Diabetic Retinopathy Treatment in iran

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. Proper management is essential to prevent the condition from getting worse and causing vision loss.

What Is Diabetic Retinopathy?

Diabetic retinopathy is a complication of diabetes that impacts the eyes. It occurs when high blood sugar levels damage the blood vessels in the retina, the light-sensitive tissue present at the back of the eye. In the initial stages, diabetic retinopathy may not cause prominent symptoms. As it progresses, you may experience symptoms such as blurred or patchy vision, floaters (spots or dark strings floating in your field of vision), difficulty seeing at night, eye pain or redness, and, eventually, vision loss.

Regular eye exams are crucial for people with diabetes to detect and manage diabetic retinopathy early. Treatments may include laser therapy, medication, or surgery, depending on the severity of the condition. Good blood sugar control and overall diabetes management can also help reduce the risk of developing diabetic retinopathy.

The risk of developing diabetic retinopathy increases with the duration of diabetes and poor blood sugar control. Increased blood pressure and cholesterol levels can also lead to its progression.

What Are The Types Of Diabetic Retinopathy?

Diabetic retinopathy can be categorized into two main types based on its severity and advancement:

1. Non-proliferative diabetic retinopathy (NPDR): This is the early stage of diabetic retinopathy. In NPDR, the blood vessels in the retina become weak and may leak small amounts of blood or fluid into the eye. If this leaking and swelling happens over the macula, it is known as macular edema. If the swelling continues to advance, it can cause the blood vessels to close off entirely, leading to macular ischemia, which will cause irreversible central visual loss that is not treatable and is permanent.

2. Proliferative diabetic retinopathy (PDR): This is the advanced stage of diabetic retinopathy. In PDR, new, weak blood vessels develop on the surface of the retina and into the vitreous gel inside the eye. These new vessels are prone to bleeding, which can cloud the vitreous and lead to extreme vision loss. Scar tissue can also form, leading to retinal detachment and potentially complete blindness.

Both types of diabetic retinopathy can impact one or both eyes. It is essential to note that diabetic retinopathy is a progressive medical condition. NPDR can progress to PDR over time, specifically if diabetes is not managed properly. Regular eye exams are important for early detection and management of diabetic retinopathy to prevent severe vision loss.

How Can Diabetic Retinopathy Be Diagnosed?

Diagnostic tests for diabetic retinopathy are crucial for early detection and monitoring of the condition. Here are some diagnostic tests used by ophthalmologists or optometrists to diagnose diabetic retinopathy:

• Dilated eye examination: This is the most common and important test for diabetic retinopathy. The eye doctor will use eye drops to dilate the pupils, allowing them to analyze the inside of the eye more thoroughly. Using a unique magnifying lens, they will inspect for signs of diabetic retinopathy, such as abnormal blood vessels, inflammation, and changes in the retina.

• Visual acuity testing: Visual acuity test uses an eye chart to measure how well you can see at various distances (near and far distances). It helps determine how much diabetic retinopathy may have impacted central vision.

• Fluorescein angiography: In this diagnostic test, a special organic dye is injected into a vein in the hand or arm. The dye travels through the blood vessels in the eyes, making them visible in photographs. Your doctor utilizes a special eye camera to take pictures of the retina. You look into one side of the camera while the doctor looks through the other side. The camera blazes a dim blue light into the eye, which causes the dye flowing through the retina arteries to appear fluorescent green. The doctor takes pictures of the eyes to examine more closely later. This test helps identify leaking blood vessels, blockages, and abnormal blood vessel development in the retina.

• Optical coherence tomography (OCT): OCT is a non-invasive imaging technique that provides clear and detailed cross-sectional images of the retina. It helps assess the thickness of the retina and recognize swelling (edema) or fluid accumulation in the macula. This test is useful for quantitative as well as qualitative assessment of structural differences that occur in diabetic retinopathy. It also enables the detection of subclinical diabetic macular edema.

• Fundus photography: In this assessment test, high-resolution photographs are taken of the inside of the eye to confirm the presence and progression of diabetic retinopathy.

• Tonometry: Tonometry measures intraocular pressure (IOP) and is primarily used to diagnose glaucoma, which is more common in people with diabetes.

• Visual field testing: This test measures peripheral vision and can help detect any loss of side vision caused by diabetic retinopathy or other eye conditions.

• Amsler grid test: Amsler grid test can detect early and sometimes subtle visual changes in various macular diseases, including diabetic macular edema.

Early detection through regular eye exams is important for managing diabetic retinopathy effectively. However, the frequency of eye examinations will depend on the stage of diabetes, how well your blood sugar is maintained, and your doctor’s recommendations. If diabetic retinopathy is detected, your eye care provider will determine the suitable treatment plan to prevent or manage vision loss.

