Diabetic Retinopathy

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What is Diabetes?

Estimates suggest that nearly one person in twenty-five in the UK is affected by diabetes mellitus, a condition which means that, due to a lack of insulin, the body cannot cope normally with sugar and other carbohydrates in the diet.

Diabetes can start in childhood, but more often begins in later life. It can cause complications which affect different parts of the body, the eye being one of them. There are two different types of diabetes mellitus:

  • Type 1 diabetes, which can also be referred to as insulin dependent diabetes mellitus (IDDM). This type commonly occurs before the age of 30 and is the result of the body producing little or no insulin. Type 1 is controlled by insulin injections.
  • Type 2 diabetes, which can also be referred to as non-insulin dependent diabetes mellitus (NIDDM). This type commonly occurs after the age of 40. In this type the body does produce some insulin, although the amount is either not sufficient or the body is not able to make proper use of it. This type of diabetes is generally controlled by diet or tablets, although some people in this group will require insulin injections.
The importance of annual eye examinations

If you have diabetes this does not necessarily mean that your sight will be affected, but there is a higher risk. If your diabetes is well controlled then you are less likely to have problems, or they may be less serious. Most sight loss due to diabetes can be prevented, but it is vital that it is diagnosed early.

Diabetic Retinopathy

Diabetes can effect the eye in a number of ways. The most serious eye condition associated with diabetes involves the retina and the blood vessels lying within it. This is known as diabetic retinopathy and it usually develops some time before there are any visual symptoms. Routine checks of the back of the eye (screening) are important, because if diagnosed at this early stage, diabetic retinopathy can generally be treated very effectively. Over the past 15 years laser treatment has been shown to be helpful in either stopping the progress of the disease or in maintaining sight.

Diabetic retinopathy is a complication of diabetes that affects the retina. The retina is the layer at the back of the eye which is sensitive to light and to function properly, light must be able to pass through the eye uninterrupted to reach the retina. Light passes through the cornea, lens and vitreous (a jelly-like substance in the eye) to reach the retina in the same way that light rays pass through the lens of a camera to reach the film. The focused light or images are then relayed to the brain by the optic nerve. The macula is the area of the retina concerned with central detailed vision especially for reading. Diabetes causes the capillaries (tiny blood vessels in the retina) to become blocked, this may then lead to leakage in the central retina (diabetic maculopathy) or result in the growth of new vessels which may bleed and fill the eye with blood (vitreous haemorrhage). Both conditions are treatable by laser in the early stages but may require surgery.
Good diabetic control can slow down the rate of the progression of complications.

You should:
  • Control your diet 
  • Always take your diabetic treatment
  • Avoid becoming overweight 
  • Avoid smoking completely 
  • Avoid excessive alcohol 
  • Have blood pressure checks and treat any hypertension 
  • Check your cholesterol level and take tablets to reduce it if high 

Improving diabetic control can have an effect on diabetic retinopathy itself, and should be maintained to try to prevent any further deterioration.
Initially by laser photocoagulation. This procedure focuses a laser beam in small bursts onto the damaged retina. 

There are 2 laser techniques
Maculopathy: This requires precise laser treatment around the macula at the centre of the retina to seal the leaking blood vessels.
Proliferative: extensive laser treatment to the starved retina is undertaken. The new vessels then shrink and this reduces the chance of haemorrhage. Treatment is usually performed on an outpatient basis and can be lengthy or may need to be repeated. Laser treatment is designed to maintain vision not improve it.

It is highly effective in most patients. Blindness can be prevented in 80-90% of cases.
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