Diabetic retinopathy and maculopathy

Diabetic retinopathy is a complication of long-standing or poorly controlled diabetes. High blood sugar damages the small blood vessels in the retina (nerve layer) of the eye, causing patches of bleeding and leakage of proteins or fat within the retina.

There are several stages of retinopathy, and the transition from early stage to advanced retinopathy may take many years. This means that there are many opportunities for early and moderate stage retinopathy to be picked up before it reaches the later stages. Advanced retinopathy causes potentially blinding complications like severe bleeding, scar formation and retinal detachment.

Maculopathy (or diabetic macular edema) is a specific sub-type of diabetic retinopathy involving the central fixation point of the eye (macula). In these cases, the macula become swollen and vision may be affected early. Visual impairment may be permanent if not treated early.

Once retinopathy sets in, it indicates that significant damage has accumulated within blood vessels in the body, and it is possible that the kidneys, heart and small nerve endings of the fingers and toes have also been affected.

Treatment

In early stage diabetic retinopathy, eye treatments may not be necessary. However, good control of blood sugar levels will help to slow down the disease process and regular eye examinations are important to catch the disease if it enters a more severe stage.

More advanced stages of diabetic retinopathy and maculopathy may be treated in several ways:

1. Laser therapy

Laser therapy is done to slow down the disease process and reduce the risk of visual loss. It is done as an outpatient procedure and may need to be performed over several sessions.

Laser treatment in progress.

2. Intravitreal injection therapy

Intravitreal “antiVEGF” injections are now considered standard treatment for many cases of diabetic maculopathy. This involves the injection of medication (antiVEGF agents) into the eye using a very tiny needle, and has been shown in clinical studies to deliver good vision results. The injection is done as an outpatient procedure and multiple injections may be necessary.

Eye scan shows a very swollen macula in diabetic maculopathy.

Eye scan shows resolution of the swelling after intravitreal injection therapy.

3. Surgery

In very advanced retinopathy (proliferative diabetic retinopathy) where there is severe bleeding in the eye or a retinal detachment, “vitrectomy” surgery may need to be performed to remove the blood and scar tissue, or reattach the retina.

Micro-scissors and micro-forceps removing scar tissue during vitrectomy microsurgery.

Diabetic eye screening

All diabetics are recommended to undergo regular eye examinations to pick up diabetic retinopathy early. Even in the absence of symptoms, eye examinations should be done at least once a year as there may be no symptoms in early stages of retinopathy.

Those already diagnosed with diabetic retinopathy should be monitored more frequently for worsening which may require treatment.

The minimum eye screening will involve having a photograph taken of the retina (diabetic photoscreening). A detailed eye examination is recommended for those at higher risk of diabetic retinopathy or those not suitable for photoscreening. If diabetic retinopathy or maculopathy is seen, further tests like fluorescein angiography or “OCT” scans may be ordered to assess the extent of the damage.

FAQs about diabetic retinopathy and maculopathy