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Diabetic Retinopathy:

Who gets diabetic retinopathy?

The longer you have diabetes the greater the chance of developing diabetic retinopathy. 80% of patients with diabetes longer than 15 years have some signs of retinopathy. There is nothing you can do to completely avoid problems but good control of your diabetes is essential, with a healthy diet and regular exercise.

How does diabetes affect the eye?

In diabetes mellitus blood sugar levels are poorly controlled and can become too high. This can damage the small blood vessels at the back of the eye (in the light sensitive layer called the retina), leading to bleeding and leakage into the retina which may obscure vision. Early changes in the retina are known as background diabetic retinopathy and no treatment is indicated. However, if the central area of the retina (the macula) becomes swollen, vision is reduced due to diabetic maculopathy. Laser treatment is required to reduce the leakage to improve vision and prevent deterioration. In some patients tiny new blood vessels grow on the surface of the retina, known as proliferative diabetic retinopathy. These blood vessels can bleed into the vitreous jelly that fills the back of the eye (vitreous haemorrhage), leading to severe loss of vision.

Can diabetic retinopathy be treated?

Yes. Fortunately in most diabetics treatment is not necessary. However in some patients treatment may be required to prevent loss of vision.

INTRAVITREAL INJECTIONS

Recently it has been shown that patients with maculopathy (leakage in the central retina) may be best treated with a series of intravitreal anti-VEGF injections (Lucentis). Intravitreal Lucentis therapy has received NICE approval for use in diabetics with maculopathy (macular oedema greater than 400 microns) in the UK. This can be supplemented with laser.

LASER TREATMENT

The mainstay of treatment in diabetic eye disease has been laser (or photocoagulation) for many years. A precise beam of laser is directed at the back of the eye to seal leaking blood vessels in diabetic maculopathy. In proliferative retinopathy laser burns are scattered over parts of the retina to reduce the production of new vessels and reduce the risk of bleeding.

SURGERY

Vitreous haemorrhage is the major indication for surgery: the blood-filled vitreous jelly is removed (vitrectomy) and replaced with a clear fluid so that vision is improved. Often further retinal laser treatment is performed at the same time. There are other indications for vitrectomy surgery in diabetic eye disease:

Recurrent vitreous haemorrhage. Sometimes vitreous haemorrhage clears only to rebleed repeatedly due to tiny areas of traction on abnormal new blood vessels on the retina. Vitrectomy stabilises the situation by removing sites of traction and preventing further bleeds.

Tractional retinal detachment. Contraction of the abnormal blood vessels and associated tissue may produce retinal detachment. To stabilise the situation vitrectomy be required.

How do I know if I diabetic retinopathy?

You may not. The early changes of diabetic retinopathy may not be noticed by the patient as the vision is not affected. However your doctor or optometrist may be able to see early signs of diabetic retinopathy by examining the retina. Drops to dilate (widen) your pupils are used as this aids the examination of the back of the eye.

If you do need to have dilating drops your eyes will be very light sensitive for a few hours afterwards: it is best to get someone to drive you home.

Sometimes special photographs are taken of the retina (fluorescein angiography) to help your eye specialist decide if treatment is required.

Regular eye checks for diabetics are available at local optometrists who should be a part of your local community diabetic screening programme. Make sure that you have regular eye checks, at least once a year, either with your trained optometrist, or your eye specialist.

If your optometrist spots a problem he will refer you to an eye specialist for further examination.

Stephen Charles has over 20 years experience of treating patients with diabetic eye disease. As a vitreoretinal specialist he has expertise in both the laser treatment of diabetic retinopathy and the surgical treatment of more severe disease by vitrectomy, together with intravitreal injection therapy.

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REMEMBER: THE EARLY DETECTION OF DIABETIC RETINOPATHY CAN PREVENT LOSS OF VISION. HAVE A REGULAR EYE CHECK

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