DIABETIC RETINOPATHY

Q.What is diabetic retinopathy ?

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people
who have diabetes. It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of your eye).

Q.What are the symptoms of Diabetic retinopathy ?

You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, you might develop:
> Spots or dark strings floating in your vision (floaters)
> Blurred vision
> Fluctuating vision
> Dark or empty areas in your vision
> Vision loss

Q.When to see eye doctor, If I have diabetis ?

Careful management of your diabetes is the best way to prevent vision loss. If you have
diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision
seems fine. Developing diabetes when pregnant (gestational diabetes) or having diabetes before
becoming pregnant can increase your risk of diabetic retinopathy. If you're pregnant, your
eye doctor might recommend additional eye exams throughout your pregnancy.
Contact your eye doctor right away if your vision changes suddenly or becomes blurry,
spotty or hazy

Q.What are the different stages/types of Diabetic retinopathy ?

Early diabetic retinopathy:  In this more common form — called Nonproliferative diabetic retinopathy (NPDR) — new blood vessels are no;t growing (proliferating). When you have nonproliferative diabetic retinopathy (NPDR), the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter as well. NPDR can progress from mild to severe as more blood vessels become blocked.

Diabetic macular edema: Sometimes retinal blood vessel damage leads to a buildup of fluid (edema) in the center portion (macula) of the retina. If macular edema decreases vision, treatment is required to prevent permanent vision loss.

Advanced diabetic retinopathy:

Diabetic retinopathy can progress to this more severe type, known as proliferative diabeticretinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels are fragile and can leak into
the clear, jellylike substance that fills the center of your eye (vitreous).
Eventually, scar tissue from the growth of new blood vessels can cause the retina to detach
from the back of your eye. If the new blood vessels interfere with the normal flow of fluid
out of the eye, pressure can build in the eyeball. This buildup can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma.

Q.What are the risk factors for diabetic retinopathy ?

Anyone who has diabetes can develop diabetic retinopathy. The risk of developing the eye
condition can increase as a result of:
> Having diabetes for a long time
> Poor control of your blood sugar level
> High blood pressure
> High cholesterol
> Pregnancy
> Tobacco use

Q. How can you prevent Diabetic retinopathy ?

You can not always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help
prevent severe vision loss. If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:
> Manage your diabetes. Make healthy eating and physical activity part of your daily routine.
Try to get at least 150 minutes of moderate aerobic activity, such as walking, each week.
Take oral diabetes medications or insulin as directed.

> Monitor your blood sugar level. You might need to check and record your blood sugar level several times a day — or more frequently if you're ill or under stress. Ask your doctor how often you need to test your blood sugar.

> Ask your doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test,
or hemoglobin A1C test, reflects your average blood sugar level for the two- to three-month
period before the test. For most people with diabetes, the A1C goal is to be under 7%.

> Keep your blood pressure and cholesterol under control. Eating healthy foods, exercising
regularly and losing excess weight can help. Sometimes medication is needed, too.

> If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking
increases your risk of various diabetes complications, including diabetic retinopathy.

> Pay attention to vision changes. Contact your eye doctor right away if your vision suddenly
changes or becomes blurry, spotty or hazy.

Remember, diabetes doesn’t necessarily lead to vision loss. Taking an active role in diabetes
management can go a long way toward preventing complications.

Q.What are the complications of Diabetic retinopathy ?

Diabetic retinopathy involves the growth of abnormal blood vessels in the retina.Complications can lead to serious vision problems:
> Vitreous hemorrhage. The new blood vessels may bleed into the clear, jellylike substance
that fills the center of your eye. If the amount of bleeding is small, you might see only a few
dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely
block your vision.
Vitreous hemorrhage by itself usually doesn’t cause permanent vision loss. The blood often
clears from the eye within a few weeks or months. Unless your retina is damaged, your vision will likely return to its previous clarity.

> Retinal detachment. The abnormal blood vessels associated with diabetic retinopathy
stimulate the growth of scar tissue, which can pull the retina away from the back of the eye.
This can cause spots floating in your vision, flashes of light or severe vision loss.

> Glaucoma. New blood vessels can grow in the front part of your eye (iris) and interfere with
the normal flow of fluid out of the eye, causing pressure in the eye to build. This pressure
can damage the nerve that carries images from your eye to your brain (optic nerve).

> Blindness. Diabetic retinopathy, macular edema, glaucoma or a combination of these
conditions can lead to complete vision loss, especially if the conditions are poorly managed.

Q.How is diabetic retinopathy treated ?

In the early stages of diabetic retinopathy, your eye doctor will probably just keep track of
how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.  
In later stages, it’s important to start treatment right away — especially if you have changes
in your vision. While it won’t undo any damage to your vision, treatment can stop your
vision from getting worse. It’s also important to take steps to control your diabetes, blood
pressure, and cholesterol.

1.Injections

1. When you get injections in your eye, your eye doctor will:
2. Put numbing medicine on your eye to make you more comfortable during the injection.
3. Clean your eye to help prevent infections.
4. Put the medicine in your eye with a very small needle and a syringe Injections don’t change your vision right away. Most people can go back to their normal activities right after the treatment. You may have short-term side effects, but they should clear up in a day or 2. 

You may Feel 

> Irritation in your eye caused by the antiseptic used to clean it

>See floating air bubbles — which look similar to floaters

> Contact your eye doctor right away if you have pain or vision problems that are getting worse after an injection. These could be signs of infection.

