Diabetic Retinopathy

Diabetic retinopathy can develop in any patient having type 1 or type 2 diabetes.
The condition may lead to no symptoms or mild symptoms in the initial stages. But, if left untreated, it may lead to blindness.

Types:

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Risk factors:
The following may have an increased risk of developing diabetic retinopathy:

  1. Long-term diabetes
  2. Poorly controlled blood sugar levels
  3. High cholesterol
  4. High blood pressure
  5. Pregnancy
  6. Use of tobacco
  7. Black, Native American, or Hispanic race

Symptoms:
The symptoms associated with the later stages of diabetic retinopathy include:

  1. Floaters (spots or dark strings that float in the patient’s vision)
  2. Fluctuating vision 
  3. Blurred vision
  4. Empty or dark areas in your vision
  5. Loss of vision
  1. Visual acuity: This test can gauge how clearly a patient can see.
  2. Intraocular pressure test: This test is done to rule out glaucoma (optic nerve damage due to disorders of the eye).
  3. Eye muscle function test: This test helps the doctor in checking how well a patient can move his or her eyes.
  4. Peripheral vision test: This test is done to check how well a patient can see from the sides of his or her eyes.
  5. Pupil response: This test is done to assess how the pupils react to light.
  6. Comprehensive dilated eye exam: The doctor will put some drops in the eyes to widen or dilate the pupils and allow the doctor to obtain a better view inside the eyes. These drops may lead to blurred vision for a couple of hours. The doctor will look for abnormalities in the inside and outside parts of the eyes.
  7. Fluorescein angiography: Once the eyes are dilated using eye drops, a dye will be injected into a vein in the arm. Certain pictures are taken as the due circulates through the blood vessels of the eyes. These images help in pinpointing the blood vessels that are broken, closed, or leaking.
  8. Optical coherence tomography (OCT): This test helps in obtaining cross-sectional images of the retina to check the thickness of the retina. This test helps in determining how much fluid has leaked into the retinal tissue. Later, this test helps in monitoring how well the treatment is working.

 

The type of treatment performed for a patient will depend on many factors like age, medical history, extent of retinal damage, visual acuity, and HbA1C levels of the patient. The early stages of diabetic retinopathy will not need any treatment, but regular eye exams are needed every two to four months.
In the later stages of diabetic retinopathy, the following different types of treatments may be needed:

  1. Injections: Certain medicines, like anti-vascular endothelial growth factor drugs or corticosteroids, may be injected into the eye. These medicines help in slowing down the progression of the disease and improve vision.
  2. Photocoagulation or focal laser treatment: A laser is used to slow or stop blood leakage and fluid leakage in the eye. The leaks from the abnormal blood vessels are treated with laser burns.
  3. Panretinal photocoagulation: Also known as scatter laser treatment, this procedure enables shrinking of abnormal blood vessels and the formation of scars. 
  4. Vitrectomy: This is a form of eye surgery performed if a patient has cloudy vision due to the leakage of the blood vessels. The doctor makes a small incision or cut in the eye to repair the blood vessels and remove the scar tissue.

 

The complications associated with untreated diabetic retinopathy include:

  1. Vitreous hemorrhage (leakage of blood into the clear, jelly-like substance present in the center of the eye)
  2. Glaucoma (a group of eye disorders that damage the optic nerve)
  3. Retinal detachment (pulling away of the tissue lining the back of the eye from the tissues supporting it)
  4. Macular edema (when the fluid swells the macula, which is present at the center of the vision and is responsible for visual sharpness)
  5. Blindness

The complications associated with the treatment of diabetic retinopathy are:

  1. Blurred vision
  2. Eye irritation 
  3. Discomfort
  4. Increased sensitivity to light
  5. Reduced night or peripheral vision
  6. Bleeding into the eye
  7. Objects floating in the vision (floaters)
  8. Small, permanent, blind spot near the center of the vision
  9. Dry or watery, itchy eyes
  10. Headaches
  11. Increased eye pressure
  12. Cataracts
  13. Retinal detachment
  14. Eye infection
  15. Fluid buildup in the cornea (the outer layer at the front of the eye)

 

  • Most patients go home on the same day after treatment. In case of eye surgery, the patient may go home on the same day or the next day after surgery.
  • You may need to wear an eye patch for the first few days following eye surgery.
  • It is normal to have blurred vision for a few days after surgery, which will gradually disappear. It may however take several months before the vision completely returns to normal.
  • Follow your doctor’s instructions on which activities to avoid during the recovery period.
  • Have regular follow-up appointments with your doctor and go for regular eye check-ups after treatment.

