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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 RetinopathyFacts
  • 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

  1. Early PDR needs prompt laser and good sugar control to achieve best reults.

  2. Tractional Retinal Detachment - It causes vision loss to a significant extent and mosgt of the times retina surgery (Vitrectomy) to give some functional vision.

  3. 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.

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Normal Retina

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Mild and Moderate NPDR – no treatment required

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Severe NPDR – close monitoring required

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Tractional retinal detachment

Vitreous hemorrhage

 Total retinal detachment 

So our goal is to prevent a diabetic from progressing towards these complications of Diabetic retinopathy and prevent blindness caused due to it. 

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