Diabetic Retinopathy

The eye is the most commonly affected organ by diabetes leading to Diabetic Retinopathy (DR). Diabetic retinopathy is one of the foremost frequent causes of blindness world-wide. In India, awareness of the diabetic retinopathy, its seriousness and treatment modalities among the community and general physicians is low. Diabetic Retinopathy is symptomless in its early stage but timely treatment can prevent vision loss from diabetic retinopathy. So retinopathy screening is the only way to identify these patients and prevent blindness.

More than 75% of patients who have diabetes mellitus for more than 20 years will have some form of diabetic retinopathy. According to WHO, 31.7 million people were affected by diabetes in India in the year 2000 which will estimated to be rise to 79.4 million by 2030. It is estimated that 15 to 25% of the diabetic population have diabetic retinopathy, and everyone has the potential to develop it over a period of time.

Onset and severity of Diabetic Retinopathy depends on type of Diabetes and its Duration, control of Diabetes Mellitus, Hypertension, Anemia, Renal status, Pregnancy, Hyperlipidaemia etc. Early stage diabetic retinopathy has no early warning signs or symptoms. There is no pain, and vision remains unaffected until the disease becomes severe. Frequent change of glass power, difficulty in reading or driving may be early signs of macular edema. Whenever patient comes to ophthalmologist with visual symptoms it is thought that DR already has started damaging retina.

Examination of dilated fundus of eye by slit lamp biomicroscopy with +90D or +78D lens and Indirect ophthalmoscope is ideal. Clinical features of DR include microaneurysm, macular edema, retinal hemorrhage, exudates, new vessels formation, vitreous hemorrhage, retinal detachmant etc.  Additional investigation like Fundus Fluorescein angiography (FFA) and optical coherence tomography (OCT) are useful for proper management in some stage.

Fig: OCT showing macular edema

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