Diabetes affects the nerves in the eye causing loss of vision. Most commonly it affects the kidneys, the eyes and the peripheral nerves. A look at treatment options for diabetic retinopathy and maculopathy.

Diabetes is considered the mother of all diseases, as it affects almost every part of our body. Most commonly it affects the kidneys, the eyes and the peripheral nerves. In the eye, diabetes affects the innermost layer of the eye, the retina, and this condition is called diabetic retinopathy. The major risk factors are long duration of disease, poor blood sugar control, high blood pressure, kidney diseases, pregnancy, obesity, high cholesterol levels, smoking and anaemia.

Damage to retina

In diabetic retinopathy, the retina's blood vessels are affected blocking blood flow to the retinal tissue. This causes oxygen deprivation. Another phenomenon is blood leaking through the damaged walls of the blood vessels causing retinal swelling. When the central and most important part of the retina, macula, is affected, it is called diabetic maculopathy. There are three stages of diabetic retinopathy.

In background diabetic retinopathy, tiny enlarged blood vessels, bleeding and yellow particles are visible during examination.

The next stage is pre-proliferative diabetic retinopathy. Here examination shows white particles caused by lack of oxygen and resulting in nerve damage. Associated bleeding vessels can also be seen.

Proliferative diabetic retinopathy is the last stage where there will be formation of new blood vessels. These are highly friable leading to sudden bouts of bleeding causing loss of vision. Fibrous band formation will lead to traction on the retina causing retinal detachment and sudden loss of vision.

Diabetic maculopathy can happen at any stage. If the onset happens in the first stage, vision is affected early. Sometimes even in the last stage, vision may not be affected since there is no maculopathy.

Strict control of blood sugar is the first line of treatment. In case of new blood vessel formation, laser is applied to new vessels to prevent sudden bleeding and loss of vision. Laser is used to produce a therapeutic burn to a pre-selected area of the retina while causing minimal damage to the surrounding tissues.

Treatment

Fluorescien Angiography is necessary for proper assessment of retinal vessels. This is photo of the retina taken after injecting special dyes into the blood vessels. This will clearly show the area where laser needs to be applied. All those with clinically significant maculopathy require laser treatment. In its absence, there should be a follow-up every three to six months. Laser treatment prevents further visual loss.

In case of severe bleeding, which prevents visualisation of the retina, surgical evacuation of blood may be required. But it is necessary to see if natural resorption happens. If retinal detachment is noticed, then immediate surgery is required to evacuate the blood, release the fibrous bands and reattach the retina.

Associated complications like glaucoma or raised eye pressure and cataract should be treated promptly. Other problems like hypertension, anaemia and kidney diseases should also be treated.

Self-help

Avoid obesity, smoking and drinking. Keep a watch on your diet. Exercise or take a brisk walk.

Control your blood sugar strictly.

Consult your eye specialist every six months for the first five years after the onset of diabetes. Thereafter it should be every three months. This is will help detect and treat complications early.

See that high blood pressure and kidney ailments are treated at the earliest.

Avoid severe physical exercise, hypoglycaemia and direct eye trauma to prevent bleeding in the proliferative stage.

Avoid pregnancy during the proliferative stage as it is known to worsen the condition.

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