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Diabetic Retinal Disease

What Causes Diabetic Retinopathy?

Diabetic retinopathy occurs in individuals with diabetes, a condition in which the levels of glucose (sugar) in the blood are too high. The high blood sugar levels damage the blood vessels in the retina, the innermost layer of the eye responsible for one’s vision. Diabetic retinopathy manifests in various ways:

Non Proliferative Diabetic Retinopathy (NPDR)

NPDR is an early stage of diabetic retinopathy in which tiny blood vessels within the retina leak blood, fluid, or cholesterol. This leakage can lead to blurry vision if it affects the macula, a small area in the center of the retina that enables us to see fine details clearly. When damaged blood vessels leak fluid into the retina it results in a condition known as diabetic swelling of the macula, a region that provides the sharp vision needed for reading and recognizing faces.
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What Are Some Symptoms of NPDR?
In the early stages of the disease, patients may not even know that they have NPDR as the condition is asymptomatic.
In general, NPDR does not require specific treatment, however in an individual with severe NPDR with a higher risk of progression to PDR, treatment is similar to PDR with intravitreal injections of anti-VEGF medications , or laser photocoagulation to the retina.

Otherwise, individuals with milder forms of NPDR are serially monitored.
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Proliferative Diabetic Retinopathy (PDR)

PDR develops when abnormal new vessels start growing on the surface of the retina. The main cause is due to a lack of blood flow from many closed retinal blood vessels. New blood vessels termed “neovascularisation” are formed to supply blood to the area where the original vessels closed. Unfortunately, the new abnormal blood vessels are very fragile, leading to further leakage of blood. The following consequences can develop in an eye with PDR:
  • Bleeding into the vitreous gel
  • Bleeding onto the retinal surface developing into scar tissue that may cause wrinkling or detachment of the retina. Macular wrinkling or detachment can cause visual distortion or severe vision loss
  • Growth of blood vessels on the iris, causing clogging of the fluid drainage pathway in the eye, resulting in high eye pressures and a serious eye condition known as neovascular glaucoma.
If left untreated, these complications can cause blindness and even loss of the eye.
What Are Some Symptoms of PDR?

PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision.

 

Other symptoms of PDR include:

  • Blurry vision
  • Difficulties with night vision
  • Floaters
  • It may also take a long time for eyes to adjust to changes in lighting conditions (ie, going from a dark room to the bright outdoors, or vice versa).

Strict control of your blood sugar and blood pressure will significantly reduce the long-term risk of vision loss from diabetic retinopathy.

Diabetic retinopathy is best diagnosed with a comprehensive dilated eye exam. For this exam, drops placed in your eyes widen (dilate) your pupils to allow your doctor a better view inside your eyes.
  • Visual acuity test: This test will be done to assess the sharpness of your vision.
  • Optical coherence tomography (OCT): With this test, pictures provide cross-sectional images of the retina that show the thickness of the retina. This will help determine how much fluid, if any, has leaked into retinal tissue. Later, optical coherence tomography (OCT) exams can be used to monitor how treatment is working.
  • Retinal photography: An ultrawide fundus image is captured to assess the retina
  • Fluorescein angiography: After your eyes are dilated, a dye is injected into a vein in your arm. Then pictures are taken as the dye circulates through your eyes' blood vessels. The images can pinpoint blood vessels that are closed, broken or leaking.

What Causes Diabetic Macular Oedema (DMO)?

DMO occurs when high blood sugar levels damage the tiny blood vessels in the macula, the central portion of the retina responsible for fine and precise vision. Tiny bulges, called microaneurysms, form in the blood vessels, leaking fluid into the retina. The fluid can cause swelling in the macula.
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What Are the Symptoms of DMO?
  • Blurry vision or double vision
  • Difficulty seeing colours
  • Dark spots or patches in vision
  • Straight lines appear bent or curved
  • Difficulty seeing when there’s glare or bright light
One of the ways that providers treat DME is with a series of intravitreal injections of medications into the eye. At Ascend Eye Clinic, we offer the following medications:
  • Aflibercept (Eylea)
  • Faricimab-svoa (VABYSMO)
  • Ranibizumab (Lucentis)
  • Dexamethasone (Ozurdex)
Intravitreal injections of anti-VEGF are the main form of treatment for DMO
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Why Choose Us?

DR ERROL CHAN

Specialised Experience in Retinal Care

Dr Chan is a triple-Fellowship trained and experienced Ophthalmologist. He has international clinical experience from McGill University and Moorfields Eye Hospital London, and has been awarded Ophthalmology accreditation from the UK, Canada & Singapore. He specialises in diagnosing, managing and treating vitreoretinal diseases, including complex and second opinion cases.
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Meet Dr Errol Chan

DR ERROL CHAN

Meticulous Approach

Our meticulous approach means that every detail is considered, from your medical history to your lifestyle needs, as we aim to provide you with the most optimal retinal care.
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Meet Dr Errol Chan

DR ERROL CHAN

Comprehensive Diagnostic Technologies

A comprehensive detection of retinal tears or detachment necessitates specialised imaging equipment that are available at Ascend Eye Clinic.
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Meet Dr Errol Chan

DR ERROL CHAN

Individualised Treatment

With the aim to optimally preserve your eye health as far as possible, we create personalised treatment plans that are tailored to your specific needs and vision goals.
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Meet Dr Errol Chan

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