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Darlingdownseye.com.au

Dr. Gilda Kert
MBBS (QLD) FRANZCO
DIABETIC RETINOPATHY
Diabetic retinopathy occurs in diabetics and usually one of three
forms predominates:
1. Background Diabetic Retinopathy
2. Macula oedema
3. Proliferative Diabetic Retinopathy

Background Diabetic Retinopathy (BDR)
This is the commonest eye condition affecting diabetics and
fortunately rarely results in visual loss. The eyes of most diabetics
show signs of BDR which include scattered retinal hemorrhages
(bleeds) and exudates (leaking areas of fluid) to a greater or lesser
extent. This condition needs to be monitored by Dr. Kert at least
every 12-18 months for signs of progression to the worse forms of
diabetic retinopathy (see below)
Macula Oedema
This condition is more common in Type II diabetics and can be
very difficult to treat if it presents late. It is caused by the collection
of fluid at the very centre of the retina and can impair reading,
driving a car and other visual tasks. It can lead to blindness. The
mainstay for treatment is focal laser photocoagulation and this is
more effective if it is initiated before you notice any visual loss.
There are other treatments available for this condition including
intra-vitreal injections into the eye itself (avastin or triamcinolone).
Proliferative Diabetic Retinopathy (PDR)
This is a serious condition which represents the end stage of years
of damage to the retina by the high blood sugar levels in diabetics.
It is characterised by the development of abnormal new blood
vessels in the retina which are fragile and can bleed, impair vision
and cause scarring. In time this process can result in retinal
detachment and blindness. Several large studies have shown that
pan- retinal laser photocoagulation (PRP) is the best treatment for
this condition and results in a 50% reduction in severe visual loss.
Risk Factors for Diabetic Retinopathy

The two major factors that influence the development of diabetic
retinopathy are:
1. The duration of diabetes. The longer you have had diabetes, the more likely you are to have diabetic retinopathy 2. The control of diabetes. The worse the control, the more likely you will develop diabetic retinopathy earlier. Other factors also contribute to progression of diabetic retinopathy a. Kidney Damage b. High blood pressure that is not controlled c. Pregnancy d. Concurrent illness e. Smoking Remember that early detection of diabetic retinopathy results in
the best vision long-term

Pan-Retinal Photocoagulation (PRP)

Pan- retinal photocoagulation is indicated for diabetic patients who
have proliferative diabetic retinopathy and are at high risk of
progression and blindness. If you have this condition, you might be
unaware of it, or you might have experienced a haemorrhage
(bleed) into the back of the eye which looks like a dark floating
cloud.
Dr. Kert will preferentially perform a fluorescein angiogram (dye
test) to better demonstrate the extent of the disease and this gives
you an opportunity to see pictures of the condition in your eye.
During PRP, a special laser is used to make tiny burns that seal
the retina and destroy some of the poorly functioning (sick) retina.
The aim of the laser is to stop the retina manufacturing new blood
vessels which in turn cause all the bleeding and scarring.
It is important not to expect any improvement in vision after
laser treatment. The purpose of laser is to stop the vision
from deteriorating further.

Laser Treatment for PDR

It is normal to have blurred vision for a few days after treatment.
Vision may sometimes be more noticeably decreased due to
swelling of the retina after laser treatment. This usually recovers
over 2-3 months, but in some patients the vision will remain
permanently damaged. You can experience recurrent bleeds
between the treatment intervals and during the regression phase
as the blood vessels retract.
Recurrences of the proliferative retinopathy may occur even after
an initial response to laser and you may require further treatment
down the track.
PRP laser sacrifices peripheral vision in order to save as much
central vision as possible. You may experience a reduction in your
side vision or night vision.
Other less common side effects include a dilated pupil (may be
permanent), loss of accommodation (difficulty reading without
glasses)
Laser for Macula Oedema

This is similar to that described above, but treatments take less
time and are targeted to a central location in your retina. It is really
important that you follow instructions to the best of your ability and
maintain steady fixation with your fellow eye.
The treatment lasts 10-15 minutes, applying 30-100 shots and is
usually completed in one session. Dr. Kert will review you 6 weeks
after the treatment and the treatment may need to be repeated in
the future.
What to expect on procedure day
Your treatment will be performed in a specially equipped laser
room.
It is advisable to take some panadol or nurofen at home, one hour
prior to the treatment.
When you arrive, your treatment eye will be dilated and a contact
lens placed on the eye to focus the laser beam. You will be asked
to maintain fixation with the fellow eye so that the treatment can be
targeted correctly, and this can be achieved by staring at a
designated target. Each session usually lasts about 15-30 minutes.
You will need someone to transport you home and you might need
to take a panadol or nurofen at home if you experience a dull ache
Regular follow-up visits are required.
Please contact Dr. Kert if you have any questions

Source: http://www.darlingdownseye.com.au/Uploads/Documents/Diabetic%20Retinopathy-%20info%20sheet.pdf

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