Prevention of diabetes Retinopathy

Prevention is always better than cure, however you can’t always prevent diabetes Retinopathy. By getting a regular eye checkup, control on blood sugar levels and blood pressure and early prevention for vision problems can avoid severe vision loss.

Following are few ways to prevent diabetes Retinopathy in people with diabetes.

-          Manage your diabetes – Have a healthy diet plan and regular physical exercise as a part   of daily routine. Follow the medication suggested by the physician.

-          Monitor your blood sugar level – Keep a regular check on your blood sugar level per       day the frequency increases if you are ill or under stress on the suggestion of a physician.

-          Glycosylated hemoglobin test – This test reflects your average blood glucose level for      2-3 months period before the test. The ideal test result is 7%.

-          Keep your blood pressure and cholesterol under control – By maintaining a healthy     food, regular exercising and excess weight loss can be helpful.

-          Quit Smoking –  It increases your risk to various diabetes complications which includes    diabetic retinopathy.

-          Monitor vision changes – Keep regular checks on your vision and consult a doctor if       your experience any sudden vision changes like blurred, spotty or hazy vision.

People with diabetes need to maintain healthy levels of the following to prevent diabetic retinopathy:

               ·         blood pressure

               ·         blood sugar

               ·         cholesterol

Other ways to prevent or manage the condition include the following:

              ·         Quit smoking.

              ·         Regular exercise as per the suggestions from your healthcare team  

              ·         Regular eye checkups.

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Treatment for Diabetic Retinopathy

For people with early diabetic retinopathy the options for treatment are very few. Regular eye checkups needed to determine if treatment is necessary. By managing diabetes in optimal level, the retinopathy progress can be slowed down.

People with advanced retinopathy are given treatment basing on the type and severity of retinopathy.

To prevent the loss of vision photo-coagulation surgery can be performed, in this laser is used to control or stop the leakage by burning the vessels to seal them.

Types of photo-coagulation

-          Scatter photocoagulation –  uses laser to burn hundreds of tiny holes in the eyes to reduce the risk of   blindness.

-          Focal photocoagulation – uses laser to target leaky vessels in the macula

-          Vitrectomy – removal of scar tissue and cloudy fluid from the eye

Risk factors

People with diabetes have the risk of developing diabetic retinopathy. The risk factors increase because of:

-          Based on the duration of occurrence of diabetes. Longer the duration greater is the risk

-          Blood sugar level imbalance

-          Hight blood pressure

-          During pregnancy

-          Excess use of tobacco

-          Dark colored people have higher risk  

Complications

Complication may lead to serious eye problems or blindness

-          Vitreous hemorrhage – the newly formed vessels have the risk of leaking into the retina. If the leakage is small you can see only small dark spots, if the leak is severe blood may pour into the eye and block your vision.

-          Usually the blood clears within weeks or months. You may loss your vision if the retina is damaged.

-          Retinal detachment – Scar tissues are formed by associating with abnormal blood vessels. This scar tissue can pull the retina from the back of the eye, which can lead to floats in your vision.

-          Glaucoma – Due to the formation of new vessels the normal flow of the fluids is interfered causing to build up pressure in the eye. Due to this pressure the nerves are damaged which carry images to brain.

-          Blindness – Diabetic retinopathy and glaucoma lead to blindness.

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Diabetic Retinopathy

Causes for diabetic retinopathy:

Retina is a tissue layer lying behind the eye which is responsible for changing of image, but due to high levels of blood sugar over a long period leads to blockage of the blood vessels which supply blood to the retina. So, the eye attempts to produce new blood vessels, which are usually weak and can leak easily and create scar tissue that can cause a loss of vision. High blood pressure also leads to diabetic retinopathy.

People with diabetes for longer period are certainly to show the chances of developing diabetic retinopathy. By maintaining the diabetes under control will help slower the process of retinopathy.

Women with diabetes should have an eye exam before planning to get pregnant.

Diabetic retinopathy leads to haemorrhages, exudates and even swelling of the retina.

Diagnosis of diabetic retinopathy:

Diabetic retinopathy is detected by comprehensive dilated eye exam which includes

Visual acuity testing – Here eye chart is used to measure the persons ability to see at various distance and how much the eye is being damaged.

Tonometry – It is performed to measure the pressure inside the eye.

Pupil dilation – Here eye drops are used to dilate the pupil which helps the physician to easily examine the retina and the nerves

Optical coherence tomography (OCT) – A similar technique used in ultrasound but here instead of sound waves light waves are used to capture pictures of tissues. By OCT a detailed image of the tissue.

 

Fluorescein angiogram – Here Fluorescein angiogram is used to detect the damaged or leaky blood vessels. In this test, fluorescent dye is injected into the bloodstream usually to the arm vein, as the dye reaches the eye pictures of the retinal blood vessels are taken and examined.

By performing a comprehensive dilated eye exam, the physician can examine:

-          Changes in the blood vessels

-          Leakage of blood vessels or signs of leaky blood vessels

-          Swelling of the macula

-          Changes in the lens if required or not

-          Any damage to the nerve tissue

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Diabetic Retinopathy

Definition:

It is a condition where the blood vessels of the retina are damaged in people who have diabetes either type 1 or 2, along with uncontrolled blood sugar levels. Initially the vision is blurred mildly and in later stages if untreated may lead to blindness.

Types of diabetic retinopathy

Non-proliferative diabetic retinopathy (NPDR)

It is the early stage in diabetic retinopathy where the eye doesn’t make new blood vessels, so it is called as “non-proliferative”. It is also called as background retinopathy. During this stage usually, the damaged blood vessels leak blood and fluids into the eye, in few cases nerve fibers in the retina begin to swell. This leads to the condition called macula edema. NPDR contains three stages mild, moderate and severe, which further leads to Proliferative diabetic retinopathy (PDR).

