Diabetic Retinopathy in India

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What is Retinopathy?

Retinopathy refers to the enduring harm inflicted on the retina. Patients may remain unaware of the gradual development of inflammation leading to this condition. In advanced retinopathy, blood vessels in the retina weaken, causing leaks and vision-blocking clots. Laser treatment proves effective in sealing these leaky blood vessels, addressing the condition. Diagnosis is carried out by an ophthalmologist through a comprehensive examination of the eye.

What is Diabetic Retinopathy?

Diabetic retinopathy occurs in individuals with diabetes, leading to gradual damage to the retina. This condition stems from the harm inflicted upon the small blood vessels that nourish the retina. The leakage of blood and fluids from these vessels results in vision clouding and swelling of the retinal tissue. Both eyes can be impacted, particularly in individuals with long-standing diabetes. Diabetic retinopathy is considered a significant and sight-threatening condition.

Symptoms of Diabetic Retinopathy

  • Difficulty in seeing well at night.
  • Seeing floaters or spots in a particular field of vision.
  • The problem in seeing or having blurred vision.
  • The empty or dark spot in the center of the vision.
  • Cobwebs, tiny specks, or spiders floating in the vision.

Causes of Diabetic Retinopathy

Diabetic retinopathy is a consequence of prolonged periods of elevated blood glucose levels, eventually causing damage to the small blood vessels in the retina. This damage can lead to swelling and hemorrhaging of the retina over time.

Stages of Diabetic Retinopathy

Diabetic retinopathy is categorized into different stages, including:

Mild Nonproliferative Retinopathy : This is the initial stage, characterized by the presence of microaneurysms—small areas of swelling in the blood vessels of the retina.

Moderate Nonproliferative Retinopathy : As the disease progresses, the blood vessels that nourish the retina become blocked in this stage.

Severe Nonproliferative Retinopathy : This stage involves the blocking of numerous blood vessels, leading to the deprivation of specific areas of the retina from their blood supply. In response, signals are sent by these deprived retina areas to the body, triggering the formation of new blood vessels, which then receive nourishment.

Proliferative Retinopathy : The proliferative stage marks the advanced phase of diabetic retinopathy, where new blood vessels grow in response to signals from the retina seeking nourishment. This is known as proliferative retinopathy. The newly formed blood vessels, however, are fragile and abnormal. They develop along the clear surface of the vitreous gel and throughout the retina, filling the eye. While the blood vessels themselves don't directly cause vision loss or symptoms, their fragility poses risks.

Diagnosis of Diabetic Retinopathy

The diagnosis involves a series of eye examinations, with a focus on evaluating both the macula and retina. Various tests are conducted, including:

  • Measuring the intraocular pressure.
  • The tests include a comprehensive review of the patient's medical history, examining for the presence of diabetes, vision issues, and overall health factors that may impact their vision.
  • Assessment of ocular structures includes the examination of the retina, often performed through dilation of the pupil for a thorough evaluation.
  • Refraction is conducted to assess the need for changes in an eyeglass prescription.
  • Visual acuity measurements are performed to ascertain the degree of damage to central vision.

Classification of Diabetic Retinopathy

  • Proliferative Diabetic Retinopathy (PDR)
  • Non-Proliferative Diabetic Retinopathy (NPDR)

Treatments for Diabetic Retinopathy

The initial three stages of diabetic retinopathy typically do not necessitate treatment. Intervention becomes necessary when an individual develops macular edema. Diabetic individuals should proactively manage their blood sugar levels, blood pressure, and cholesterol levels to prevent the advancement of diabetic retinopathy.

Laser surgery, specifically scatter laser treatment, is employed to address proliferative retinopathy in diabetic patients. This procedure aims to shrink abnormal blood vessels by administering 1000 to 2000 laser burns across specific areas of the retina, strategically placed away from the macula. The entire process usually spans 2-3 sessions due to the substantial number of laser burns required. Scatter laser treatment is recommended before the onset of bleeding from new blood vessels, underscoring the importance of a dilated eye exam. In certain cases, scatter laser treatment may still be considered even if bleeding has commenced, contingent on the extent of the bleeding. In instances of severe bleeding, vitrectomy, a surgical procedure, may be recommended.

Cost of Diabetic Retinopathy

Diabetic retinopathy treatment is highly affordable in India, where medical facilities integrate cutting-edge technologies. The cost of treatment is influenced by factors such as the type of diabetic retinopathy and the severity of the condition. Additionally, the previous response of the retinopathy to treatments can play a role in determining the overall cost.

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