Many perceive diabetes as a severe medical condition that can cause serious impact only on the heart and kidney. But little do they know that such condition can also damage the eyes and may even result in blindness if left untreated. Once diabetes starts to affect the eyes, such condition is known as diabetic retinopathy.

Diabetic retinopathy starts as soon as diabetes damages the blood vessels of the retina, the light-sensitive tissue at the back of the eye. Diabetic patients are also prone to develop cataracts and glaucoma hut the disease’s effect on the retina is the main threat to vision, according to Dr. Ma. Dominga Padilla, president of the Philippine Academy of Ophthalmology. Eyecomplications from diabetes affect both type 1 and type 2 diabetic patients. And most patients develop diabetic changes in the retina after about 20 years of having diabetes. Even women with gestational diabetes are not exempted from suffering diabetic retinopathy.

Generally, there are various stages of diabetic retinopathy.
1. Mild nonproliferative retinopathy – During this earliest stage, microaneurysms occur. Microaneurysm is a tiny swelling that forms on the side of the blood vessels. Once the swelling breaks, the blood leaks into nearby tissues.
2. Moderate nonproliferative retinopathy – As the condition progresses, some blood vessels that nurture the retina is blocked.
3. Severe nonproliferative retinopathy – At this stage more blood vessels are obstructed, which prevents blood supply to some areas of the retina. Such areas of the retina send signals to the body to grow new blood vessels for nourishment.
4. Proliferative retinopathy – During this stage the signal sent by the retina for nourishment stimulates the growth of new blood vessels.These blood vessels are not the normal blood vessels that are sturdy. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye.

Macular edema can occur at any stage of diabetic retinopathy. However, there is a greater chance to develop this condition as the disease progresses.

Initial Signs
Patients may not be aware that they are already experiencing the warning signs of diabetic retinopathy. But the common symptoms that may manifest among patients includes ‘cobwebs’ or tiny specks floating into the vision, dark streaks or red film that blocks the vision, a dark or empty spot in the center of the vision, poor night vision and difficulty to adjust in both dim and bright lights.

And once the bleeding occurs during the advanced stage of diabetic retinopathy, patients can experience few spots floating into their vision. There are times that even patients’ vision may become clearer even without any treatment. “But, as soon as the bleeding starts, then that can cause severe loss of vision or eventually blindness,” says Dr. Padilla.

Detection and diagnosis
Since the early and most treatable stages of diabetic retinopathy can damage a patient’s eyes with no visual symptoms or pain, early detection is crucial in preventing total vision loss. Dr. Padilla recommends that diabetic patients need to see an ophthalmologist regularly for a thorough examination. “Once the initial signs of diabetic retinopathy have been detected, we usually tell the patients to consult every six months, and also depending on the gravity of diabetic retinopathy they have to see their doctor more often.”

To identify the leaking blood vessel, a diagnostic procedure known as fluorescein angiography may be used. Fluorescein angiography is an eye test that uses an orange-colored, fluorescent dye. It provides information about the circulatory system and the condition of the back of the eye.

The optical coherence tomography (OCT) examination is also another effective way. OCT is a noninvasive imaging scan that gives high resolution images of the retina which shows retinathickness and presence of fluid leaks into retinal tissue. It can be useful both as a diagnostic tool and a way to judge the efficacy of the therapy.

Treatment
Dr. Padilla emphasizes that diabetic retinopathy is treatable but not curable. “Although a patient has already undergone a medical procedure, the condition can still recur. It doesn’t mean that the patient is free from diabetic retinopathy. There is always a possibility of rebleeding.”

If the patient is suffering from macular edema, the doctor will rely on pan retinal photocoagulation (PRP) or laser treatment. “The idea of this therapy is to remove the leaks and lessen the edema. When this happens, the vision may improve and the vision can be preserved,” says Dr. Padilla.

With PRP, physicians use laser to destroy the oxygen-deprived retinal tissue outside the patient’s vision. “So when we do the laser treatment, some of the peripheral and night visions are sacrificed,” she explains. Dr. Padilla adds that, “The idea behind such form of treatment is to preserve or block-off the circulation in some areas and concentrate the blood circulation where it is needed the most. It’s like sacrificing the periphery to save the center.”

For diabetic patients who are suffering from vitreous hemorrhage (bleeding in a gel-like substance that fills the eye), vitrectomy (a form of surgery) can be done. With this procedure, the blood and vitreous are carefully removed from the eye and a clear salt solution is replaced. The surgeon may also gently cut the filament of vitreous attached tothe retina. But the main problem with such procedure is that it could lead to retinal detachment or tears.

Dr. Padilla also talks about recent anti-angiogenetic drugs that have been developed. These drugs can be injected inside the eyes to reverse these abnormal new vessels from forming. “These are exciting new medicines that can be offered not just to diabetics, but also to other diseases that involves abnormal blood vessels,” she adds.

On vigilance
Diabetic retinopathy is a condition that requires proper attention not just on the part of the doctors but similarly among patients. “Vigilance is really important,” emphasizes Dr. Padilla. To avoid this dreaded eye complication, she reiterates the importance of healthy living. Patients have to eat the right food, control blood pressure, monitor cholesterol and regularly check their blood sugar. Smoking cessation should also be practiced as it affects normal blood flow. Also, consulting both an internist and ophthalmologist regularly will not only ease the treatment by preventing further complications but also lessen the treatment cost.

Despite diabetic retinopathy’s alarming nature, it can always be prevented. Empowering patients with the right information may be a simple but an effective way to combat this growing cause of blindness.

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