Diabetes Mellitus as we know has taken the form of a global pandemic. More so, India has been termed the diabetic capital of the world along with China, with almost one in every three Indians affected. As our population continues to grow soon we will have a large number of people in the middle and elderly aged group who are the most affected by this lifelong disease. Diabetic retinopathy is an ocular complication of the systemic disease which manifests in proportion to its duration and glycemic control. Majority of the patients are Type-2 diabetics. Almost 100% patients with Type 1 diabetes will develop retinopathy with 20 years of duration while almost 60% of Type 2 diabetics will do so after 20 years. However a large majority of Type 2 diabetes goes unrecognized in its early phases due to multiple factors such as lack of awareness, poor health services, unawareness on the part of treating physician and lack of symptoms in the early stages. Type 1 diabetes usually has a hyperacute onset prompting early detection and treatment.
What are the symptoms of diabetic retinopathy?
In its early stages diabetic retinopathy may not have any symptoms. As the disease advances patient may have decreased vision and difficulty in reading due to macular edema (swelling in the central retina). Macular edema is the commonest cause of visual morbidity in diabetes. With further progression the patient can develop sudden loss in vision due to bleeding inside the cavity of the eye secondary to formation of abnormal blood vessels and retinal detachment due to traction from these vessels. In end stage diabetic retinopathy the visual loss is profound and maybe due to optic atrophy, neovascular glaucoma and chronic retinal detachment.
When should a patient get screened for diabetic retinopathy?
A type 1 diabetic should typically have an eye screening within 5 years of diagnosis of diabetes or at puberty if early onset. A type 2 diabetic should have the first screening at the time of diagnosis as many times the diabetes is detected late. This fact is often missed by treating physicians and in our country by the universal presence of quacks and unqualified doctors. Further checkups should be done according to the advice of a retinal specialist. Pregnant diabetic females should have a checkup before conception and once in each trimester and one examination 2 months post-delivery.
What are the stages of diabetic retinopathy?
Diabetic retinopathy has broadly two stages: Non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). PDR requires active treatment. NPDR generally requires observation and strict glycemic control but may need treatment in the presence of macular edema.
Is diabetic retinopathy reversible?
No. Once a particular stage of retinopathy has been achieved it is not reversible. However complications like macular edema, bleeding and retinal detachment can be treated.
Is treatment of the eye enough to stop diabetic retinopathy?
This is a common misconception among patients that treatment of the ocular complication of diabetes is enough. As we know, diabetic retinopathy is a complication of diabetes mellitus and along with it other diseases such as high blood pressure, kidney disease, anemia, high cholesterol etc. A rigorous control and treatment of these systemic problems is also essential for good response to the eye treatment.
I want a one-time solution for my diabetic retinopathy. Is it possible?
Again a common misconception is that a single shot of treatment is enough to treat diabetic retinopathy. Diabetic retinopathy treatment is not like cataract surgery. Patients have to understand that as they have to undergo lifelong treatment of diabetes similarly they may have to undergo repeated treatments for diabetic retinopathy as with the eye treatment we are only targeting the eye disease but diabetes itself is present for a lifetime.
What is the treatment for diabetic macular edema (swelling in the retina)?
Depending on the reduction in vision and the amount of swelling, treatment involves repeated injections of medicines (Anti VEGF/steroids) inside the eye combined with or without laser treatment. Laser treatment alone also can be done.
What is the treatment for bleeding in the retina or abnormal blood vessels and retinal detachment?
Proliferative diabetic retinopathy is generally treated with laser treatment which is usually done in 3-4 sittings. If bleeding does not improve then retinal surgery may be needed. Retinal detachment needs surgery.
What are the costs involved in treatment?
Anti VEGF injections cost anywhere between 7000-25000 rupees per injection depending on the brand and hospital. Steroid injections range between 1500 to 35000 rupees per injection. Retinal laser costs between 1500-6000 rupees depending on type of laser and type of sitting. Retinal surgery can cost between 25000 to 50000 rupees depending on the hospital.
Is there any benefit with alternative medicine like Ayurveda or homeopathy for diabetic retinopathy?
There is no evidence to suggest that Ayurveda or homeopathy can halt or treat retinopathy however we do not discourage patients to try the same provided they understand the seriousness of the disease.
Will cataract surgery and lens implantation improve my vision if I have diabetic retinopathy?
Only if you really have cataract. Patients have a common misconception that implanting a lens inside the eye will solve all problems but it is not so. Infact diabetic retinopathy can worsen in some cases after cataract surgery.
Whom should I consult for evaluating/treating diabetic retinopathy?
Only a qualified ophthalmologist with experience in vitreoretinal diseases should treat diabetic retinopathy. However, in remote areas a trained general ophthalmologist can pick up retinopathy and refer for treatment.