CHENNAI: Diabetes is one of the largest global health concerns of the century, and a leading cause of mortality together with cardiovascular disease (CVD), respiratory disease, and cancer. Previously considered to be a disease of the affluent “Western developed” countries, it has now spread globally affecting both older and younger age groups. According to the World Health Organization, (WHO), the burden of diabetes is growing rapidly in low- and middle-income countries. With rapidly changing socioeconomic status in conjunction with urbanisation, population growth, unhealthy eating habits, and a sedentary lifestyle the number of people affected by diabetes has risen significantly over the decade.
While type 1 diabetes is more common in children and adolescents, there is an increase in the trend of the younger population getting affected by type 2 diabetes likely due to an increase in the prevalence of obesity and unhealthy lifestyle. Diabetic retinopathy is a complication of diabetes that was earlier more prevalent among older individuals due to the chronicity of the disease.
It affects the younger population as well, especially those who have had diabetes for a long period of time and those with poor blood sugar control. Eye specialists have emphasised the paramount importance of regular eye screening for diabetics. Patients with diabetic retinopathy do not often exhibit any symptoms in the early stages of the disease. Many patients do not have symptoms till they have reached stage 3 of the five stages of the disease. Timely detection and intervention can prevent or slow down the progression.
Investigations for diabetic retinopathy involve a range of eye examinations and imaging techniques to evaluate the health of the retina, which is part of the eye involved in converting light into neural signals, as it is predominantly affected by the disease. Visual acuity testing involves the measurement of how well a person can see at various distances. The pressure inside the eye is assessed using a device called a tonometer as an increase in pressure can be a sign of certain eye conditions including diabetic retinopathy. Dilated eye examination involves using eye drops to dilate the pupils allowing a retina specialist to examine the retina and optic nerve for any signs of damage or abnormalities.
Imaging techniques such as fundus photography help capture detailed images of the retina to monitor and identify signs of retinopathy. Detailed information about retinal thickness and its structural integrity can be studied through non-invasive imaging techniques such as Optical Coherence Tomography (OCT). To identify abnormal blood vessel growth and leakage an angiographic test where a dye is injected into the arm and a series of images are taken as the dye circulates through the blood vessels in the eye.
A relatively new imaging technique called Optical Coherence Tomography Angiography (OCT-A) helps provide detailed three-dimensional imaging of retinal blood vessels without the need for dye injections. With the advent of artificial intelligence, handheld smartphone-enabled cameras such as Remedios non-mydriatic, an infrared, smartphone-based fundus camera. Apart from its superior image quality camera, it has a major advantage of not requiring mydriasis i.e does not require dilatation (typically achieved using eye drops, allowing a better view of the retina) making it more convenient for the patient as it reduces the screening time, and is more comfortable.
Once diagnosed, the management of diabetic retinopathy involves various approaches. Control of blood sugar levels is crucial. Combination of good glycaemic control by medication, a healthier lifestyle with dietary changes, and exercise. Specific treatment plans are made for the management of an individual’s condition depending on the stage of diabetic retinopathy and the presence of complications such as bleeding (vitreous hemorrhage), retinal detachment or diabetic macular edema.
Laser Therapy (photocoagulation) treatment helps in sealing off leaking blood vessels or destroying abnormal vessels to slow the progression of the disease. Injections of medications called anti-VEGF drugs are administered into the eye in severe cases. These drugs can help reduce swelling and prevent the growth of abnormal vessels. In some cases, implants and devices containing steroids can be injected into the eye to control inflammation and swelling.
In advanced cases where there has been bleeding for a long period of time or if there is detachment of the retina then a surgical procedure called vitrectomy is considered. It is a minimally invasive vitreoretinal surgery (25G) where smaller incisions and instruments are used resulting in lesser trauma to the eye, and lesser patient discomfort both during and after surgery.
This advanced technology has more precise instrumentation enabling surgeons to perform intricate retinal procedures with accuracy. Understanding the risks and potential sight-threatening complications is important in helping individuals make informed decisions about their health and proactively take steps to prevent diabetic retinopathy. Early detection and appropriate treatment are crucial as they impact an individual’s quality of life, productivity, and overall well-being and also thereby reducing healthcare costs.