What Are The Various Treatment Options For Diabetic Retinopathy?

Here’s an overview of both surgical and non-surgical treatment options for diabetic retinopathy:

Surgical Treatment Options

Surgical treatment options for diabetic retinopathy include:

1. Vitrectomy (vitreoretinal surgery): Vitrectomy is a surgical procedure that involves removing the vitreous gel and any scar tissue that may be pulling on the retina. It is commonly used in cases of severe diabetic retinopathy with substantial bleeding into the vitreous or tractional retinal detachment. It is also used when other non-surgical treatments, such as laser therapy or injections, have not effectively managed the condition. During the procedure, the surgeon creates tiny incisions in the eye to access the vitreous gel. The vitreous gel is extracted, and any scar tissue or blood in the vitreous is also cleared. If an individual requires a vitrectomy in both eyes, a surgeon will only perform surgery on one eye at a time. They will typically schedule surgery for the second eye after recovery from the first procedure.

2. Laser photocoagulation: Laser photocoagulation is a medical procedure that utilizes a laser beam to treat various eye diseases, including diabetic retinopathy. This treatment seals specific leaking blood vessels in a small area of the retina, usually near the macula. During laser photocoagulation, a focused laser beam is directed into the eye. The laser creates small, controlled burns in the targeted areas of the retina. The laser is commonly applied to the peripheral or outer regions of the retina, particularly targeting areas with abnormal blood vessels or areas where fluid is leaking into the retina. The heat induced by the laser seals the blood vessels, preventing further growth and leakage. In the case of macular edema, diabetic retinopathy laser treatment can help reduce swelling.

3. Panretinal photocoagulation (PRP): Similar to laser photocoagulation, PRP involves applying laser treatment to the peripheral regions of the retina to lower the growth of abnormal blood vessels in proliferative diabetic retinopathy. The PRP laser treatment prevents abnormal new vessels on the retina and in the drainage system of the eyeball from developing and encourages existing ones to shrink. This makes them less likely to bleed into the jelly in the eyeball (vitreous hemorrhage) or to cause painful pressure within the eye (neovascular glaucoma). During the procedure, the doctor will place a multitude of laser burns across a wide area of the peripheral retina. The burns cause the abnormal blood vessels to shrink and scar. At times, the procedure is broken up into two or three treatment sessions depending on the extent of the disease and the patient’s tolerance for the procedure.

4. Eye injections: In some cases of diabetic retinopathy, injections of a medicine called anti-VEGF (vascular endothelial growth factor) may be given directly into the eyes to prevent new blood vessels from forming at the back of the eyes. These injections help reduce swelling, control abnormal blood vessel growth, and enhance vision. The main medicines used are ranibizumab (Lucentis) and aflibercept (Eylea). During the procedure, the skin around the eyes is cleaned and covered with a sheet. Small clips are utilized to keep the eyes open, and local anesthetic drops are given to numb the eyes. Then, a very fine needle is guided into the eyeball, and the injection is given.

FAQs about Diabetic Retinopathy treatment in iran

How long does diabetic retinopathy surgery take?

Typically, surgical treatment of diabetic retinopathy takes around 40 to 60 minutes. The average time is around one hour, depending on how long the anesthesia takes to numb the eyes. The duration may also differ if additional treatment is being performed.

How much is the cost of diabetic retinopathy treatment in iran ?

The cost of treating diabetic retinopathy can vary significantly depending on the severity of the condition and the treatment required. Mild cases of diabetic retinopathy may require only monitoring and lifestyle changes, while more severe cases may require invasive procedures such as laser treatment or surgery.

Laser treatment for diabetic retinopathy involves using a laser to shrink abnormal blood vessels and prevent further damage to the retina. The cost of laser treatment depending on the clinic and the number of sessions required.

In some cases, surgery may be required to repair retinal detachment or to remove blood from the vitreous gel. The cost of surgery can vary depending on the type of surgery required .

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Can diabetic retinopathy recur after treatment?

Yes, diabetic retinopathy can recur even after surgical treatment as the underlying cause of the condition cannot be cured. If you fail to manage diabetes even after surgery, the condition can progress again.

What are the foods to avoid to prevent diabetic retinopathy?

By following a healthy lifestyle and sticking to the recommended diabetic diet, you can maintain healthy eyes and prevent the progression of diabetic retinopathy. It is essential to consult your doctors or nutrition experts regarding the consumption of foods to prevent diabetic retinopathy. Some of the foods that should be avoided include highly processed foods, saturated and trans fats, and excess salt.