Diabetic Retinopathy

Diabetic retinopathy is damage to the small blood vessels of the retina caused by diabetes. Vessels leak, close off, and in advanced stages fragile new vessels grow that can bleed or pull the retina off. Swelling at the centre of the retina, called diabetic macular oedema, can occur at any stage and is the usual cause of blurred central vision.

It causes no symptoms until it is advanced, which is why yearly screening matters. Found early, sight loss is largely preventable with good diabetes control, injections and laser. Damage that has already occurred is often only partly reversible.

Symptoms

• No symptoms at all in the early and even moderately advanced stages
• Gradually blurred or distorted central vision from macular oedema
• Vision that fluctuates with blood sugar
• A sudden shower of floaters or a red haze, from bleeding into the vitreous
• Patches of missing vision
• Poor night vision

Causes and risk factors

Years of raised blood glucose injure the lining of retinal capillaries. The main risk factors are duration of diabetes, poor glucose control (high HbA1c), high blood pressure, raised lipids, kidney disease, smoking and pregnancy. Both type 1 and type 2 diabetes are affected. Very rapid tightening of glucose control, including after starting some newer injectable diabetes drugs or after bariatric surgery, can temporarily worsen retinopathy, so an eye check beforehand is wise.

How it is diagnosed

• Dilated retinal examination or retinal photography: The screening test, recommended yearly for everyone with diabetes.
• OCT scan: Measures macular thickness and detects oedema; guides injection treatment.
• Fluorescein angiography or OCT angiography: Maps leaking vessels and areas of closed capillaries.
• Ultrasound: Used when blood in the eye blocks the view of the retina.
• Blood tests and blood pressure: HbA1c, lipids and kidney function, because general control drives the eye disease.

Treatment options

• Glucose, blood pressure and lipid control: The foundation. Slows progression at every stage.
• Anti-VEGF injections: Medicine injected into the eye, first-line for macular oedema and increasingly used for proliferative disease. Usually monthly to begin with, then less often, for a year or more.
• Steroid implants or injections: An option when anti-VEGF does not work well enough; can raise eye pressure and cause cataract.
• Panretinal laser photocoagulation: Makes new vessels regress in proliferative retinopathy. Delivered over 1 to 3 sessions. Durable, with some loss of side and night vision.
• Focal macular laser: Now a secondary option for leaking spots away from the centre.
• Vitrectomy: For bleeding that does not clear or scar tissue pulling on the retina.

When it is urgent

A sudden loss of vision, a sudden burst of floaters, a dark curtain across your sight, or a painful red eye with a history of proliferative retinopathy needs urgent assessment by an eye service near you within 24 hours. Do not wait for a planned trip.

Travelling to Türkiye for treatment

This is a chronic disease and its core treatment, repeated injections every 4 to 8 weeks with OCT monitoring, cannot be delivered by occasional travel. What a visit can sensibly offer is a thorough retinal work-up with OCT and angiography, a second opinion on a proposed plan, panretinal laser completed over a short stay, or a planned vitrectomy with suitable recovery time. Make sure a retinal service at home will continue your care, and bring your HbA1c results and previous scans.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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