Diabetic Retinopathy Treatment and Surgery

What is Diabetic Retinopathy ?

Retina is the inner most layer of the eye that is sensitive to light. Diabetes affects the small vessels of the retina in the eye.

Stages of Diabetic retinopathy :

  • Non-proliferative or background diabetic retinopathy : When blood vessels in the retina are damaged, they can leak fluid or bleed. This causes the retina to swell and form deposits called exudates. This is an early form of diabetic retinopathy and may not lead to any decrease in vision, but it can lead to other more serious forms of retinopathy that affect the vision.
  • Macular edema : The fluid and exudates collects in the macula (the part of the retina that us to see fine details), thus decreasing the vision. Sometimes there may be a macular edema without any loss of vision. Therefore it is important to have periodic checkup to detect and treat these conditions at an early stage with the help of vast expertise of oureye specialist in Pune.
  • Proliferative diabetic retinopathy : This is an advanced stage of diabetic retinopathy, where the blood supply of vessels grows on the surface of the retina (neovascularization). These new vessels are very fragile and bleed easily. These may lead to serious vision problems if they bleed into the vitreous (the clear, jelly-like substance that fills the center of the eye) which is known as vitreous hemorrhage. This prevents the light from reaching the retina and thus can blur the vision. The new blood vessels and the bleed into the vitreous can also cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and can lead to blindness if untreated.

The longer the person has diabetes, the greater are his/her chances to develop diabetic retinopathy. Almost 80% of people, who have diabetes for 15 years or more, have some damage to the blood vessels in their retina. The other risk factors are high blood pressure, anemia, kidney diseases, and pregnancy.

There is no treatment that can prevent diabetic retinopathy altogether. Persons with any form of diabetes may develop diabetic retinopathy. But it has been proven that a good control of diabetes can delay and slow down the rate of progress of diabetic retinopathy and its complications. Besides a good control of blood sugar, one must exercise regularly, keep the blood pressure under control, avoid smoking, and avoid obesity.

You might not know that you are having diabetic retinopathy, as there are no symptoms in the earlier stages of the disease. Therefore it is essential to have periodic evaluation of your eye by our retina specialist in Pune to detect the condition early. Early diagnosis and timely treatment is very essential in preventing the complications of this disease and thus maintaining vision.

How frequently should I get my eye examined?

If you have diabetes, you should get a yearly examination with your ophthalmologist. Your pupils may be dilated with eye drops, so that your ophthalmologist may have a good look at the back of your eye. Once you develop diabetic retinopathy, then your ophthalmologist will advise you if you need some investigations, treatment or just need to follow up. In these cases the frequency of follow up visits is decided on basis of the severity of the disease.

What are the tests done for diabetic retinopathy?

Your vision is assessed by the usual charts. The back of your eye is examined after dilating your pupils, using an instrument called ophthalmoscope. Sometimes your ophthalmologist may advise a special test called Fluorescein angiography.

What is fluorescein angiography?

It is test in which a series of photographs of the retina are taken with the help of a special camera. These photographs are taken after giving the patient an injection of a yellow dye. This dye reaches the retina through the blood stream and helps in seeing the blood vessels of retina more clearly. This test helps the doctor to determine which areas to be treated with laser.

The treatment of diabetic retinopathy is decided on the basis of the stage of the disease. In the very initial stages, it just requires periodic follow up to look for progression of disease. Our diabetic retinopathy surgeon in Pune decides when to see a patient next depending upon the severity of changes in the retina.

Later when the disease is more advanced he/she may decide to treat it with one or more of the following options:

  • Laser Treatment

    There are well-defined criteria for laser therapy. Laser therapy is done there is significant maculopathy, or when there are significant new blood vessels in the retina or iris.

  • Anti-VEGF agents (Lucentis, Avastin, Macugen)

    These agents are being used in selective cases alone or in addition to laser treatment or surgery.

  • Surgery

    Vitrectomy surgery and other additional procedures may be required to manage complications of diabetic retinopathy, like vitreous hemorrhage, retinal detachment, severe macular edema, etc.

