Stages of Diabetic Retinopathy

Non Proliferative Diabetic Retinopathy (NPDR) - This represents the early stage of Diabetic Retinopathy. Your vision may or may not be impacted at this point by the changes to the retina.

Proliferative Diabetic Retinopathy (PDR) - At this advanced stage, the retina starts growing fragile new blood vessels. These fragile vessels frequently bleed into the jelly-like eye substance (vitreous), which may result in a few light floaters or completely obscure vision.

Who is at Risk for Diabetic Retinopathy?

Individuals who have diabetes, regardless of type, are susceptible to DR.

The risk of developing DR may increase as a result of:

• Duration of diabetes — the longer you have diabetes, the greater the risk of developing diabetic retinopathy
• Poor control of blood sugar level
• High blood pressure
• Pregnancy
• High cholesterol
• Tobacco use

Signs and Symptoms of Diabetic Retinopathy

• Blurry vision
• Dark spots
• Floaters
• Poor night vision
• Vision that changes from blurry to clear

Photographs of the eyes taken during a diabetic eye screening can present early indicators of the condition, so be sure to schedule an appointment with your eye doctor for an accurate diagnosis.

How is Diabetic Retinopathy diagnosed?

Your ophthalmologist will:

• Examine your visual acuity
• Evaluate your eye pressure
• Detect signs of cataracts
• Dilate your eyes

For the dilated eye assessment, eyedrops are used to widen your pupils so that your doctor can see more of what's going on inside your eyes. Until the drops wear off, which could take several hours, your near vision may be blurry.

During the eye assessment, your optometrist will look for:

• Abnormal blood vessels
• Abnormalities in your optic nerve
• Growth of new blood vessels and scar tissue
• Bleeding in the clear, jelly-like substance that fills the centre of the eye (vitreous)
• Swelling, blood or fatty deposits in the retina
• Retinal detachment

To obtain finer details, the ophthalmologist may use ancillary tests such as OCT (Optical Coherence Tomography) & FFA (Fundus Fluorescein Angiography).

How to prevent Diabetic Retinopathy

If you have diabetes, do the following steps to lower your chance of developing diabetic retinopathy:

• Participate in physical activity regularly
• Manage your diabetes well
• Maintain an ideal weight
• Practise healthy eating
• Consume oral diabetes medication or insulin as directed by your doctors
• Maintain healthy levels of cholesterol and blood pressure
• Stop smoking
• Pay attention to vision changes such as clouding, spotting, or blurriness

How to treat Diabetic Retinopathy

Treatment aims at delaying or stopping the development of the disease and is largely based on the type and severity of diabetic retinopathy.

NPDR

The requirement for immediate treatment may not be necessary if you have mild or moderate nonproliferative diabetic retinopathy. But to determine when you might require treatment, your eye doctor will closely monitor your eyes.

PDR

If you have proliferative diabetic retinopathy or macular edema, you should get treatment immediately. Depending on the precise retinal issues, you may have the following photocoagulation surgery options:

Photocoagulation

1. Focal: The leakage of blood and fluid into the eye can be stopped or delayed by this laser treatment. A single session of focal laser therapy is often performed in your doctor's eye clinic.
2. Panretinal (PRP): Abnormal blood vessels can be shrunk by this scatter laser procedure. During the operation, scattered laser burns are used to treat the retinal regions away from the macula. The abnormal new blood vessels shrink and scar as a result of the burns.

   Typically, it takes two or more sessions and is completed in your doctor's office or eye clinic. Your vision will be blurred for about a day after the procedure. There could be some loss of night vision or peripheral vision following the procedure.

3. Vitrectomy: During a vitrectomy, scar tissue that is pulling on the retina and blood from the gel of the eye (vitreous) are removed through a small incision in the eye. It is carried out under local or general anaesthesia.
4. Medication injected into the vitreous of the eye: Your doctor could advise doing this. By limiting the impact of the growth signals the body sends to produce new blood vessels, this medication, known as vascular endothelial growth factor (VEGF) inhibitors, may help prevent the creation of new blood vessels.
   These medications may be prescribed by your doctor as a stand-alone treatment or in combination with panretinal photocoagulation.

Surgery frequently slows or stops the progression of diabetic retinopathy, but it is not a cure. There is still a potential for further retinal degeneration and visual loss, as diabetes is a chronic illness.

At Eyecentric at Bukit Tinggi Medical Centre (BTMC), you are under the best care of fully-trained eye professionals who are experienced in a wide range of eye disorders. Our ophthalmologists and eye surgeons will be there for you every step of the way, guiding you through your concerns and providing the best advice to maintain your vision.