Diabetic retinopathy

Diabetes mellitus is one of the fastest-growing chronic conditions globally, affecting multiple organs—one of the most significant being the eyes. Diabetic retinopathy is a microvascular complication of diabetes that damages the retina, the light-sensitive tissue at the back of the eye. If left untreated, it can lead to partial or complete vision loss.

Due to increasing diabetes rates, particularly in low- and middle-income countries, diabetic retinopathy has become a major public health concern. Early detection, timely treatment, and proper management of blood sugar levels are critical in preventing vision impairment. It is a leading cause of blindness among working-age adults and demands collaborative care between endocrinologists and ophthalmologists.

Diabetic retinopathy is an eye condition that occurs when high blood sugar levels damage the tiny blood vessels in the retina. These damaged vessels may leak fluid or bleed, leading to vision problems. In advanced stages, abnormal new blood vessels grow on the surface of the retina, which can result in scarring and retinal detachment.

It typically affects both eyes and progresses gradually, often without early warning signs. Over time, diabetic retinopathy can lead to diabetic macular oedema (DME), retinal detachment, or neovascular glaucoma. The impact on vision can be severe, interfering with daily activities like reading, driving, and recognising faces.

Globally, diabetic retinopathy affects approximately one-third of people with diabetes. According to the International Diabetes Federation, in 2021, around 103 million people worldwide had diabetic retinopathy.

In India, the prevalence ranges from 18% to 28% among individuals with diabetes, with higher rates observed in urban populations. As India currently has over 77 million adults living with diabetes, the burden of diabetic retinopathy is substantial and growing. Studies suggest that with the growing diabetic population, more than 10 million individuals in India may be at risk of vision-threatening diabetic retinopathy.

Diabetic retinopathy is broadly classified into two types:

1. Non-Proliferative Diabetic Retinopathy (NPDR):
   
   
   • Early stage
   • Blood vessels in the retina weaken, bulge, or leak
   • May cause retinal swelling and blurred vision
   • Sub-classified as mild, moderate, or severe depending on the extent of vascular damage
2. Proliferative Diabetic Retinopathy (PDR):
   
   • Advanced stage
   • New, abnormal blood vessels form on the retina
   • High risk of bleeding, scar tissue formation, and potential vision loss
   • May lead to vitreous haemorrhage or tractional retinal detachment

Another associated condition is Diabetic Macular Oedema (DME), where fluid builds up in the macula, the central part of the retina responsible for sharp vision. DME can occur at any stage of retinopathy and is a major cause of vision loss.

The primary cause of diabetic retinopathy is prolonged high blood sugar levels, which damage the retinal blood vessels. Other contributing factors include:

• Poorly controlled blood pressure
• High cholesterol levels
• Smoking
• Kidney disease
• Long duration of diabetes
• Sedentary lifestyle
• Unhealthy diet

These factors collectively increase the risk of retinal damage and vision complications. Genetic predisposition may also influence susceptibility to diabetic retinopathy.

Diabetic retinopathy may not present symptoms in its early stages. As the condition progresses, symptoms may include:

• Blurred or fluctuating vision
• Dark or empty areas in your vision
• Impaired colour perception
• Vision loss
• Spots or floaters in the field of vision
• Difficulty seeing at night
• Reduced contrast sensitivity

Because symptoms often appear only when the disease has advanced, regular eye screenings are crucial.

Early diagnosis can prevent vision loss. A comprehensive eye exam includes:

• Dilated Eye Exam: Allows a detailed view of the retina
• Fluorescein Angiography: Detects leaking or blocked vessels
• Optical Coherence Tomography (OCT): Measures retinal thickness and swelling
• Fundus Photography: Captures images of the retina for monitoring progression

Diabetics should have a detailed eye examination at least once a year or more frequently if signs of retinopathy are found.

Treatment depends on the severity of the condition:

1. Early NPDR:
   
   • Tight control of blood sugar, blood pressure, and cholesterol
   • Regular monitoring
   • Lifestyle modifications
2. Advanced NPDR or PDR:
   
   • Anti-VEGF Injections: Inhibit abnormal blood vessel growth. (Bryzta 100mg injection and Avastin 4ml injection)
   • Laser Photocoagulation: Seals leaking vessels and prevents further growth
   • Vitrectomy: Removes blood or scar tissue from the vitreous and may repair retinal detachment

With timely treatment, significant visual improvement and disease stabilisation can be achieved. Patients often need multiple therapy sessions for lasting results.

While alternative therapies are not a replacement for medical treatments, some supportive approaches include:

• Nutritional Supplements: Antioxidants like lutein, zeaxanthin, vitamin C, E, and zinc support eye health
• Ayurvedic Medicine: Herbal preparations such as Triphala and Amalaki under professional guidance
• Yoga and Meditation: Help reduce blood pressure and stress, improving overall diabetic control
• Acupuncture: May aid in diabetic control and circulation (research still limited)

Always consult a doctor before starting alternative therapies.

Several factors increase the risk of developing diabetic retinopathy:

• Long duration of diabetes (more than 10 years)
• Poor glycaemic control
• Hypertension
• High cholesterol
• Pregnancy (in diabetic women)
• Smoking
• Obesity
• Sedentary lifestyle
• Presence of kidney disease (nephropathy)

Managing these risk factors can reduce disease progression. Regular screening and holistic diabetic care are essential.

Untreated diabetic retinopathy can result in:

• Diabetic macular oedema
• Retinal detachment
• Neovascular glaucoma
• Vitreous haemorrhage
• Permanent vision loss
• Cataract development (common in diabetics)

These complications can severely impact quality of life and independence. Vision impairment may also increase the risk of falls and depression.

• Stay committed to diabetes management
• Monitor vision changes and report them promptly
• Follow eye treatment plans strictly
• Use vision aids if necessary (magnifiers, large-font screens)
• Join support groups for emotional and practical assistance
• Maintain a diabetes diary for glucose readings and symptoms
• Plan regular follow-ups with healthcare providers

A proactive lifestyle can help manage the condition effectively.

• Myth: Only older people get diabetic retinopathy
  
  
  • Fact: It can affect anyone with diabetes, including younger adults
     
• Myth: If vision is fine, eye exams aren’t needed
  
  
  • Fact: The condition can progress silently without symptoms
     
• Myth: Laser treatment cures the disease
  
   
• Fact: It helps manage the condition but doesn’t cure it
   

See an ophthalmologist if:

• You have diabetes and haven’t had an eye exam in the past year
• You notice sudden changes in vision
• You see floaters, flashes, or experience vision loss
• You are pregnant and diabetic (retinopathy may progress faster during pregnancy)

Timely intervention can preserve eyesight and prevent complications.

• How often should I get my eyes examined?
• What stage of diabetic retinopathy do I have?
• What treatment options are best for me?
• Are there lifestyle changes I should make?
• Can this condition be reversed?
• How will treatment affect my daily life?
• Will I need multiple treatments or long-term care?

• Help them attend regular appointments
• Encourage healthy habits and treatment adherence
• Assist with tasks if vision is impaired
• Be patient and understanding of their emotional challenges
• Offer to accompany them to support groups
• Help organise medication schedules and health logs

Compassionate support plays a vital role in management and recovery.

Diabetic retinopathy is a leading cause of preventable blindness, especially in countries with rising diabetes rates like India. Understanding the condition, adhering to regular screenings, and managing diabetes diligently are key to protecting vision.

Medical advancements offer effective treatments, but awareness and proactive care remain the first line of defence. Collaborative care involving general physicians, endocrinologists, and eye specialists can yield the best outcomes.