Home remedies:

Some of the following home remedies can be useful in treating diabetic retinopathy:

  1. Take amla juice daily in the morning on an empty stomach.
  2. Bottle gourd juice can be consumed daily in the morning on an empty stomach.
  3. Apply sandalwood paste on closed eyelids to get relief from pain and inflammation.
  4. Fenugreek seeds have medicinal qualities and can be effective in treating diabetic retinopathy.

Prevention:

The risk of developing diabetic retinopathy can be reduced in the following ways:

  1. Manage your blood sugar levels
  2. Monitor your sugar levels many times a day
  3. Take the glycosylated hemoglobin test (HbA1C) test and try to maintain the three-month average of A1C under 7%
  4. Keep your cholesterol and blood pressure levels under control
  5. Quit smoking
  6. Contact your ophthalmologist immediately if your vision changes or becomes hazy or blurred

Cost of Diabetic Retinopathy in India- 

The cost of diabetic retinopathy treatment in Mumbai is between INR 25,000 to INR 90,000.
The cost of diabetic retinopathy treatment in Delhi is between INR 23,000 to INR 85,000.
The cost of diabetic retinopathy treatment in Bangalore is between INR 23,000 to INR 85,000.
The cost of diabetic retinopathy treatment in Chennai is between INR 22,000 to INR 80,00

 

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Diabetic Retinopathy

Diabetic retinopathy can develop in any patient having type 1 or type 2 diabetes.
The condition may lead to no symptoms or mild symptoms in the initial stages. But, if left untreated, it may lead to blindness.

Types:

Diabetic retinopathy may be of the following different types:

  1. Nonproliferative diabetes-related retinopathy: This is the early stage of diabetic retinopathy. In this stage, the patient has blood vessels that leak in the retina. This leads to the development of fluid, blood, or lipid (fat) in the retina. These blood vessels will close eventually leading to ischemia (poor flow of blood).
  2. Proliferative diabetes-related retinopathy: When diabetic retinopathy progresses further, the abnormal blood vessels start growing in response to the ischemia. These abnormal blood vessels may leak blood into the gel-like substance, known as the vitreous, that fills the eye and causes tractional changes to the retina surface, leading to its detachment, and resulting in severe loss of vision in the later stages.

Causes:

  1. Too much sugar in the blood can cause the blockage of the tiny blood vessels of the eye that nourish the retina.
  2. The damaged blood vessels lead to ischemia (poor blood flow), inflammation, and ultimately blindness, if not treated.
  3. The loss of blood will cause the eye to grow new blood vessels.
  4. These blood vessels usually do not develop properly and may leak easily and may lead to scar formation that may lead to loss of vision.

 

Symptoms

Risk factors:
The following may have an increased risk of developing diabetic retinopathy:

  1. Long-term diabetes
  2. Poorly controlled blood sugar levels
  3. High cholesterol
  4. High blood pressure
  5. Pregnancy
  6. Use of tobacco
  7. Black, Native American, or Hispanic race

Symptoms:
The symptoms associated with the later stages of diabetic retinopathy include:

  1. Floaters (spots or dark strings that float in the patient’s vision)
  2. Fluctuating vision 
  3. Blurred vision
  4. Empty or dark areas in your vision
  5. Loss of vision

Diagnosis

  1. Visual acuity: This test can gauge how clearly a patient can see.
  2. Intraocular pressure test: This test is done to rule out glaucoma (optic nerve damage due to disorders of the eye).
  3. Eye muscle function test: This test helps the doctor in checking how well a patient can move his or her eyes.
  4. Peripheral vision test: This test is done to check how well a patient can see from the sides of his or her eyes.
  5. Pupil response: This test is done to assess how the pupils react to light.
  6. Comprehensive dilated eye exam: The doctor will put some drops in the eyes to widen or dilate the pupils and allow the doctor to obtain a better view inside the eyes. These drops may lead to blurred vision for a couple of hours. The doctor will look for abnormalities in the inside and outside parts of the eyes.
  7. Fluorescein angiography: Once the eyes are dilated using eye drops, a dye will be injected into a vein in the arm. Certain pictures are taken as the due circulates through the blood vessels of the eyes. These images help in pinpointing the blood vessels that are broken, closed, or leaking.
  8. Optical coherence tomography (OCT): This test helps in obtaining cross-sectional images of the retina to check the thickness of the retina. This test helps in determining how much fluid has leaked into the retinal tissue. Later, this test helps in monitoring how well the treatment is working.

