Consultancy Corner: Preventive approaches of diabetic retinopathy

The impact of visual impairment among diabetic individuals has profound implications for the person affected and society as a whole. Visual disability significantly affects life and increases risk of injury.

The most distressing effects of diabetes in the eye with regard to visual impairment are in the retina (inner layer of the eye) called as diabetic retinopathy. Preventive approaches to diabetic retinopathy can be categorized into three levels: the first is Primary Prevention of retinopathy. 

This is an early approach where early detection and treatment delay the onset of the diabetic retinopathy by good control of blood sugar, blood pressure and lipids. It is mandatory that every Type 2 diabetic individuals should have a retinal examination during diagnosis and for Type 1 diabetic subjects, retinal examination should be done 5 years after diagnosis and every year thereafter.

Diabetic retinopathy can be divided into two types – non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. Non-proliferative diabetic retinopathy is the early stage and at this stage, there are small balloon-like sacs (out pouching of capillaries) called as micro aneurysms. In the next stage, these sacs leak fluid and blood into the retina. During this stage, sight is present. However, when diabetic retinopathy progresses, it would form the second approach or Secondary Prevention.

As a follow up, dilated retinal examination should be done frequently at this stage. As retinopathy  individuals may not have any symptoms, life-long evaluation is necessary.

The two sight threatening forms of diabetic retinopathy are diabetic macular edema (DME) and proliferative diabetic retinopathy. In DME, there is collection of fluid in the central region of the retina, called as the ‘macula’ (the ‘seeing’ portion of the eye). In the second condition – Proliferative DR, there are ‘New Vessels’ on the retina. These new vessels are outgrowths from the normal vessels and appear in the retina due to lack of oxygen called as hypoxia. The problem is that their walls are very fragile and tend to bleed. If this stage is not treated, it may lead to visual disability.

Tertiary Prevention is where complications have reached a very critical stage and procedures like laser therapy or surgical procedures are required to prevent the disease and stabilise vision. Laser therapy is a simple out-patient painless procedure. If done properly, the changes can be reversed. After the procedure, regular monitoring is necessary. Timely treatment can prevent upto 90% of vision loss.

Other diabetes related eye problems are glaucoma (damage to optic nerve fibres), senile cataract (clouding of the lens) and nerve palsies (affection of extra ocular muscles). Diabetic people are likely to suffer from glaucoma and risk increases with age and duration of diabetes.

Thus, people with diabetes can prevent/reduce the occurrence of diabetic eye complications through awareness, education, screening and treatment that will prevent or help reduce the blindness due to diabetic eye disease.