Diabetic Retinopathy

What is Diabetic Retinopathy?

In diabetes, high levels of sugar (glucose) in the blood can damage the small blood vessels that are important to the health and function of your retina. This is called diabetic retinopathy or diabetic eye disease.

The damage causes two problems with the blood vessels.

Firstly, the damaged blood vessels can leak, causing your retina to become waterlogged and affecting its function. This swelling commonly occurs in the macula, which is the central part of the retina. This is called diabetic macular oedema (or DMO).

Secondly, the damage can prevent blood from flowing through the blood vessels. The retina becomes starved of oxygen and stops working. This is called non-proliferative diabetic retinopathy (or NPDR).

As the blood vessel damage worsens, the retina tries to repair this blood supply by growing new blood vessels. This is proliferative diabetic retinopathy (or PDR). These blood vessels are abnormal and they bleed or turn into scar tissue that can cause the retina to detach. If this is not treated, there is a risk that you may lose your sight.

What are the symptoms of Diabteic Retinopathy?

Your symptoms will depend on the type and severity of damage present:

In diabetic macular oedema, you may notice a blurring of your vision that gradually worsens.

You may not have any symptoms with early non-proliferative diabetic retinopathy. As this condition progresses, you may notice difficulty seeing at night or difficulty using your peripheral vision.

With proliferative diabetic retinopathy, you may suddenly notice misty vision or floaters if there is bleeding inside your eye.

With a retinal detachment from diabetes, you may lose your vision.

How do you treat Diabetic retinopathy?

It is important to investigate your eyes before treatment. This is usually done with retinal scans and sometimes using angiography, where a dye is injected into your arm and photographs of the retinal blood circulation are taken. This allows me to accurately assess any damage present and demonstrate this to you.

These investigations may incur an additional cost from the Nuffield Hospital. I will not charge a separate fee for reporting on investigations as I believe that these are essential to a proper and comprehensive consultation.

Mild cases of diabetic macular oedema can be observed. If there is further deterioration, some cases may be suitable for laser treatment to the retina. Severe cases of DMO can be treated with a course of injections of drugs into the affected eye. These drugs stop the damaged blood vessels from leaking. This treatment is usually provided by the NHS on an outpatient basis.

Non-proliferative diabetic retinopathy requires regular monitoring to check for the development of new abnormal blood vessels. If proliferative diabetic retinopathy is present, the laser treatment to the retina is critical to decrease the risk of loss of vision.

Bleeding inside the eye or retinal detachment may require surgery.

What does the surgery/treatment involve?

Laser treatment for diabetic macular oedema is an outpatient procedure. The setup is very similar to the examination at your consultation. The pupil in your affected eye will be dilated and anaesthetic drops will be used to numb the surface of your eye. This allows a temporary lens to be placed against your eye that helps to keep your eye still. You will notice bright flashes of light when the laser is used and the treatment lasts a few minutes. There is no special aftercare required.

Diabetic macular oedema can also be treated by injections into the eye, performed with local anaesthetic drops as an outpatient procedure. After the surface of your eye is numbed, a cleaning solution is used to disinfect the area. Your eyelids are gently held open and the drug is delivered through the white of the eye. The entire process lasts around 5 minutes. There is no special aftercare required.

Laser treatment for proliferative diabetic retinopathy is called panretinal photocoagulation (or PRP). PRP is similar to the treatment for diabetic macular oedema described above. This treatment can last up to 30 minutes as more laser treatment is required.

Surgery for diabetic bleeding or retinal detachment is usually done as a day case under local anaesthesia. The length of the operation depends on the severity of damage present. It involves a procedure known as vitrectomy, where microscopic instruments are introduced through the white of the eye to remove any blood or scar tissue and deal with any retinal detachment.

Where will the surgery take place?

Laser treatment, injections and surgery are performed at the Nuffield Health Bristol Hospital.