 

Treatment

The type of treatment performed for a patient will depend on many factors like age, medical history, extent of retinal damage, visual acuity, and HbA1C levels of the patient. The early stages of diabetic retinopathy will not need any treatment, but regular eye exams are needed every two to four months.
In the later stages of diabetic retinopathy, the following different types of treatments may be needed:

  1. Injections: Certain medicines, like anti-vascular endothelial growth factor drugs or corticosteroids, may be injected into the eye. These medicines help in slowing down the progression of the disease and improve vision.
  2. Photocoagulation or focal laser treatment: A laser is used to slow or stop blood leakage and fluid leakage in the eye. The leaks from the abnormal blood vessels are treated with laser burns.
  3. Panretinal photocoagulation: Also known as scatter laser treatment, this procedure enables shrinking of abnormal blood vessels and the formation of scars. 
  4. Vitrectomy: This is a form of eye surgery performed if a patient has cloudy vision due to the leakage of the blood vessels. The doctor makes a small incision or cut in the eye to repair the blood vessels and remove the scar tissue.

 

Risks

The complications associated with untreated diabetic retinopathy include:

  1. Vitreous hemorrhage (leakage of blood into the clear, jelly-like substance present in the center of the eye)
  2. Glaucoma (a group of eye disorders that damage the optic nerve)
  3. Retinal detachment (pulling away of the tissue lining the back of the eye from the tissues supporting it)
  4. Macular edema (when the fluid swells the macula, which is present at the center of the vision and is responsible for visual sharpness)
  5. Blindness

The complications associated with the treatment of diabetic retinopathy are:

  1. Blurred vision
  2. Eye irritation 
  3. Discomfort
  4. Increased sensitivity to light
  5. Reduced night or peripheral vision
  6. Bleeding into the eye
  7. Objects floating in the vision (floaters)
  8. Small, permanent, blind spot near the center of the vision
  9. Dry or watery, itchy eyes
  10. Headaches
  11. Increased eye pressure
  12. Cataracts
  13. Retinal detachment
  14. Eye infection
  15. Fluid buildup in the cornea (the outer layer at the front of the eye)

 

After Procedure

  • Most patients go home on the same day after treatment. In case of eye surgery, the patient may go home on the same day or the next day after surgery.
  • You may need to wear an eye patch for the first few days following eye surgery.
  • It is normal to have blurred vision for a few days after surgery, which will gradually disappear. It may however take several months before the vision completely returns to normal.
  • Follow your doctor’s instructions on which activities to avoid during the recovery period.
  • Have regular follow-up appointments with your doctor and go for regular eye check-ups after treatment.

Home remedies:

Some of the following home remedies can be useful in treating diabetic retinopathy:

  1. Take amla juice daily in the morning on an empty stomach.
  2. Bottle gourd juice can be consumed daily in the morning on an empty stomach.
  3. Apply sandalwood paste on closed eyelids to get relief from pain and inflammation.
  4. Fenugreek seeds have medicinal qualities and can be effective in treating diabetic retinopathy.

Prevention:

The risk of developing diabetic retinopathy can be reduced in the following ways:

  1. Manage your blood sugar levels
  2. Monitor your sugar levels many times a day
  3. Take the glycosylated hemoglobin test (HbA1C) test and try to maintain the three-month average of A1C under 7%
  4. Keep your cholesterol and blood pressure levels under control
  5. Quit smoking
  6. Contact your ophthalmologist immediately if your vision changes or becomes hazy or blurred

Cost of Diabetic Retinopathy in India- 

The cost of diabetic retinopathy treatment in Mumbai is between INR 25,000 to INR 90,000.
The cost of diabetic retinopathy treatment in Delhi is between INR 23,000 to INR 85,000.
The cost of diabetic retinopathy treatment in Bangalore is between INR 23,000 to INR 85,000.
The cost of diabetic retinopathy treatment in Chennai is between INR 22,000 to INR 80,00

 

FAQ Section

Q. What is diabetic retinopathy?

A. Diabetic retinopathy is a condition in which there are changes and damage to the blood vessels and tissues of the retina of the eye due to diabetes.

