Diabetic Retinopathy

Why worry about Diabetic Retinopathy

Diabetes - fast gaining status of a potential epidemic in India
In 2000, 171milliondiabetics in diabetics in the world, 31.7 million diabetics in India-highest in the world
Predictions for number of diabetics for 2030- 366 million in the world and 79.4 million in India.
Currently in 2020, around 8 crore Diabetics already in India and the number is expectdto increase due to sedentary lifestyle, change in dietary habits, stress, poor eating habits, lack of physical activity

Diabetic Retinopathy Facts

DR causes vision impairment more than blindness
Blindness or vision impairment is most in working age group
Large number of person – years of vision loss
More disability during the working years = huge financial loss for the patient and hence Large economic costs for the community and country at large
But vision loss is avoidable if diagnosed early and treated in time

Risk factors for development of Diabetic Retinopathy in Diabetics

Longer duration of diabetes-as duration of diabetes increases, chances of developing diabetic retinopathy increases
> 75% of Diabetic Retinopathy patients had > 15 years of Diabetes
Systolic hypertension –BP >160/110 mm Hg
Patients with poor blood sugar control
Deranged lipid profile
Elevated HbA1C
Diabetics suffering from Diabetic Kidney disease – identified as leakage of proteins in urine and in later stages by increase in blood urea and creatinine

Normal Eye Vs Diabetic Eye

Normal Eye Diabetic Eye

2 major causes of vision loss in Diabetic retinopathy are :

Proliferative diabetic retinopathy (PDR)
Diabetic Macular Edema (DME)

PDR : The precursor for PDR is NonproliferativeDiabetic Retinopathy(NPDR) – wherein there are few blood spots(hemorrhages), vascular dilatations(aneurysms) and cotton wool spots(soft exudates) on the retina. Control of all risk factors at this stage can prevent progression for NPDR to PDR.

Classification of Diabetic Retinopathy

Non-proliferative DR (NPDR)

Mild
Moderate
Severe
Very severe

Proliferative DR (PDR)

Stages of Diabetic Retinopathy - NPDR

Stages of diabetic retinopathy - PDR

Diabetic Macular Edema

Major contribution to vision loss from diabetes
10% in patients > 10 years of Diabetes
25% in patients > 25 years of Diabetes

Most mild-moderate vision loss (2- 6 lines) due to DME
Significant morbidity, often irreversible
Untreated - visual loss of 2 lines or more in > 50%

Treatment

NPDR: The treatment of NPDR is good blood sugar control so that it does not progress to PDR.

PDR: The treatment depends on the stage of PDR

Early PDR needs prompt laser and good sugar control to achieve best reults.
Tractional Retinal Detachment - It causes vision loss to a significant extent and mosgt of the times retina surgery (Vitrectomy) to give some functional vision.
Vitreous Hemorrage - The vision loss in this disorder is sudden and very severe most of the times. Depending on the severity treatment can be either Laser or Vitrectomy.