Proliferative Diabetic Retinopathy - Symptoms and Treatment

Diabetic retinopathy is a complication that arises as a result of diabetes and has an effect on the patient's eyes. It predominantly affects the retinal layer of the eye. It occurs due to the blockage in the blood vessels supplying the eyes. Diabetic retinopathy commonly occurs due to poor blood sugar control in patients with diabetes.

Initially, diabetic retinopathy may not produce very prominent symptoms. Even when the symptoms appear, they are very mild. However, diabetic retinopathy is serious and can even cause blindness, if not treated in time. 

Diabetic retinopathy is classified into two types:

1. Non-proliferative diabetic retinopathy
2. Proliferative diabetic retinopathy.

Diabetic retinopathy progresses from mild non-proliferative retinopathy to proliferative retinopathy if not diagnosed and treated on time. Proliferative diabetic retinopathy is the final stage of diabetic retinopathy, where the damage is worse. There are four stages of diabetic retinopathy, where stage 4 is the final stage. Diabetic retinopathy progresses in the following way to reach proliferative diabetic retinopathy:

1. Mild non-proliferative diabetic retinopathy: This is the stage where diabetic retinopathy is at its earliest point. In this stage, the retina's small blood vessels swell up, also called microaneurysms. Here, macular swelling can occur due to fluid leakage into the retina. 
2. Moderate non-proliferative diabetic retinopathy: In this stage, blood flow to the retina is disturbed as the blood vessels keep swelling. This increased swelling prevents the retina from getting nourished properly. As a result, blood and other fluids start accumulating in the macula. 
3. Severe non-proliferative diabetic retinopathy: In this stage, the blood flow to the retina is significantly decreased due to the blockage by the swollen blood vessels. As a result of this reduced supply of blood, the body generates signals to start making new blood vessels in the retina. This is where diabetic retinopathy advances to reach its final stage, proliferative diabetic retinopathy. Progression from severe non-proliferating diabetic retinopathy to proliferative retinopathy may occur in 12 months. 
4. Proliferative diabetic retinopathy: The last stage of diabetic retinopathy is characterised by the growth of new blood vessels in the retina and posterior surface area of the vitreous.  This is known as neovascularization. These newly grown blood vessels are incredibly fragile and may often break and bleed into the vitreous, making it difficult to see properly. Eventually, scar tissue forms in the retina, which ultimately causes retinal detachment from the back of the eye. This results in severe loss of vision in the later stages.  

In the early stages, the patient is unlikely to experience any signs and symptoms. Even when the symptoms appear, they are very mild. The symptoms which indicate the change to proliferative diabetic retinopathy include the following:

1. The appearance of floaters in the vision
2. Blurred vision
3. Vision fluctuations
4. Weak night vision 
5. Colours appearing faded 
6. Reading problems 
7. Trouble seeing distant objects
8. Sudden loss of vision

The major cause of proliferative diabetic retinopathy is diabetes, which includes type 1, type 2 and gestational diabetes. Diabetes causes damage to small blood vessels in the whole body, including the blood vessels in the retina. 

Increased and uncontrolled blood sugar levels lead to new blood vessels and scar tissue forming on the retina, which leads to proliferative diabetic retinopathy. 

Who is at risk of developing Diabetic Retinopathy?

 

Although anyone with diabetes can develop diabetic retinopathy, which, when left unattended, eventually progresses to proliferative diabetic retinopathy, its risk is higher in the following people:

1. Pregnant women 
2. People having long-term diabetes 
3. People with high blood pressure or high levels of cholesterol
4. People who consume tobacco 

The best way to reduce the risk of proliferative diabetic retinopathy is by preventing its progression through timely diagnosis and treatment in its early stages. The following tips can also help in preventing and lowering the risk:

1. Effective management of blood sugar levels
2. Getting eye examinations done annually
3. Avoiding or quitting smoking
4. Eating healthily
5. Exercising regularly
6. Taking the prescribed medications on time 

To diagnose diabetic retinopathy, the doctor will conduct a detailed dilated eye examination, where the doctor will check the insides and outsides of the eye for any abnormality. To perform this examination, the doctor will begin by adding eye drops to dilate the pupils, as it gives the doctor a better visual of the insides of the eye. 

In the next step, fluorescein angiography is performed by injecting a dye into the arm of the patient. The injected dye moves into the blood vessels in the eye. The doctor clicks pictures of the eyes, showing the blood vessels in the eye that are broken, closed or leaking. 

Additionally, optical coherence tomography (OCT) can also be performed by the doctor to get cross-sectional images which will help in viewing the thickness of the retina and the amount of fluid that has leaked into the tissue of the retina.

Note: The eye drops added for eye dilation may cause blurred vision until its effect is gone. 

How to prepare for the doctor's consultation?

