Diabetic Retinopathy

In India, according to various studies the prevalence of diabetes mellitus is about 4-5% in rural population and 10-12% in urban population. Diabetic retinopathy is a leading cause of blindness and visual disability. Diabetic retinopathy is primarily a direct, long-term consequence of sustained hyperglycemia, modified to a variable extent by genetic and acquired factors. In particular, these include the duration of diabetes, glycemic control, and systemic hypertension. Most patients with diabetic retinopathy are referred to vitreo-retinal surgeons who specialize in treating this disease. The treatment options are laser treatment and vitreoretinal surgery for advanced cases.

International Clinical Diabetic Retinopathy Disease Severity Scale

1. No apparent Retinopathy: No abnormalities
2. Mild Non-Proliferative Diabetic Retinopathy (NPDR): Microaneurysms only
3. Moderate NPDR: More than just microaneurysms but less than Severe NPDR
4. Severe NPDR
5. Very Severe NPDR
6. Proliferative Diabetic Retinopathy (PDR)

Treatment Recommendations:

Normal (No NPDR): The patient with a normal retinal exam should be re-examined annually. No investigation and treatment is required.

Mild and Moderate NPDR: Patients should have an examination every 6 to 12 months, because disease progression is common. Laser surgery and fluorescein angiography are not indicated for this group of patients.

Severe and Very Severe NPDR: Careful follow-up at 3 to 4 months is important. Fluorescein angiography may be used to determine the need for treatment and to establish the cause of a documented loss of visual acuity.

PDR: Most patients with PDR (particularly high-risk PDR) should receive laser scatter treatment without delay. Scatter photocoagulation causes regression of neovascularization. Following scatter photocoagulation, additional laser treatment may be required.

For patients who have Clinically significant macular edema (CSME) in addition to high-risk PDR, giving both focal and panretinal photocoagulation at the first treatment session may be considered. Vitrectomy also may be helpful in selected patients with extensive active neovascular or fibrovascular proliferation.

Summary and Recommendations for Physicians and Patients:

Diabetic Retinopathy is often asymptomatic in its most treatable stages. Early detection of diabetic retinopathy is critical. The elevated blood pressure (BP) is an independent risk factor for the onset and progression of DR. Hence, good systemic control goes a long way in the prevention and treatment of DR, along with PRP and focal laser.
Because diabetic retinopathy and diabetic macular edema cannot be prevented, routine early evaluation, timely laser surgery, and careful follow-up are critical. The following examination schedule is designed to ensure the early detection and monitoring of diabetic eye disease:

All patients with IDDM of more than five years duration but less than 30 years of age and if more 30 years of age then irrespective of duration of disease; and all patients with non-insulin-dependent diabetes mellitus should have yearly eye examinations.

Retinopathy may progress more rapidly during puberty. Children in this developmental stage should have yearly eye examinations, regardless of how long they have had diabetes.

Any woman who is planning pregnancy should be examined before pregnancy. Any woman with known diabetes who becomes pregnant should be examined for retinopathy early in the first trimester.

Remind all patients to report all ocular symptoms, since essentially any symptoms may be diabetic in origin. Blurred vision while reading may indicate macular edema. The presence of floaters may indicate hemorrhage, and flashing lights may indicate retinal detachment. Inform patients that early detection and appropriate treatment of diabetic eye disease greatly reduces the risk of visual loss.

Article Topic : Diabetic Retinopathy

Article Compiled By : Dr. Nishank Mittal
M.S., D.N.B., M.N.A.M.S., F.M.R.F., F.A.G.E.
Vitreo-Retina Fellow – Sankara Nethralaya, Chennai
Ex-Consultant, Venu Eye Institute and Research Center, Delhi.
Mittal Eye Care & Retina Centre
E-104, Mansarover Garden, (Near Indian Overseas Bank, Ring Road), West Delhi.
011-25934363/64, 9873139539, 9871155582,