Diabetic Retinopathy Eye Surgery - Diagnosis, Surgery & Recovery

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. 

Non-surgical Treatment Options

Some of the non-surgical treatment options for diabetic retinopathy include the following:

• Medication: Diabetic retinopathy is primarily managed through medical treatments to control underlying diabetes. Here are some medications commonly used in the treatment of diabetic retinopathy:
• Corticosteroids: Steroid medications can be used to reduce swelling in the retina, particularly in cases of diabetic macular edema. Corticosteroids like bevacizumab, ranibizumab, and aflibercept are used to treat diabetic macular edema. 
• Medications to control blood sugar: Medications to control blood sugar levels, such as insulin or various oral medications, are essential for managing diabetes and slowing the advancement of diabetic retinopathy.
• Medications to control blood pressure: If you have high blood pressure, your eye surgeon may prescribe medications to control it. Proper blood pressure management is important in managing diabetic retinopathy.
• Lifestyle modifications: Lifestyle modifications can play a huge role in managing diabetic retinopathy and preventing its progression. Here are some key lifestyle changes that can help and should be followed diligently:
• Blood sugar control: Observe your blood sugar levels as advised by your healthcare provider. Keeping the blood sugar within target ranges is essential for managing diabetic retinopathy.
• Follow a balanced diet: Follow a well-balanced diet that is rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy. Also, restrict your intake of sugar, refined carbohydrates, and saturated fats. Furthermore, be mindful of portion sizes to help manage calorie intake and blood sugar levels.
• Regular exercise: Engage in regular physical activity as your healthcare provider recommends. Exercise can help reduce blood sugar levels and enhance overall health.
• Blood pressure control: Regularly check your blood pressure and follow your doctor’s advice for maintaining healthy levels. If prescribed, take blood pressure medications as directed.
• Quit smoking: If you smoke, quitting smoking is vital. Smoking can exacerbate diabetic retinopathy and increase the risk of other complications.
• Alcohol consumption: If you consume alcohol, do so in moderation. Restricting alcohol intake can help control blood sugar levels and blood pressure.
• Regular eye examinations: Make sure you have routine eye examinations with an ophthalmologist. Early detection and treatment are essential in managing diabetic retinopathy.
• Foot care: Inspect your feet daily for any sores, blisters, or signs of infection. Proper foot care is crucial, as diabetes can impact foot health.
• Stress management: Practice stress-reduction strategies such as deep breathing, meditation, or yoga to handle stress, which can affect blood sugar levels.

The choice between surgical and non-surgical treatments depends on several factors, such as the stage of diabetic retinopathy, the presence of macular edema, the severity of symptoms, and the patient’s overall health. An eye specialist will evaluate the person’s condition and advise the most suitable treatment approach. Regular eye exams and early intervention are essential to manage diabetic retinopathy effectively and prevent vision loss.

What Are The Benefits Of Early Treatment Of Diabetic Retinopathy?

Early treatment of diabetic retinopathy offers several important benefits:

• Preservation of vision: One of the most essential benefits of diabetic retinopathy treatment is preserving your vision. Early treatment can help prevent or slow down vision loss.
• Prevention of complications: By addressing diabetic retinopathy in its early stages, you can lower the risk of developing more severe complications, such as proliferative diabetic retinopathy or diabetic macular edema.
• Better quality of life: Maintaining good vision enhances overall quality of life. It enables you to engage in day-to-day activities and work without significant visual impairment.
• Reduced need for intensive treatments: Early intervention often requires less aggressive treatments than advanced stages of diabetic retinopathy. This can mean fewer injections or surgical procedures.
• Improved long-term outcomes: Early treatment can lead to better long-term results, including preserving visual acuity and preventing severe complications like retinal detachment.

Reduced risk of blindness: The ultimate benefit of diabetic retinopathy treatment is reduced risk of blindness. Timely intervention can help prevent diabetic retinopathy from advancing to a stage where vision loss becomes irreversible.

How To Prepare For Diabetic Retinopathy Surgery?