Anti-VEGF drugs

In certain eye diseases, the body makes too much of a protein called vascular endothelial
growth factor (VEGF), which can cause blood vessels to leak, leading to swelling in the retina (the light-sensitive layer of tissue at the back of the eye). Too much VEGF can also cause blood vessels to grow abnormally, which could damage the eye. Anti-VEGF drugs block VEGF and can improve vision. Your eye doctor may prescribe anti-VEGF injections if you have:
> Diabetic retinopathy
> Macular edema from various retinovascular diseases, including diabetic macular edema (DME) or vein occlusion, such as CRVO.
> Ocular histoplasmosis syndrome (OHS)
> A type of age-related macular degeneration (AMD) called neovascular or “wet” AMDMedicines called anti-VEGF drugs block this protein and help improve vision. Common anti-VEGF drugs include:
> Avastin (bevacizumab)
> Lucentis (ranibizumab)
> Eylea (aflibercept)
> Beovu (brolucizumab)

>Vabysmo (faricimab)

Most people who get anti-VEGF injections will need injections once a month at first. Overtime, you may need injections less often. Some people can eventually stop getting the injections, but others need to keep getting injections to protect their vision.

Steroids

If you have macular edema, DME, uveitis, or another eye disease that causes swelling in the retina or inflammation in the eye, your doctor may suggest a medicine called a steroid as a treatment. Steroids can help reduce swelling and inflammation. Common steroid injections include:
> Triesence (triamcinolone acetonide)
> Kenalog (triamcinolone acetonide)

Other ways to take steroids for eye conditions
People often take steroids as injections or eye drops — or your doctor can put a special device called an implant in your eye. The implant gives you constant small doses of the medicine over time. If you get the implant, you may be able to stop getting monthly steroid injections.

Common steroid implants include:
> Ozurdex (dexamethasone) for short-term use Steroids can increase your risk for cataracts and glaucoma. If you take steroids to treat an eye disease or another health condition, it’s important to get regular eye exams to check for signs of these problems.

Laser treatment

Laser surgery might be used to help seal off leaking blood vessels. This can reduce swelling
of the retina. Laser surgery can also help shrink blood vessels and prevent them from
growing again. Sometimes more than one treatment is needed.

What can I expect from laser treatment?

You can get this laser treatment at your eye doctor’s office. Your eye doctor will: 
> Put numbing medicine in your eye 
> Aim a laser into your eye using a special lens 

During the treatment, you may see flashes of light and your eye may sting or feel uncomfortable. Your vision will be blurry for the rest of the day, so you’ll need someone to drive you home. You may need more than 1 session of scatter laser surgery. 

Is laser treatment right for me?

Like any surgery, this treatment has risks. It can cause loss of peripheral (side) vision, color vision, and night vision. But for many people, the benefits of this treatment outweigh the risks. 

Talk with your doctor to decide if scatter laser surgery is right for you.

Vitrectomy

If you have advanced PDR, your ophthalmologist may recommend surgery called vitrectomy.
Your ophthalmologist removes vitreous gel and blood from leaking vessels in the back of
your eye. This allows light rays to focus properly on the retina again. Scar tissue also might
be removed from the retina.

What eye conditions does vitrectomy treat?

Vitrectomy can help doctors treat several different eye conditions. For example, vitrectomy
may be part of the treatment plan for:
> Retinal detachment, by helping your doctor repair any holes or tears in the retina.
> Diabetic retinopathy, by replacing cloudy vitreous and helping your doctor find and
repair sources of bleeding in the retina.

Like any surgery, this treatment has risks. Talk with your doctor about the risks and benefits
of vitrectomy.

What happens during vitrectomy?

During vitrectomy surgery, your eye doctor will make very small openings in your eye wall
and remove most of the vitreous from your eye with a suction tool.
Depending on your treatment plan, your doctor may also:
> Use a laser or freeze treatment to reattach or repair your retina
> Inject a bubble of air, other gas, or silicone oil into your eye to hold your retina in place
Doctors can either use numbing eye drops or shots so you won’t feel pain during the
surgery, or they can use general anesthesia to put you to sleep for the surgery. Before your
vitrectomy surgery, talk with your doctor about your anesthesia options. If you need vitrectomy in both eyes, you’ll only get surgery on 1 eye at a time. Your doctor can schedule surgery on the second eye after the first eye has recovered.

How long does it take to recover?

Most people go home the same day of surgery. You’ll need someone to drive you home
from the hospital. Your eye may be swollen and red for several weeks after the surgery. While your eye is healing, you may have some eye pain and your vision may be blurrier than before the
surgery. You’ll have follow-up appointments so your eye doctor can check your vision and
make sure your eye is healing.

After the surgery, you’ll need to:
> Wear an eye patch, usually for about a day
> Use eye drops to reduce swelling and prevent infections
> Avoid some activities — like driving, intense exercise, and heavy lifting — while your eye heals
> Take some time off work — usually 2 to 4 weeks

Ask your doctor when it’s safe to go back to work and start driving and exercising again.

If the doctor puts a gas bubble in your eye, you’ll need to:
> Hold your head in a certain position for a few days to a few weeks, to keep the gas bubble in the right spot.
> Avoid flying in an airplane or traveling to high altitudes while the bubble is in your eye.
Ask your doctor how long you need to keep doing these things after surgery.
Eventually, your eye will make new fluid to replace the vitreous that was removed during the surgery. If the doctor put silicone oil in your eye during your surgery, you may need a second surgery to remove the oil.