Diabetic Retinopathy | Rupal Morjaria | Consultant Ophthalmic Surgeon

Summary
Diabetic retinopathy is the fifth common cause of blindness in the world and a major cause of blindness among working population in developed countries.

Diabetic retinopathy is treatable and vision loss can be prevented or delayed if treated early.

Diabetic complications in the eye occur due to the effects of poor blood sugar control together with other risk factors such as high blood pressure, high cholesterol,smoking.

It can result in mild diabetic changes such as a few haemorrhages that do not require treatment but monitoring.

More severe disease causes bleeding or new vessels in the eye called proliferative diabetic retinopathy (PDR) or fluid build-up in the camera film of the eye (diabetic macula oedema, DMO).

Both of these require urgent treatment.

Figure 1. patient who has had panretinal photocoagulation

Figure. 2 Wide field Optos image of a diabetic patient who has had a bleed in their eye

Treatment
‍Diabetic Retinopathy used to be traditionally graded as mild (R1) moderate (R2) or severe (R3), but several different classification systems exist.

If you have a mild or moderate disease, changes can be made in your diet, lifestyle and medication to reverse these changes.

Dr Morjaria will advise you on this. However, once you have severe diabetic retinopathy urgent treatment is usually required to prevent or slow down sight loss.

Dr Morjaria will tailor your treatment for diabetic retinopathy considering your general health and lifestyle.

It will include injections to the back of the eye to slow down the growth of new vessels with anti-VEGF (vascular endothelial growth factor) drugs such as aflibercept, Faricimab (Vabysmo), Broclucizumab (Beovu), Biosimilars and Bevacizumab (Avastin), together with laser to the areas of the eye that are not receiving sufficient oxygen.

Laser treatment (panretinal photocoagulation, prp) to these areas helps to divert the essential resources to areas of theretina (camera film) that are the most important for your reading vision.

Diabetes and Glaucoma
People who suffer with diabetes are at a higher risk of developing glaucoma.

This is when the pressure in the eye is too high and can cause damage to the nerve sending messages to the brain.

If this is not detected early, it can cause changes in your field of vision.

It is important that the doctor monitoring your eyes for diabetes also checks the pressure of the eye and the nerve at the back of the eyes.

Oedema
Macula oedema affects the macula region of the retina. The macula is the region of the retina used for sharp, clear vision when reading or focusing on an image.

Macula oedema is the condition when you get fluid deposition in the retinal layers in the macula region.

This can result in symptoms of difficulty reading and loss of vision. Treatment of macula oedema includes gentle laser or injections to the back of the eye.

The injections needed may be anti-VEGF drugs or steroid implants depending on how long you have had the condition and how much treatment you have had.

Diabetes and Cataract
Cataract is a cloudy lens. The lens helps to focus images from the outside world onto a small part of the camera film called the fovea.

As people get older their lens gets thicker and ‘yellower’. Having fluctuating blood sugars can speed up this process and people with diabetes may require cataract surgery earlier.

Dr Morjaria specialises in seeing people with diabetes and cataracts. She is thorough to take additional steps to avoid swelling and inflammation after surgery.
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Dr Morjaria fully assesses the eye for risks of post-operative macular oedema before her patients undergo surgery.

People with diabetes may need additional treatments during or after surgery to help them get the best outcome.

Sometimes additional injections of anti-VEGF agents or steroids are needed at the time of cataract surgery to help get the best outcome. Dr Morjaria can discuss the risks and benefits of these treatments.

Tests‍Below are tests that are available for Diabetic Retinopathy.

Fluorescein angiogram‍

Figure. 3 This is a late fluorescein angiogram image of a right eye of a patient with poor diabetic control. Fine new vessels are growing in the central area called the optic disc and the periphery shows previous laser marks and also areas where the retina (cameral film) is starved of oxygen and ischaemic.

You may need additional tests that involve having a yellow dye injected into your hand to take pictures of the blood circulation in your eye.

This will allow Dr Morjaria to assess for areas of the eye that are not getting enough oxygen or areas that need laser treatment to prevent bleeding in your eye.

OCT Scan - Optical Coherence Tomography ‍

fig. 4 Image show a normal Oct scan. An OCT scan looks at the layers of the camera film of the eye in high resolution.

The OCT scan is a quick, non-invasive scan which looks at the layers of the retina focusing on the macula region.

This provides Dr Morjaria with a detailed picture of the back of your eye. Taking regular images enables more accurate monitoring of your condition over time.

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