink. Multiple applications may be necessary, and vision may be temporarily blurred for a day or more after each session. Some loss of peripheral and night vision may also occur.
Focal Laser Surgery: This surgery targets macular edema, which involves fluid buildup in the retina. The surgeon aims to stop or decrease the leaking of blood or fluid into the eye by burning and sealing the damaged blood vessels. Typically performed as an outpatient procedure during a single session.
Vitrectomy: This surgery involves making a tiny incision in the eye to remove blood from the vitreous fluid, along with any scar tissue that could lead to retinal detachment. General anesthesia is typically used for this procedure.
How to Prevent the Onset of Diabetic Retinopathy
Effectively managing blood sugar levels is paramount in preventing diabetic retinopathy.
Timely detection of symptoms significantly enhances the efficacy of treatment.
Additionally, high blood pressure, or hypertension, plays a contributing role. Individuals with diabetes can take proactive steps to control their blood pressure, including:
Diabetic retinopathy is a condition that specifically affects individuals with diabetes and, if left untreated, can lead to serious complications, including vision impairment.
Undergoing a comprehensive dilated eye examination at least annually is crucial. This proactive measure enables individuals to detect the condition early on, ultimately preventing potential complications.
The author is the Director and Vitreo-retina and Phaco-Refractive surgeon, Nandadeep SERI Eye Hospital.