 

Q. How long can it take for diabetic retinopathy to develop?

A. Normally, it will take about five to ten years for diabetic retinopathy to develop. Uncontrolled levels of blood sugar may lead to an early onset of diabetic retinopathy, even if clear symptoms of the condition are not present. It is therefore essential for diabetic patients to manage diabetes and get regular eye check-ups done.

Q. Will all patients having diabetic retinopathy need eye surgery?

A. No, eye surgery, known as vitrectomy, is only recommended in patients whose diabetic retinopathy has advanced to the proliferative stage. Up until this stage, diabetic retinopathy can be managed using anti-growth or steroid injections, as well as laser treatment.

 

Q. What are the symptoms of diabetic retinopathy?

A. Early cases of diabetic retinopathy may show no symptoms. Moderate to severe cases of diabetic retinopathy have symptoms like blurriness, floaters, dark vision areas, and difficulty in perception of colors.

Q. Which doctor will treat diabetic retinopathy?

A. Diabetic retinopathy is treated by an ophthalmologist.

 

Q. Which is the best type of treatment for diabetic retinopathy?

A. Laser treatment is considered to be the best form of diabetic retinopathy treatment if the retina of the eye is not severely damaged.

Q. What is the age at which diabetic retinopathy is most commonly seen?

A. A study shows that patients above 60 years of age are more likely to develop diabetic retinopathy than patients under 60 years of age.

 

Q. What is the cost of diabetic retinopathy treatment in India?

A. The cost of diabetic retinopathy will vary depending on the extent of eye damage present, the health condition of the patient, the type of treatment being performed, and the expertise of the ophthalmologist performing the procedure.
On average, the cost of diabetic retinopathy treatment in India will vary between INR 22,000 to INR 90,000.

Q. Will diabetic retinopathy recur after surgery?

A. Yes, uncontrolled blood sugar levels can lead to the recurrence of diabetic retinopathy even after surgical treatment.

 

Q. What are the different ways in which diabetic retinopathy can be treated?

A. The following different types of treatments may be needed to treat diabetic retinopathy:

  1. Injections: Certain medicines, like anti-vascular endothelial growth factor drugs or corticosteroids, may be injected into the eye. These medicines help in slowing down the progression of the disease and improve vision.
  2. Photocoagulation or focal laser treatment: A laser is used to slow or stop blood leakage and fluid leakage in the eye. The leaks from the abnormal blood vessels are treated with laser burns.
  3. Panretinal photocoagulation: Also known as scatter laser treatment, this procedure enables the shrinking of abnormal blood vessels and the formation of scars. 
  4. Vitrectomy: This is a form of eye surgery performed if a patient has cloudy vision due to the leakage of the blood vessels. The doctor makes a small incision or cut in the eye to repair the blood vessels and remove the scar tissue.

Q. Can diabetic retinopathy surgery be performed on both eyes at the same time?

A. Yes, diabetic retinopathy is usually a bilateral and symmetric condition. The surgery for the treatment of diabetic retinopathy can be performed on both eyes at the same time.

 

Q. How to prevent vision loss due to diabetic retinopathy?

A. Loss of vision due to diabetic retinopathy can be prevented in the following ways:

  1. Take diabetes medications on time
  2. Follow your prescribed diet
  3. Regular checking of your blood sugar levels
  4. Keep blood sugar levels under control
  5. Controlled blood pressure and cholesterol levels
  6. Periodic eye exams
  7. Avoid smoking and alcohol consumption 

Q. Can diabetic retinopathy be reversed on its own?

A. No, diabetic retinopathy cannot reverse on its own. Early detection of the condition can prevent loss of vision.

 

Q. How does diabetic retinopathy affect the daily life of a person?

A. Diabetic retinopathy can lead to difficulty in driving, especially at night, difficulty in reading, decreased visual acuity, and ability to perform daily activities may be associated with diabetic retinopathy.

Q. What are the different types of diabetic retinopathy?

A. The different types of diabetic retinopathy are:

  1. Nonproliferative diabetes-related retinopathy: This is the early stage of diabetic retinopathy, in which the patients have blood vessels that leak in the retina. This stage involves the accumulation of fluid, fat, or blood in the retina. These blood vessels will eventually close causing a poor flow of blood, known as ischemia.
  2. Proliferative diabetes-related retinopathy: When diabetic retinopathy progresses, the abnormal blood vessels will grow in response to ischemia. These abnormal blood vessels will leak blood into the gel-like substance or vitreous that fills the eye and leads to changes to the retina surface of the eye, causing loss of vision in the late stages.