Diabetic Retinopathy

People with diabetes are at risk of damage to their eyesight. The retina (sensitive layer in the back of the eye) needs a constant blood supply to work properly. It has a network of tiny blood vessels. When control of blood sugar or insulin levels in the body is poor, the small blood vessels of the retina become damaged. This condition is called “Diabetic Retinopathy”.

Diabetic retinopathy often builds up over a period of many years, which may vary from one person to another depending on the severity of diabetes, level of blood sugar control, and other contributing risk factors such as high blood pressure or cholesterol levels.

Diabetic retinopathy is a leading cause of blindness in the world. Therefore, early screening and prompt treatment are often recommended.

There are two main sight-threatening complications of diabetic retinopathy called diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR).

Regular eye checks are essential for all diabetics, so signs of diabetic retinopathy can be detected as early as possible. The treatment is more effective in stabilizing the condition if performed early and promptly.

Another important consideration is the optimal control of blood sugar levels and other risk factors, such as high blood pressure and cholesterol levels, as diabetic retinopathy often accumulates over time.

If you have diabetes and experience any level of vision loss, you should visit a retina specialist immediately for an eye examination. This examination often involves:

You may also need a further examination called “fluorescein angiography”. In this test, a dye is injected into a vein in your arm, and pictures are taken as the dye passes through the blood vessels of the eye. This test would allow the retina specialist to identify the leaking blood vessels in the eye and plan your treatment.

In diabetic macular oedema, the damaged blood vessels may leak fluids into the retina that may accumulate into the macula (the central and most sensitive part of the retina). This leads to swelling of the tissues of the retina and blurring of central vision as in reading or driving.

Diabetic macular oedema is diagnosed by clinical examination and retinal scans called Optical coherence tomography (OCT).

Treatment of diabetic macular oedema have evolved over the past few years. The main lines of treatment are:

This involves placing tiny laser treatment to the area of leaking blood vessels. This may help to slow the leakage into the retina and reduce the fluid in the macula. The response to laser varies from one to another depending on the severity of damage to the blood vessels. Laser treatment is often performed if the leaking is away from the central part of the vision.

This involves the injection of medications inside the eye, a procedure called Intra-vitreal injection. This treatment is often performed if the leakage is involving the central part of the vision. Injection into the eye is a quick a very safe procedure.

Mr Ellabban will discuss the treatment options with you and advise you on the best option that can work for your condition.

Proliferative diabetic retinopathy is an advanced stage of diabetic eye disease. When the blood vessels of the retina are severely damaged as a consequence of diabetes, the retina is starved of blood. In response, abnormal blood vessels grow on the surface of the retina. These abnormal blood vessels are fragile and can easily bleed into the back of the eye causing a condition called “vitreous haemorrhage.”.
They can also cause scarring and proliferation of the tissues, leading to a condition called “Tractional retinal detachment.”

Proliferative diabetic retinopathy is mainly treated with a laser treatment called panretinal photocoagulation. Some advanced cases of proliferative diabetic retinopathy will need vitrectomy surgery or a combination of both.

At the same time, it is important to achieve optimal control of your blood sugar, blood pressure, and cholesterol levels.

This laser treatment is called pan-retinal photocoagulation (PRP). In this treatment, the laser is applied across the peripheral retina. The laser is performed in 2-3 sessions, depending on the condition of the eye. The goal of laser therapy is to cause the abnormal blood vessels to shrink and disappear. This would help to prevent severe vision loss. Laser therapy does not improve your vision, but it can prevent long-term complications from diabetes.

If proliferative diabetic retinopathy is left untreated, the eye may develop further sight-threatening complications as vitreous haemorrhage or tractional retinal detachment that will require surgery.

Laser is performed in the eye outpatient clinic using the eye examination machine, connected to laser system. Initially, dilating drops are applied followed by some numbing drops. The retina specialist will put a contact lens on your eyes to stabilize the eye to do the laser. The laser session often takes about 10 minutes.

Mr Ellabban will discuss with you in details the laser procedure, possible benefits vs risks and the care after the laser.

Vitreous haemorrhage is a bleed in the vitreous (gel in the back of the eye). In advanced diabetes, abnormal blood vessels build up on the surface of the retina called “neovascularization”. These abnormal blood vessels are fragile and can easily bleed into the gel cavity of the eye.

If the bleed is small, the retina specialist may consider initial observation for a few weeks. However, the retina specialist may consider vitrectomy surgery if:

The surgery to remove the bleed from the back of the eye is called “Vitrectomy”. This involves removing the gel inside the eye using very small instruments. This is usually combined with trimming any scar tissue in the back of the eye, a step called “Delamination” and treating the peripheral retina with laser treatment.

Vitrectomy surgery is performed with the aid of local anaesthetic (small injection of anaesthetic solution around the eye) as day surgery. Your eye will be numbed and you will not feel any pain, although you may feel some pressure sensation during the surgery.

Mr Ellabban will discuss with you the procedure in details and will be able to advised you about the surgery, potential benefits and possible risks.

In advanced stages of diabetes, the retinal proliferations can cause scar tissue, which can grow on the surface of the retina and pull it away from the layer underneath. This pulling force will lead to the separation of the retina from the layer underneath, or “retinal detachment.”

Tractional retinal detachment is the most advanced form of diabetic retinal disease.

In the early stages of tractional retinal detachment, the proliferations can be stopped by prompt laser treatment. However, if the proliferations are large or have involved the central part of vision, surgery is indicated.

The surgery is called “vitrectomy” which involves removing the gel inside the eye using very small instruments and careful microscopic dissection of the fibrous scar tissue from the surface of the retina. The laser is often performed simultaneously at the end of the surgery to reduce the risk of the vessels recurring.

Every diabetic tractional retinal detachment is different, and a surgical plan is tailored to every case. The specific risks and benefits of the procedure will be discussed with each patient on an individualized basis.