Diabetic Retinopathy FAQs


CKWhat is Diabetic Retinopathy?
Why is Diabetic Retinopathy Important?
How Can I Tell if I Have Diabetic Retinopathy?
How is Diabetic Retinopathy Diagnosed?
What is Fluorescein Angiography ?
What is a LASERr?
How is LASER Treatment Performed?
How is Diabetic Retinopathy Treated?
What is Proliferative Diabetic Retinopathy?
Will My Vision Improve After LASER Treatment?
Will the LASER hurt?
What Happens if the LASER Doesn't Work?
Will a vitrectomy operation allow me to see properly again?
Will Glasses Help?
What should I do if I see blood in my vision?
Our Technological Advance


WHAT IS DIABETIC RETINOPATHY?

Diabetic retinopathy is a term used to describe the changes in the blood vessels of the retina. 
There are two types of retinopathy-Background and Proliferate diabetic retinopathy.
Background or non-proliferative is much, more common. There may be bleeding within the layers of  the retina (hemorrhages); leakage of serum into the retina causing protein deposits in the retina called exudates.
If there is fluid in the macula eye then vision drops (macular edema). If the process becomes severe enough, the retina does not receive enough oxygen.  New abnormal vessels develop in the retina in response to the lack of oxygen. These new vessels, which develop during the Proliferative Phase, are fragile and are prone to bleed.  If they bleed into the jelly in the center of the eye, a vitreous hemorrhage develops. Often these bleeding episodes cause severe visual loss in patients. Smaller bleeding episodes may clear up on their own but larger, repeated or bleeds lasting more than 6 mos.  may need surgery. These newly formed abnormal vessels may also produce fibrous bands in the retina that may contract and  produce a retinal detachment.  Fortunately, Proliferative diabetic retinopathy especially with vitreous bleeding is uncommon.

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WHY IS DIABETIC RETINOPATHY IMPORTANT?
The risk of diabetic retinopathy, which causes leakage of the small blood vessels,  increases with duration and control of blood sugar levels. After 5 years, approximately one-quarter of patients with IDDM will demonstrate damage to the retinal  blood vessels. By 15 years, almost everyone with IDDM will have some retinal involvement. Diabetics have 25 times the usual risk of blindness. Glaucoma, cataract, and corneal disease are more common in people with diabetes and contribute to the high rate of blindness. In addition, high blood pressure or pregnancy increases the risk of retinopathy in diabetics. These statistics demonstrate the risk for diabetic patients; the need for regular eye check-ups and treatment,which will reduce the risk of blindness.

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HOW CAN I TELL IF I HAVE DIABETIC RETINOPATHY?
Diabetes earliest sign may be an abrupt change in your eye glass prescription.  The blood sugar effects with water content of the lens of the eye and, therefore, your eyeglass prescription.  Sudden increases in blood sugar will cause an increase in myopia.  This often occurs before the detection of the disease.  Diabetic retinopathy may begin in your eyes without you noticing any change in vision. Unfortunately, there may be extensive and severe  changes before your vision is affected. Thus, it is very important to have your eyes examined regularly at six-month or yearly intervals depending on duration and/or severity of your diabetes.

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HOW IS DIABETIC RETINOPATHY DIAGNOSED ?
dilated retinal examination is performed. Dilatation, is like opening the door of closet, so that we can see what is inside to properly evaluate the retina.  We look for evidence of diabetic retinopathy. Based on this examination a Fluorescein Angiogram may be advised.

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WHAT IS FLUORESCEIN ANGIOGRAPHY?
Fluorescein angiography is a dye test often used to assess the damage to the retina and it's blood vessels from diabetes. A dye is injected into a vein of one arm. Pictures are taken of the retina as the dye passes through the vessels of the eye.  Since there is a risk of allergic reactions, a history of allergic reactions is important. There may be mild nausea during the procedure. The skin and urine may turn yellow for 24 to 48 hours.

These angiograms show areas of leakage, areas of oxygen-starved retinas, and weak, fragile new vessels. Based on the results a LASER may be advised.

 

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WHAT IS A LASER?
Laser stands for Light Amplification by Stimulated Emission of Radiation. The Laser produces a concentrated beam of light that burns small areas of the retina.

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HOW IS LASER TREATMENT PERFORMED ?
Laser surgery is usually an outpatient procedure. First, an anesthetic drop is instilled in the eye. A contact lens is put on the eye which directs the laser light to the retina. The treatment is usually painless. It can take up to 60 minutes to complete the treatment.


HOW IS DIABETIC RETINOPATHY TREATED ?

The most important treatment for diabetes and its complications including diabetic retinopathy is control of the diabetes. Tight control of both blood sugar, weight and blood pressure control are important in preventing the ocular complications of diabetes and slowing the progression of the disease.

In addition diabetics should keep a tight control on their blood chemistry.  The following are the recommended values:

Hemoglobin A1C < 7
Blood pressure < 130/80
Cholesterol < 200
HDL < 45
LDL < 100
Triglycerides < 150


Once retinopathy occurs, laser therapy is the current modality of treatment. Lasers have been used since the 1970s.  Laser treatment is an office outpatient procedure.  Most patients tolerate the procedure extremely well with little discomfort. Laser surgery is used to treat both diabetic macular edema and proliferative diabetic retinopathy.