Preparing for the consultation in this way will ensure that you get the most out of your visit and that the doctor has all the information they need to give you an accurate diagnosis and appropriate treatment plan. To prepare yourself for consulting a doctor if you have proliferative diabetic retinopathy, you can follow the below-mentioned tips:

1. Before heading to the doctor's clinic for consultation, book an appointment beforehand.
2. During the procedure, the doctor will ask questions about the symptoms one may be experiencing.
3. During the examination, one may ask questions regarding the condition, its progression and how to prevent it.

The treatment for proliferative diabetic retinopathy is dependent on certain factors. The doctor will consider the following factors while formulating a treatment plan:

1. Age of the patient 
2. The medical history of the patient 
3. The extent of retinal damage 
4. Visual acuity 
5. HgbA1c
6. Patient's response to the previous treatment 

In the early stages of diabetic retinopathy, the doctor may wait and monitor the patient. This method is called watchful waiting. At this point, the patient will be required to undergo eye exams every 2 to 4 months. In most cases, the doctor may prescribe ways to manage blood sugar levels to slow down the progression of diabetic retinopathy. 

In the case of proliferative diabetic retinopathy (advanced stage), the following treatments may be prescribed depending on how severe the condition is. The treatment options available include, 

Injections 

1. The doctor will inject medications like anti-vascular endothelial growth factor (anti-VEGF) drugs or corticosteroids to treat the patient. These medications reduce the swelling and leakage from the blood vessels into the eyes. 
2. Before injecting, the doctor will numb the eyes. Initially, the injections may be required daily. However, over time the frequency will reduce or may not be given.  

Laser Treatment

1. Laser therapy helps shrink and seal the blood vessels in the eye. Laser treatment is also known as Scatter laser surgery or photocoagulation. The doctor may either use scatter laser treatment to shrink the blood vessels in the eyes or a focal laser to either control or stop the leaking of blood and fluid. 
2. A patient might require more than one laser treatment session to see its effect. 

Surgery

1. If the proliferative retinopathy is very advanced, then surgery may be required. This surgery is called a vitrectomy. In a vitrectomy, the doctor will remove the fluid present in the eye, known as the vitreous fluid. As a result of which, the cloudy fluid affecting the eye's vision will be removed.
2. During this time, the doctor will also repair blood vessels and remove the scar tissue. After the surgery, the patient must wear an eye patch for around a day. The doctor will also prescribe EYE drops to help reduce swelling and prevent infections.
3. It is essential to know that surgery cannot cure diabetic retinopathy. It may only inhibit or slow the advancing of the symptoms. Since diabetes is a long-term problem, diabetic retinopathy and loss of vision may happen, regardless of the treatment provided to the patient.

Treatment Method	Cost of treatment
Laser treatment	₹30,000 - ₹50,000
Surgery	₹50,000- ₹80,000

The various complications that may occur due to proliferative diabetic retinopathy include the following:

1. Diabetic macular oedema
2. Retinal detachment 
3. Neovascular glaucoma
4. Vitreous haemorrhage
5. Severe fibrovascular proliferation

The diet that is to be taken by patients with proliferative diabetic retinopathy is the same as the one that is to be taken during diabetes. A patient with proliferative diabetic retinopathy can get a diet prescribed by a doctor or a dietician. However, in general, the following foods are to be included and avoided in a patient with proliferative diabetic retinopathy:

Foods to Eat

1. Fruits and vegetables 
2. Nuts and seeds
3. Whole grains like oatmeal, millet and quinoa
4. Beans 
5. Tofu 
6. Low-fat cheese, milk and yoghurt 
7. Oils like olive oil and grape seed oil
8. Fatty fish, eggs and chicken

Foods to avoid 

1. Anything that contains sugar like fruit juices, ice creams and sweets
2. Deep fried and fast foods as they contribute to cholesterol 
3. Honey, maple syrup, fruit flavoured yoghurts and Dried fruits

Diabetic retinopathy is common in diabetic patients. Where non-proliferative diabetic retinopathy means that the condition is in its early stages, proliferative diabetic retinopathy indicates the disease is in its advanced stage. It is essential to get annual eye examinations done to find diabetic retinopathy in its early stages. 

When left untreated, diabetic retinopathy can give rise to several complications like diabetic macular oedema, retinal detachment, and neovascular glaucoma. The treatment modalities of diabetic retinopathy include eye injections, laser therapy, and surgery. 

Since surgery cannot cure proliferative diabetic retinopathy, it is best to prevent the disease from progressing by managing blood sugar levels effectively.

At HexaHealth, our team of highly qualified eye doctors helps the patient in finding diabetic retinopathy in its early stages as well as provides the best treatment to those in their advanced stages. Our team ensures that the patient's blood sugar, cholesterol levels, and blood pressure are managed effectively to prevent diabetic retinopathy.