India, which is seeing a surge in diabetes cases, is also witnessing a rise in diabetic retinopathy, a condition that damages the retina due to high sugar levels. According to Dr MJ Barman, vitreo-retina and ocular oncology service, ASG Eyecare, Paltanbazaar, Guwahati, awareness about the condition remains low in India. He tells Kavita Bajeli-Datt that the need of the hour is to conduct regular check-ups and educate people about newer treatments that can help reduce the disease burden. Edited excerpts:
What is Diabetic retinopathy?
Diabetic retinopathy (DR) is a condition characterised by the gradual weakening of eyesight as persistently high blood sugar levels damage the blood vessels in the retina. In early-stage DR (non-proliferative DR), the damaged blood vessels leak fluid and blood into the centre of the retina, causing diabetic macular edema (DME). In advanced DR (proliferative DR), abnormal blood vessels grow as the old and damaged blood vessels close off. These fragile new vessels leak fluid that collects in the centre of the eye. These vessels can sometimes grow beyond the retina and block fluid drainage from the eye, leading to conditions like glaucoma. Another complication of DR is retinal detachment, which occurs when the retina detaches itself from the back of the eye. Most of these conditions can cause vision loss and irreversible blindness without early detection and treatment.
What are the early signs of DR?
People with diabetes should be alert to signs like blurred vision, floaters, and dark spots. Other symptoms may include faded or distorted colours or seeing dark spots. Regular eye exams are crucial for early detection, as DR may progress without noticeable symptoms until significant damage occurs.
What are the treatment options available for diabetic retinopathy?
Early stages may only require ongoing monitoring, while advanced cases can benefit from these available treatment options:
Intravitreal injections: These are administered in the eye to inhibit the growth of new blood vessels and reduce fluid buildup. Traditionally, anti-vascular endothelial growth factor (anti-VEGF) drugs were used to treat DR. However, it has been found that etiopathology of DR not only involves VEGF but has a strong inflammatory component. As such, newer options that target multiple pathways, such as faricimab (a bispecific antibody that targets both VEGF and angiopoietin-2), may prove to be most promising.
Photocoagulation: It uses a laser to seal or ablate the abnormal blood vessels, thereby stopping or slowing the leakage of blood and fluids. It prevents further loss of eyesight.
Vitrectomy: It involves making a tiny incision in the eye to remove blood from the vitreous humour (fluid in the eye), scar tissue, and membranes that can dislodge the retina.
Is it a common and serious complication for people with type-2 diabetes?
Such incidents are pretty common in patients with type-2 diabetes. DR is among several complications of diabetes, which affects more than 100 million individuals (>20 years) in India. As the disease grows at an alarming rate, so does the prevalence of DR. Approximately three million patients above the age of 40 suffer from vision-threatening DR, a severe form of the condition. Hence, early detection and timely treatment are essential for preventing vision loss.
With the rising prevalence of diabetic retinopathy in India, how important is it for the public to be aware of this condition?
In India, where diabetes rates have surged, the prevalence of diabetic retinopathy is also rising. However, awareness about DR remains low. The cost of inaction is high, both in terms of human suffering and economic burden. DR is preventable if detected early, yet the lack of awareness puts millions at risk of vision loss. Regular eye check-ups and educating patients about newer treatments can help reduce the disease burden. Diabetes care must include comprehensive eye check-ups, not just blood sugar management.