Laser treatment for diabetic macular edema  stabilizes vision by stopping blood vessels from leaking fluid into the retina. Either focal treatment for small  discreet areas of leakage or a grid pattern is used when the leakage is diffuse in nature. After treatment, the patient may notice small spots of decreased visual sensitivity. Usually these spots  become less noticeable with time.  It is possible that the vision may get a little worse after laser.  However, the laser helps prevent further reduction in vision.  Studies have shown that most  patients who receive laser for macular edema will have better vision in the future than if they hadn't received the treatment.

WHAT IS PROLIFERATIVE DIABETIC RETINOPATHY?
In the less common proliferative diabetic retinopathy new blood vessels grow onto the retina in response to need of nourishment and oxygen which is deprived by the diabetic process.  Unfortunately these new blood vessels are weak and fragile.  They bleed easily and may contract pulling on the retina causing a retinal detachment. These abnormal neo-vascular vessels (new blood vessels) found in proliferative diabetic retinopathy are treated with pan retinal (scatter) laser photocoagulation or PRP. Laser treatment is given to the peripheral retina which is not receiving an adequate blood supply. It is believed that by treating the areas of retina deprived of normal vasculature, the reduction in demand for nutrients and oxygen by damaging retina will halt the development of new blood vessels.  It is important to recognize that this laser procedure, is destructive and does not improve vision. It is intended to prevent the blinding complications of diabetic retinopathy. There is some loss of side (peripheral) and color vision is following this treatment . Pan retinal photocoagulation has been shown to reduce the risk of severe visual loss associated with proliferative diabetic retinopathy.

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WILL MY VISION IMPROVE AFTER LASER TREATMENT?
Laser therapy can only stop the progression of the retinopathy. It cannot reverse the damage already done.

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WILL THE LASER HURT?
Sometimes a dull thud sensation or occasionally a sharp pain is felt. You can relieve any discomfort experienced the same evening by taking a mild painkiller (like Paracetamol) and resting. If you have had pain on previous treatments it is a good idea to take painkillers prior to expected treatment. If pain is still persistent 24 hours after treatment report to an eye casualty department.

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WHAT HAPPENS IF THE LASER DOESN'T WORK?
While pan retinal photocoagulation is usually successful in halting the proliferative process, some patients progress despite laser treatment. Other patients may have bleeding into the vitreous of the eye. These eyes may require vitreous surgery. The main indications for vitrectomy are persistent vitreous hemorrhage and tractional retinal detachment. Vitrectomy surgery is a major eye operation. It involves removal of the vitreous  from the  eye. Frequently, the retina has to be reattached by surgically separating the scar tissue from the surface of the retina. Laser treatment is often applied at the time of vitrectomy. In some cases, a gas bubble is left in the eye following surgery to keep the retina flat against the back of the eye. 

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WILL A VITRECTOMY OPERATION ALLOW ME TO SEE PROPERLY AGAIN?
This exchange of a clear substance for cloudy vitreous allows light to reach the retina again, and can help to restore some vision. However, the improvement in vision can be limited, and sight may take weeks or even months to improve. In some cases of severe diabetic retinopathy, success means stabilising the vision, that is, preventing it from getting worse.

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WILL GLASSES HELP?
The glasses that the patient was using earlier can be continued. Often time special vision aids need to be prescribed. Magnifiers and other devices can help.

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WHAT SHOULD I DO IF I SEE BLOOD IN MY VISION?
Don't bend so that your head is below your heart and avoid strenuous activity, and see a doctor as soon as possible.

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OUR TECHNOLOGICAL ADVANCE

Pascal LASER - The Fastest Argon Retinal LASER in the world was recently made available to our patients.

Pascal LASER is a new automated laser delivery system that is ten times faster than conventional lasers and yet is less painful. This laser is used to treat diabetic retinopathy, retinal vascular disease, retinal tears, macular degeneration and even certain forms of glaucoma.

It delivers significantly enhanced benefits to both the physician and patient while remaining consistent with standard protocols. This advanced method of photocoagulation enables the Ophthalmologist to provide more rapid, precise, and safe treatment. Because of this, patients are likely to experience less discomfort and therefore have more tolerance for the procedure. Treatment delivery is much more efficient and extremely comfortable for patients with excellent therapeutic response. This innovation represents a huge leap forward in the physician's ability to deliver quality care to more patients.

Benefits of PASCAL Laser Surgery:

Speed: More efficient than standard single shot photocoagulation.

Improved Comfort: Patients are likely to experience less discomfort and therefore have more tolerance for the procedure.

Advanced Precision: Macular Grid treatment provides an improved margin of safety and dosimetry control when compared with single shot treatments. Unlike the irregular pattern placement obtained in single shot photocoagulation, PASCAL delivers more even pattern burns.

Ease of Use: The PASCAL Method of photocoagulation is similar to single shot photocoagulation, therefore physician training is minimal.