DIABETIC RETINOPATHY
Diabetes mellitus is one of the leading causes of blindness in developed countries, including Singapore. It is responsible for a spectrum of eye complications, of which the most serious is diabetic retinopathy.
In this condition, the high blood sugar levels in diabetes causes damage to the blood vessels of the retina, the light-sensitive layer of nerve cells at the back of the eye. Damage to these blood vessels results in bleeding and swelling of the retina, which can lead to poor vision.
Types of Diabetic Retinopathy
Non-proliferative Diabetic Retinopathy
In this early stage of diabetic retinopathy, the fine blood vessels in the retina are damaged or blocked, causing leakage of blood and fluid into the retina. There are usually no symptoms at this stage.
Proliferative Diabetic Retinopathy
In this advanced stage of diabetic retinopathy, damage to the existing blood vessels of the retina triggers new blood vessels to grow ("proliferate"). But these new vessels are abnormal and tend to rupture and bleed into the eyeball. Long term and repeated bleeding can lead to scarring and detachment of the retina, and results in blindness.
Diabetic Macular Edema
The macula is the central area of the retina, and is important for fine, detailed vision. Bleeding and fluid leakage from the surrounding blood vessels can result in macula swelling ("edema"). Central vision is gradually lost, resulting in difficulty with tasks like reading and driving.
Symptoms of Diabetic Retinopathy
Diabetic retinopathy may not have any symptoms in the early stages. However, in the advanced stages, it can result in :
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Blurred vision
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Fluctuation in vision throughout the day
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Difficulty reading or seeing details, even with glasses
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Sudden onset of floaters and flashes
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Sudden loss of vision in one or both eyes
Managing Diabetic Retinopathy
Controlling Your Blood Sugar
The first step in preventing diabetic retinopathy is good control of your diabetes. It has been shown that good control of blood sugar levels can prevent the development and progression of diabetic retinopathy. However, the condition may still occur after many years, despite the best of efforts.
Eye Screening
The key to successful management of diabetic retinopathy lies in regular eye screening, and early detection of the changes mentioned above. The goal is to pick up and treat any diabetic retinopathy before it can damage the eye and your vision.
All diabetic patients should have their eyes checked at least once a year, regardless of whether they have any visual symptoms.
Treatment of Diabetic Retinopathy
There is no cure for diabetic retinopathy, but there are surgical and medical treatments available that can preserve your vision.
These include:
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Laser procedures to seal leaky blood vessels, control macular edema and stop the growth of new blood vessels.
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Injection of intraocular anti-VEGF drugs. These injections into the eye can prevent the formation of abnormal blood vessels in the eye, and reduce bleeding and fluid leakage from these vessels. Regular injections may be required to maintain the effect.
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Vitrectomy surgery to repair retinal detachments, or to remove excessive bleeding from the cavity of the eyeball.
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Injection of intraocular steroids, especially for patients who have macular edema not responding to laser treatment