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Diabetic Retinopathy

What is Diabetic Retinopathy?

Patients with diabetes experience numerous complications related to elevated blood sugar levels. High levels of sugar in the blood damage the fine blood vessels in the retina. Blood vessels can either become blocked or can be damaged and start to leak.

The longer a person has diabetes, the higher their chances of developing diabetic retinopathy. Elevated blood pressure and high cholesterol are the other factors that pre-dispose to diabetic retinopathy.

Diabetic retinopathy can lead to permanent blindness. Your ophthalmologist has a range of treatments that can help prevent loss of vision; however, those treatments are most effective when they are started prior loss of vision.

Treatment of Diabetic retinopathy is aimed at preventing further vision loss

It is most effective when started early

There are two types of diabetic retinopathy and in each patient one form or the other may predominate or patients may have a combination of both.

  • Diabetic macular oedema: fine blood vessels near the centre of the vision start to leak fluid. This fluid causes the macular to become ‘boggy’ (macular oedema). This causes blurring of central vision.
    • Treatment for macular oedema:
      • Very fine laser to the blood vessels that are leaking
      • Injection into the eye with a medication ‘Avastin’ that helps stop these vessels from leaking.
  • Proliferative Diabetic retinopathy: the blood vessels in the outer retina block off starving the retina of blood. In response the retina secretes emergency substances that promote the growth of abnormal blood vessels. Unfortunately these blood vessels can bleed and contract causing hemorrhage in the eye and retinal detachments. Untreated proliferative retinopathy can lead to total loss of vision.
    • Treatment for proliferative retinopathy
      • A heavy laser is used to destroy the peripheral retina. This can lead to loss of some peripheral or night vision but decreases the retina’s requirement for blood. The abnormal blood vessels stop being produced and those that have already grown may regress-

 

Heavy laser protects from total loss of vision!

It does not restore vision!

Diagnosis

If you have diabetes you must get your eye checked every year by your local optometrist. Once they see early signs of diabetic retinopathy they will refer you to your ophthalmologist who will continue to monitor your eyes. This is important because treatment should be started prior to the development of symptoms.

What can you do to keep your sight?

If you have diabetes for long enough you will develop diabetic retinopathy. 90% of diabetics will have retinopathy after 20 years. However, the majority of people with mild diabetic retinopathy will have normal vision and in many cases early intervention can prevent most vision loss. Y

You should do the following to help preserve your sight:

  • Stop smoking if you smoke
  • Keep your blood sugar levels at recommended level
  • Keep your blood pressure under control
  • Attempt to lose excess weight through diet and exercise
  • Get your eyes checked every year or two
  • Keep your cholesterol under control

Should I be on Fenofibrate

A large study in the UK with nearly 10,000 participants found that Fenofibrate (cholesterol reducing drug) reduced the development of and the progression of diabetic retinopathy.

Ask your GP if you should be on fenofibrate.

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