Diabetic Retinopathy

Good morning friends,

I am Dr. Harshvardhan Ghorpade and today I am going to speak to you about retinal disorders especially diabetic retinopathy. Now retina is the innermost layer of the eye. It is the light-sensitive layer, it is the layer where the image of the light is formed and then transmitted to the brain, any damage to this layer leads to blurred vision. The most important sensitive part of the retina is the macula and the centermost point is called the fovea. If there is any collection of fluid or blood or damage to this part of the retina, it leads to blurriness and even blindness of vision so there are various disorders that can affect the retina that could be infections, inflammations, retinal detachments, injuries and various other disorders which ultimately lead to blurred vision.

Specifically speaking if we talk about diabetic retinopathy, it is a disorder where diabetes leads to blockage and leakage of blood vessels in the retina. Now this blockage leads to hypoxia which means less oxygen supply which in turn leads to the formation of new blood vessels and these new blood vessels can break, rupture and bleed leading to blindness.

The other part is leakage. Leakages because the blood vessels become leaky due to blood sugar in the blood as a result of which fluid starts accumulating in the central area as I said the fovea and macula, this leads to initial blurred vision; however, for long time later it can lead to scarring and finally complete loss of vision at the center.

So the most important thing in diabetic retinopathy is screening, there is no symptom of diabeticretinopathy. The patient does not have any problem until it actually occurs and therefore patients with diabetes for more than five years and patients with congenital diabetes or juvenile diabetes from the first year itself need to be screened every year. If you find any changes in the retina then the patient may have to be screened every six months or even at three months because every small change has to be monitored. This monitoring can be done by various instruments like simple fundus camera or it can be done by lenses and most new instruments have now we use is the OCT, which is a scan of the retina and which gives us the idea of the thickness of the layers and if there is any leakage the layer thickness can increase.

When we come to know about any changes in the retina through all these apparatuses then we can definitely warn the patient and we can even do preliminary treatment. The early treatment can be done by simple laser machines which are an OPD based procedure, where we can block these blood vessels which are leaking and prevent further loss of vision because as the fluid starts accumulating it can come to the center of the retina, which is the most sensitive area.

However. if the bleeding is more we might even need surgery, this surgery is called vitrectomy. In vitrectomy what we do is we cut the central area of the jelly that is present in the eye and removes all the blood that is collected, this is followed by laser therapy to the areas which are leaking and then follow-up is needed.

There are other treatments also available in which if there is a mild swelling in the center we just give injections which stop the leakage, one or more injections may be required these are called anti-VEGF injections. example is Lucentis. Now once we treat the patient with injections, lasers or surgery we need to be sure that the patient is followed up because the diabetes is going to remain throughout their life and therefore retinopathy can come again at different parts which have not been treated.

The most common treatment for severe diabetic retinopathy is panretinal photocoagulation or PRP which means retinal laser is given to the entire retina in three steps. this results in coverage of the whole retina and therefore the chances of diabetic retinopathy affecting any of the parts are less; however, it can affect your night vision and peripheral vision which is a side effect of the therapy. Apart from this, we should be careful that during injections and operations, there should not be an infection because a diabetic patient is always prone to more infections, all this care has to be taken by the doctor as well as the patient because it's a combined effort in preventing blindness due to diabetic retinopathy.

Hence, I appeal to you that every time, any patient is detected with diabetes a yearly screening of the eyes is a must and follow-up treatment if required has to be done without any delay, even a delay of a few weeks can lead to permanent blurring of vision.

Thank you very much and I hope you enjoyed my video. If you want to know more about me please contact me on lybrate.com

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