At MSEH, a variety of IOLs are available. The selection of IOL depends on the status of the cataract, patient’s needs, doctor’s recommendation, and insurance packages. Details of these factors along with diabetic retinopathy cost in Pune at our clinic can be seen on the website and also counselors provide the patient with complete information prior to cataract surgery.

Laser treatment is performed as an outpatient procedure that is you don't have to be admitted for it. The pupil of the eye is dilated using eye drops. The eye is then numbed with drops (topical anesthetics) so that you don't feel the pain. The patient is seated on a machine and a small contact lens is placed on the cornea. Following this laser treatment is given by this very precise machine. During the treatment, you may be asked to move your eyes in certain directions.

The laser treatment may have a few side effects like decrease in the peripheral field of vision, decrease in color vision and difficulty in seeing at night. Sometimes it may also reduce the central vision. This is usually temporary but sometimes this may not improve. Though no treatment is without any side effects, the risks of the laser treatment are far less than the risk of not having the treatment.

These agents (Lucentis, Avastin, Macugen) are emerging as the new modality of diabetic retinopathy treatment in Pune for various stages of diabetic retinopathy and are showing very promising results. These agents are injected within the eye (intravitreal injection) in a very small painless procedure, inside the OT under aseptic precautions.

Most of the complications of diabetic retinopathy that cause vision loss are preventable, provided they are detected early and treated. As you may not realize any problem in your vision initially, it is important that you have periodic checkups with an ophthalmologist.

No. The eye checkups do not prevent diabetic retinopathy, but recognize it at an early stage. This helps in preventing the vision threatening complications of diabetic retinopathy.

No. The aim of laser therapy is to preserve the vision and to prevent further loss of vision. It may not restore your vision once it is decreased.

Yes. The fluctuations in the blood glucose level in diabetes may lead to changes in the shape of the lens of eye. This changes the refractive power of the eye and manifests as frequently changing prescription of glasses.

The following symptoms would require you to contact your ophthalmologist early, even before your next scheduled appointment:

  • Decrease in vision
  • Sudden onset of red floaters noticed in front of eye
  • Loss of a field of vision

Do not bend down or do any strenuous activity. Contact our diabetic retinopathy surgeon in Pune at the earliest.

Yes. The diabetic retinopathy may worsen during pregnancy. Therefore, if you are a diabetic, contact your ophthalmologist before planning your pregnancy. After doing a check up, he or she may advise you to undergo diabetic retinopathy treatment In Pune before commencing pregnancy. Moreover, during pregnancy, you must visit your ophthalmologist regularly to detect any worsening of the disease.

Yes. Diabetes may sometimes lead to sudden development of cataract in young. Moreover the onset of usual cataract is earlier in diabetics than in non-diabetics.

Yes. Diabetics are a higher risk of having glaucoma.

Presence of diabetic retinopathy suggests that other complications of diabetes in the body must also be taking place. These complications affect the kidney, heart, brain, peripheral nerves and blood vessels. Your physician treating you for diabetes would do the necessary checkups and advise you regarding the essentiality of diabetic retinopathy surgery in Pune at our clinic.

One of the most important aspects in the management of diabetic retinopathy is patient education. Inform patients that they play an integral role in their own eye care.

Excellent glucose control is beneficial in any stage of diabetic retinopathy. It delays the onset and slows down the progression of the diabetic complications in the eye.

The following symptoms and/or health concerns must be addressed in any patient education program for those with diabetic retinopathy:

  • Systemic problems (eg, hypertension, renal disease, and hyperlipidemia) may contribute to disease progression.
  • Smoking, although not directly proven to affect the course of the retinopathy, may further compromise oxygen delivery to the retina. Therefore, all efforts should be made in the reduction, if not outright cessation, of smoking.
  • • Visual symptoms (eg, vision changes, floaters, distortion, redness, pain) could be manifestations of disease progression and should be reported immediately.

Diabetes mellitus, in general, and diabetic retinopathy, in particular, are progressive conditions, and regular follow-up care with a physician is crucial for detection of any changes that may benefit from treatment. You can always schedule an appointment with our eye specialist and know all the information including the diabetic retinopathy cost in Pune at our clinic and pave way for good vision.

Treatment Cost

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