New Delhi: Diabetic retinopathy is a microvascular eye disease caused by high blood sugar levels leading to damage of the blood vessels in the retina. As such, an understanding of its various stages, extreme emphasis on early detection, and then appropriate treatment plays a crucial role in protecting eyesight in diabetics. The stages of diabetic retinopathy include mild non-proliferative retinopathy, moderate non-proliferative retinopathy, severe non-proliferative retinopathy, and proliferative retinopathy.
In an interaction with News9Live, Dr. Simakurthy Sriram, Consultant, Vitreoretina, Sankara Eye Hospital, Hyderabad, shared a complete guide on the management of diabetic retinopathy.
Mild Non-Proliferative Diabetic Retinopathy
In the initial stage of diabetic retinopathy, known as “mild non-proliferative diabetic retinopathy,” there starts to grow microaneurysms within the blood vessels of the retina. At this stage, patients do not observe changes in their eyesight, as symptoms are often mild or even absent; hence, the condition is typically diagnosed at a very late stage if preventive checkups are not conducted regularly. Thus, early detection is essential because unaddressed diabetic retinopathy could become severe and cause other serious conditions that may impair eyesight.
Moderate Non-Proliferative Diabetic Retinopathy: As diabetic retinopathy progresses, some of the blood vessels in the retina can become blocked which may hinder the blood flow and affect the supply of nutrients to the retina. Retinal haemorrhages and cholesterol exudation may be noted in the retina. This phase may lead to some mild vision loss in some patients; however, many patients may remain asymptomatic. Therefore, regular eye checks are necessary to detect these early changes before they lead to more serious consequences.
Severe Non-Proliferative Diabetic Retinopathy: As diabetic retinopathy progresses, more blood vessels are occluded, eliminating larger portions of the retina from adequate circulation. In addition to the changes mentioned earlier, there may be damage to retinal veins and the development of abnormal retinal vessel anastomosis known as IRMA may develop. At this point, symptoms include more overt loss of vision such as blurring or dimming. If treatment is not sought immediately, the vision can continue to deteriorate.
Proliferative Diabetic Retinopathy (PDR): Proliferative diabetic retinopathy is known as the most advanced form of diabetic retinopathy. It is diagnosed when abnormal blood vessels grow on the retina. These new vessels are easily ruptured and will bleed into the gel that fills the eye, called vitreous. When this happens, the patient’s vision can become cloudy, greatly impaired, and may continue to worsen over time if left untreated.
At this juncture, symptoms may include initial dark spots or floaters, poor vision, and, in extreme, significant loss of vision. It is essential to seek medical attention immediately to prevent further damage and to preserve as much sight as possible.
Importance of Early Diagnosis
People affected by diabetes should have regular eye examinations since Diabetic retinopathy offers no symptoms when the disease first appears. An annual eye examination is essential to identify the abnormal appearance of the retina before the symptoms are realized and thus intervene early.
Timely Treatment: It is during this early period that treatments can begin, helping to delay or even stop the progression of the disease. Diabetic retinopathy treatments work to minimize or prevent the loss of vision by treating abnormal blood vessels and reductions in retinal edema. Any treatment for diabetic retinopathy begins with patient education and emphasis on systemic control of diabetes and local treatment modalities include giving injections of antiVEGF agents or corticosteroids directly into the eye known as intravitreal therapy or laser ablation of abnormal blood vessels and ischemic retina known as pan-retinal photocoagulation. Vitrectomy is a surgical procedure done in late stages to treat complications such as bleeding in the vitreous gel known as vitreous haemorrhage or retinal detachment.
Consequences of Late Treatment: Untreated diabetic retinopathy may cause such complications to become imminent, including macular edema, retinal detachment, glaucoma, or even permanent blindness. Studies show that effective treatment can reduce the risk of blindness to as low as 90%, making early intervention and continuous observation all the more indispensable. The delay in treatment for diabetic retinopathy leads to the loss of irreversible eyesight. Awareness and Prevention. Awareness of diabetic retinopathy is essential for its prevention. Controlling blood sugar levels constitutes a primary strategy for reducing the risk of diabetic retinopathy, given that elevated glucose levels have the potential to harm retinal blood vessels. Furthermore, managing blood pressure and cholesterol is of utmost importance, as elevated levels can accelerate the progression of retinopathy, thereby threatening visual health. A healthy lifestyle in terms of a balanced diet, exercise, and abstaining from smoking would add more protection against the development of diabetic retinopathy because it will enhance overall vascular health in postponing complications of this disease.
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