Diabetic Retinopathy

Diabetic Retinopathy is the eye disease which is caused due to uncontrolled/ prolonged Diabetes in an Individual. It is one of the leading cause of preventable blindness amogst working age group population.

With increase in incidence of Diabetes especially in our country, number of individuals suffering from Eye related disease are also increasing.

Most people with diabetic retinopathy should keep most, if not all vision, providing it is diagnosed early and all steps are taken to keep it under control.

Most people consider sight to be the most precious sense thus it is critical to be aware of the risk of diabetic eye disease and to understand how to prevent its onset. For those who already have diabetic eye disease, there are steps to be taken which can prevent further vision loss due to it.

  • It is important to tell your doctor that you are a diabetic and since how long have you had it
  • It is essential for an individual with diabetes to have a comprehensive eye examination done atleast once a year
  • If you already have diabetic retinopathy, your follow up visits will be as per treating doctor advise.
  • The longer you have had diabetes, the more important it is to have regular eye tests, even if the tests have always been clear in the past. This is because the risk of eye disease is strongly related to the duration of diabetes

Diabetes is a complex, serious, chronic metabolic disorder. It has substantial effects on various body organs such as kidneys, nerves, Eyes, Brain, Heart, Limbs etc. These effects are largely because of the damage to blood vessels caused due to diabetes.

A critical aspect about diabetes is that although it cannot be cured but the complications and related health problems can be significantly reduced or prevented in most individuals provided the diabetes is managed well. To manage this, it requires support from a number of different health professionals.

Three main types are:

  • Type I:-Autoimmune, insulin dependent condition
  • Type II:-Acquired condition. Body becomes resistant to the effect of insulin
  • Gestational:-Type of diabetes that occurs during pregnancy

Early Stages

High blood sugar levels in the body leads to vessel damage in the retina. Once these vessels are damaged, they become leaky and start oozing blood and lipids. Until these stages usually no treatment is required and is called as Non-Proliferative Diabetic Retinopathy.

Advanced Stages

Leakage of fluid and blood from these damaged blood vessels and cause retinal swelling. If this swelling occurs in the central part of retina (Diabetic Macular Edema) then vision is affected. The ability to see the detail decreases and can lead to permanent vision impairment if left untreated. With adequate treatment and Diabetes control, edema can be controlled.

Other Blinding stage of the disease is Proliferative Diabetic Retinopathy. During this stage of the disease the blood vessels of the retina are occluded and this gives rise to new and abnormal blood vessel proliferation which can bleed and cause Vitreous hemorrhage or even Retinal Detachment in Later stages. If Proliferative Disease is not treated in early stages it can also lead to blindness.


Uncontrollable Risk Factors:

  • Duration of Diabetes – strongest risk factor
  • Ethnicity – Asians are at an increased risk
  • Genetics – family history of Diabetes and Diabetic Retinopathy are associated
  • Medical history – like polycystic ovarian disease

Controllable Risk Factors:

  • High blood glucose – Target HbA1c should be adhered to.
  • High blood pressure – aggravates macular edema
  • Blood Lipids
  • Weight and Exercise
  • Smoking

Blood gluconse levels –

Strict blood sugar control reduces the long term risk of vision loss due to Diabetic Retinoathy. HbA1c must be regularly checked.

Physical Activity -

Regular physical activity in the form of aerobic exercises and resistance training are an optimal part of good diabetes management.

Aerobic exercises can include brisk walking, running, swimming and dancing etc. whereas resistance training can include modest weight training which can complement aerobic exercises.

Regular exercise also manages stress and releases tension, both of which are important for a good metabolic control.

Nutrition -

Nutrition is critical to manage blood glucose levels. Healthy eating for diabetes includes selecting high fibre, lower glycemic index (GI) carbohydrate foods and reducing fat, especially saturated fat. Food intake should be balanced with exercise to maintain a healthy body weight.


About 30-40 years ago the chances of saving sight after being diagnosed with Diabetic Retinopathy were only 50 % . Today with early diagnosis and effective management this has significantly reduced.

Symptoms –

The early non proliferative stage of the disease usually doesn’t have any symptoms until the central portion of retina i.e. macula is involved. Thus it is important for all individuals with diabetes to get a regular eye check at least once a year or as advised by ophthalmologist.

The following symptoms may not necessarily be signs of diabetic retinopathy but should be checked regularly

  • Dark spots or halos in vision
  • Blurred, distorted or Dim vision
  • Frequent change in glass prescription
  • Difficulty seeing at night
  • Visual Acuity
  • Slit lamp Examination
  • Indirect Ophthalmoscopy
  • OCT
  • FFA

It can be upsetting and confusing when diagnosed with an eye disease such as diabetic retinopathy and when dealing with low vision. In these situations it is sometimes difficult to remember what the doctor or optometrist has advised during the consultation.

When visiting a eye health professional

  • Ask a friend to take notes and be available for discussion
  • Ask the eye health professional to write down instructions
  • Request further information if still in doubt
  • If you do not fully understand what was said, feel comfortable about ringing back after the visit to ask questions


During the early or Non Proliferative stage of Diabetic Retinopathy no treatment is advised for the eye. The patient is advised to have a strict metabolic control along with regular eye checkups.


  • Diabetic Macular Edema
  • Proliferative Diabetic Retinopathy
  • Vitreous Hemorrhage

Different treatment options are available as suitable for the patient Which can be used as a stand alone procedure or a combination depending upon severity of Diabetic Retinopathy.

These Include.

  • Intravitreal ANTI – VEGF injections
  • Intravitreal Steroid Injections
  • Focal Laser
  • Pan Retinal Laser
  • Vitreo- Retinal Surgery



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