Proliferative diabetic retinopathy (PDR)

Advanced diabetic retinopathy is the stage where the new blood vessels begin to grow within the retina, these are usually abnormal and grow in the center of the eye. These leak jelly like substance that fills the center if the eye. By the growth of the new blood vessels the scar tissues are stimulated which may cause the detachment of retina from back of the eye. If the normal fluid flow out of the eye are interfered by the new blood vessels, pressure may build up in the eyeball, which can damage the nerve which carry images to the brain resulting in glaucoma.

Symptoms: 

Usually the symptoms are not seen in the early stages of diabetic retinopathy, but you can prevent it by maintaining the blood sugar levels in the body and by having regular eye check-up.

-          Difficulty in seeing at night.

-          Blurred vision

-          Difficulty in differentiation the colors

-          Seeing floaters or dark spots

-          Loss of vision

-          Eye pain

-          Double vision

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Endocrine disorders

Acromegaly – Growth disorder due to excess release of growth hormone by pituitary gland leading to excessive growth.

Addison's Disease – Also referred to as primary adrenal insufficiency.

Anaplastic Thyroid Cancer – Has poor prognosis due to aggressive behavior and resistance to cancer treatments.

Cushing's Syndrome – Body when exposed to high levels of the hormone cortisol for a long time.

Diabetes – A group of diseases that result in too much sugar in the blood.

Gestational Diabetes –  Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy.

Graves' Disease – An immune system disorder of the thyroid gland.

Growth Disorders – Prevents normal developing of height, weight, sexual maturity in children.

Hashimoto's Thyroiditis – Autoimmune disease where the thyroid glands are gradually destroyed.

Hyperglycemia – Abnormally high release of blood glucose level in the blood.

Menopause – A point of time when menstrual cycles permanently stops due to natural depletion of ovarian oocytes from aging.

Obesity –  accumulation of excessive body fat leading to health problems.

Osteoporosis – A conditions where the bones become brittle and weak.

Pheochromocytoma – A hormone secreting tumor which occurs in adrenal gland.

Polycystic Ovary Syndrome – Emblement of ovaries with cysts on the outer edge.

Prediabetes – High blood sugar levels in the blood but not high enough to cause type-2 diabetes.

Type 1 Diabetes – Low or no insulin secretion from the pancreas

Type 2 Diabetes – Long term metabolic disorder with high blood sugar levels, resistance to insulin.

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Reproductive Endocrinology

Definition: Reproductive Endocrinology deals with infertility, menopause and other reproductive hormonal related issues. Reproductive endocrinologists (RE), comes under obstetrician/gynaecologist (OB/GYN) specialization. They are (OB/GYN) Doctors, who are mastered in the study of endocrine disorders related to reproductive system in both the genders.

Conditions

Infertility – When a woman faces problem getting pregnant, the doctor by asking various details and and uses tests to find out the reason for the cause. Basing on the cause, the doctor will suggest a treatment.

Fertility preservation – When a person has any conditions, (cancer) treatment or experience which will affect their fertility. Then she may decide to have her eggs or embryos frozen before treatment.

Frequent miscarriages – Women in this case can get pregnant but have problem carrying the baby till term.

Endometriosis – It’s a condition where the lining which builds up inside the woman’s uterus grows outside the uterus. Normally a woman’s hormones get rid of this lining monthly usually during menstruation. Women with this problem have severe pain during their menstruation as the lining is being removed from both outside and inside.

Menstrual problems – Women face irregular or sometimes heavy periods.

Menopause – Hormonal changes should be managed which are common during menopause and they have to decide about hormonal replacement.

Sexual development – In few cases women need hormonal treatment for sexual development.

Treatments

They are different treatments for reproductive problems which include:

Assisted reproductive technology – It is a procedure where the eggs and embryos are handled outside of the body. Most common is the In-vitro fertilization. The eggs are removed from the woman’s body and are fused with the sperm from the partner or a donor, which are fertilized outside the body in laboratory and the fertilized egg is again placed into the uterus.

Gynaecologic surgeries – This is done to remove the uterine fibroids by perfuming surgery and treat endometriosis, treating the blocked fallopian tube.

Hormone treatments – Hormones along with reproductive technology are used to treat infertility or help carrying the baby to term. This is used to treat certain causes like polycystic ovarian syndrome.

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Diabetes Complications

Diabetes of any type can lead to many complications and diseases. People usually develop serious complication which leads to premature death. It has both type of complications – acute and long term which affect different organs and their functions. The graph of life line is lowered in people with diabetes when compared to a healthy individual.

Acute Complications

Acute complications include:

Hypoglycaemia – a stage where blood sugar levels are very low which is dangerous to our body, which may lead to acute hypoglycaemia coma, brain damage and may also cause death.

Ketoacidosis – here there is complete lack of insulin in the body, due to release of large amounts of release of ketone metabolites which leads to lowering of the blood pH, which is life threatening.

Long-Term Complications

Due to occasional elevation in the blood sugar levels long term diabetic complications are seen.

Cardiovascular disease – like heart attack, stroke, amputation

Nephropathy – like kidney failure or kidney transplant

Neuropathy – loss of sensation, erectile dysfunction and severe pain in extremities

Retinopathy – like impaired vision, may also lead to blindness

Preventive measures

Diabetic complications can be prevented by following a healthy lifestyle like:

-          Control over the blood glucose and Haemoglobin A1c levels

-          Regular exercise to maintain your body weight

-          Healthy diet plans

-          Lower alcohol intake

-          Lose weight if over weighted or obese

-          Quit smoking

-          Regular check ups

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