Before undergoing surgery for diabetic retinopathy, it’s important to prepare for the procedure and ensure the best possible result. Here are some pre-operative tips to follow before surgery:

• Consult with your healthcare provider: Schedule a consultation with your ophthalmologist or retinal specialist to discuss the treatment plan, potential complications, and expected outcomes.
• Medical evaluation: Make sure your overall health is stable. Your doctor might perform a thorough eye examination and conduct overall health assessments. Control medical conditions like hypertension and high blood pressure, if present, before the procedure. Also, discuss your full medical history, including any allergies and current medications, with your healthcare provider.
• Blood sugar management: Keep your blood sugar levels well-controlled before your diabetic retinopathy treatment. Unstable blood sugar can complicate surgery and impact recovery.
• Medication review: Review all your medications with your ophthalmologist. Some medicines may need to be adjusted or temporarily stopped before the procedure. It is important to stop taking medications that increase the risk of bleeding during surgery.
• Fasting guidelines: Follow any fasting instructions provided by your healthcare provider. You may need to avoid food and drink for a specific period before the procedure. This is usually from midnight the night before the surgery.
• Arrange transportation: Plan for transportation to and from the healthcare facility, as you may not be able to drive after the procedure due to dilation of the eyes or sedation.
• Eye drops: Use eye drops a few days before surgery if advised by your eye doctor. These can help prevent infection and inflammation.
• Discuss anesthesia and sedation: If the procedure involves the use of anesthesia or sedation, discuss these options with your healthcare provider. They will explain the type of anesthesia and any associated risks.
• Ask questions: Don’t hesitate to ask your doctor any queries or express any problems you may have about the procedure, anesthesia, or recovery.
• Pack all the essentials: Bring any essential items with you on the day of the procedure, such as your insurance information, identification, and any medications you need to take after the procedure.

What Are The Common Recovery Tips To Follow After Diabetic Retinopathy Treatment?

Recovery after diabetic retinopathy treatment is essential for the success of the procedure and for preserving your vision. Here are some post-operative tips to follow after diabetic retinopathy treatment:

• Follow medical advice: Stick to all post-operative instructions provided by your ophthalmologist or retinal specialist. This includes taking prescribed medications, protecting your eyes, and attending follow-up appointments.
• Use an eye shield: You may be given an eye shield to wear during sleep or as instructed after your procedure. Ensure to wear the eye shield as advised by your healthcare provider.
• Avoid rubbing: Avoid rubbing or touching your eyes to prevent infection or dislodging any eye shields or bandages.
• Limit activities: It’s advisable to restrict strenuous activities and heavy lifting for a few days following diabetic retinopathy treatment.
• Give your eyes rest: Give your eyes ample rest, mainly in the initial days after treatment.
• Use eye drops: If you’ve been prescribed eye drops by your eye doctor, use them exactly as recommended. They may be essential to prevent infection or manage inflammation.
• Maintain eye hygiene: Maintain good eye hygiene. Wash your hands thoroughly before touching your eyes or applying any eye drops.
• Avoid water exposure: Avoid swimming or exposing your eyes to water to reduce the risk of infection.
• Use sunglasses: Wear sunglasses to protect your eyes from bright sunlight and UV rays when you’re outdoors.
• Monitor vision changes: Be watchful about any changes in your vision, such as increased blurriness, sudden flashes of light, or the appearance of new floaters. Report these changes to your eye doctor promptly.
• Avoid smoking: Avoid any cigarettes until after you have fully recovered. Smoking cigarettes can reduce the body’s ability to fight off infection and heal properly, which can result in larger complications further down the line.
• Blood sugar control: As a diabetic, your number one job is to monitor your blood sugar levels at all times. Maintain strict control of your blood sugar levels through diet and medications as your healthcare provider recommends.
• Healthy diet: Eat a balanced diet rich in nutrients to support overall health and eye function.
• Follow-up appointments: Attend all follow-up appointments with your ophthalmologist. Regular monitoring is crucial to assess the success of the treatment and make any necessary adjustments.
• Follow driving restrictions: Ask your doctor about any restrictions on driving. It may be required to refrain from driving until you’re cleared by your eye care provider.

What Are The Complications Of Diabetic Retinopathy Treatment?

While treatments for diabetic retinopathy can effectively preserve vision and prevent further damage, they can also carry some complications and side effects. It’s important to discuss these risks with your healthcare provider before undergoing any treatment. Here are some complications of diabetic retinopathy treatments:

• Temporary vision changes: Following diabetic retinopathy treatment, some people may experience temporary blurriness or vision changes. These usually improve over time.
• Pain or discomfort: Treatments for diabetic retinopathy can cause mild discomfort or pain during or after treatment. This is generally short-lived but should be reported to your healthcare provider.
• Infection: Any invasive procedure, like surgical treatment of diabetic retinopathy, holds a small risk of infection.  
• Increased eye pressure: Some treatments, like intravitreal injections, can temporarily increase intraocular pressure, potentially leading to glaucoma.
• Scarring: Sometimes, treatments for diabetic retinopathy can cause scarring on the retina, which may impact peripheral vision or result in distorted vision.
• Hemorrhage: Rarely, intravitreal injections can lead to retinal or vitreous hemorrhages, which may need additional treatment.
• Cataracts: Some people may develop or worsen cataracts due to diabetic retinopathy treatments.
• Persistence or recurrence: In some cases, diabetic retinopathy may persist or recur even after treatment. Regular follow-up visits are required to monitor the condition’s advancement.

What Happens If Diabetic Retinopathy Is Left Untreated?

If diabetic retinopathy is left untreated, it can progress and lead to serious complications, including:

• Blindness: One of the most significant risks of untreated diabetic retinopathy is blindness. As the condition advances, it can cause severe damage to the retina, leading to total vision loss.
• Diabetic macular edema (DME): Over time, about half of people with diabetic retinopathy will develop DME. When you have diabetic retinopathy, the walls of the blood vessels in the retina become weak. They can leak fluid and blood into the central part of the retina, known as your macula. Macula is the part of the retina that is responsible for sharp, clear central vision. The macula swells and causes symptoms like blurriness, double vision, and a sudden increase in eye floaters.
• Proliferative diabetic retinopathy (PDR): Untreated diabetic retinopathy can progress to the proliferative stage, where abnormal blood vessels grow on the surface of the retina. These new vessels are weak and prone to bleeding, causing vision issues and scarring.
• Retinal detachment: The abnormal growth of blood vessels in proliferative diabetic retinopathy can pull on the retina, increasing the risk of retinal detachment. This is an emergency situation that requires surgery to repair.
• Vitreous hemorrhage:  The new blood vessels may bleed into the clear, jelly-like substance that fills the center of the eye. The blood obstructs light from reaching the retina. If the amount of bleeding is small, you might see only a few dark spots (floaters). However, in more serious cases, the blood can fill the vitreous cavity and completely obstruct your vision. The blood sometimes clears from the eye within a few weeks or months, but your eye doctor must watch you closely during this time. If it doesn’t clear, you will require vitrectomy surgery.
• Glaucoma: Untreated diabetic retinopathy can lead to increased intraocular pressure, increasing the risk of glaucoma, which can harm the optic nerve and result in vision loss.
• Poor quality of life: As vision declines due to untreated diabetic retinopathy, it can significantly affect an individual’s quality of life. Daily activities such as reading, driving, and recognizing faces can become challenging.

What Is The Diabetic Retinopathy Treatment Cost In India?

The diabetic retinopathy treatment cost in India can range from Rs. 20,000 to Rs. 50,000. However, several factors are vital in determining the overall treatment cost in India. Some major factors that determine the cost of diabetic retinopathy treatment include:

• Hospital or clinic: The hospital or clinic you choose for your treatment can greatly impact the diabetic retinopathy treatment cost in India. Reputed hospitals or specialized clinics might have higher treatment charges than general hospitals.
• Amenities at the healthcare facility: Hospitals or clinics with state-of-the-art equipment and better amenities might charge more for diabetic retinopathy treatment in India.
• Type of treatment: The specific treatment the ophthalmologist advises will significantly influence the cost of treatment in India. Eye injections, laser treatment, panretinal photocoagulation, and vitrectomy are options, each with its own costs.
• Doctor’s experience: The experience of the ophthalmologist performing the treatment can affect the cost. Highly skilled and reputed doctors charge more for their services.
• Diagnostic tests: Additional tests, such as slit lamp biomicroscopy, optical coherence tomography scans, fluorescein angiography, and visual field tests, might be essential for proper diagnosis and monitoring, adding to the overall cost of treatment.
• Follow-up visits: Diabetic retinopathy often needs multiple visits for treatment and monitoring by the doctor. The number of follow-up visits can affect the overall cost of treatment in India.
• The severity of the condition: The stage and severity of diabetic retinopathy can affect the complexity of treatment needed, which in turn can affect the cost of diabetic retinopathy treatment in India.
• Medication costs: If medications such as ranibizumab (Lucentis) and aflibercept (Eylea) are prescribed as part of the treatment plan, they can contribute to the overall costs.