Diabetic retinopathy is a major complication of uncontrolled blood sugar that damages retinal blood vessels and threatens vision, but modern medical advancements, anti-VEGF treatments, and lifestyle management can effectively prevent permanent blindness and preserve eye health.

Diabetic retinopathy is a major complication of uncontrolled blood sugar that damages retinal blood vessels and threatens vision, but modern medical advancements, anti-VEGF treatments, and lifestyle management can effectively prevent permanent blindness and preserve eye health.

Diabetic retinopathy is a major complication of uncontrolled blood sugar that damages retinal blood vessels and threatens vision, but modern medical advancements, anti-VEGF treatments, and lifestyle management can effectively prevent permanent blindness and preserve eye health.

India is amongst the top countries in the world with a very high load of diabetic patients. Because of this, India is widely known as the diabetic capital of the world. The question we always ask is why India has such a high number of diabetic patients now. This accounts for the change in lifestyle: rapid urbanisation, less physical activity, sedentary jobs. There are certain dietary changes also, which include more carbohydrates, more processed food and high-fat items and less fibre-rich foods, stress and lack of sleep is also one of the problems because it impairs the cortisol levels which affects insulin levels ,add to that is genetic predisposition is also one of the factors since the tendency to store abdominal fat which creates higher insulin resistance.

How does diabetes affect our eyes? For a basic understanding, let's imagine the eye as a camera: the cornea acts like the camera's lens, and the retina acts like its sensor. We all know that if a camera's sensor is damaged, the photo it captures will not be clear. Similarly, in patients with uncontrolled diabetes, the retina can become damaged—a condition called diabetic retinopathy. 

Diabetic retinopathy starts years after a patient has been diagnosed with diabetes, but sometimes they already have some changes in the retina when they are initially diagnosed with high blood sugars. 

Now, what basically happens in a patient with chronic hyperglycemia or uncontrolled blood sugars is that it causes microvascular damage in the blood vessels of the retina; it also causes a tendency toward occlusion in these retinal blood vessels. Both of these cause reduced blood supply to the retina and hence reduced oxygenation. This causes a chemical called VEGF to be released into the retina. VEGF causes diabetic macular oedema, which is the most common cause of diminished vision in diabetic patients. Also, it leads to the formation of new blood vessels in the retina, which are very weak and can cause haemorrhages in the retina. 

Diabetic retinopathy ranges from non-proliferative diabetic retinopathy to proliferative diabetic retinopathy, and finally to advanced diabetic retinopathy, in which there is complete vision loss. Now, the damage once done because of hyperglycemia or uncontrolled blood sugars cannot be completely reversed; there will be some permanent structural damage to the retina, but with recent advancements and technology, we can prevent severe vision loss that can cause total blindness.

Anti-VEGF injections are given inside the eye, which reduce the damage-causing chemical VEGF in the retina and can prevent and also treat diabetic macular oedema. With recent and more potent anti-VEGFs, the treatment duration has become shorter with fewer clinic visits. Recent equipment for retinal laser has made retinal laser safer, thus preventing further progression of the disease and preventing the total loss of vision.

There was a myth decades ago that if there is diabetic retinopathy, the patient would go blind; this is not true anymore. Well-controlled blood sugars with a healthy lifestyle can prevent diabetes-related multiorgan involvement, including the eyes. Periodic consultation with your physician and getting your comprehensive eye checkup yearly or as advised by your eye doctor can prevent complete vision loss due to diabetes. 

The author is a consultant ophthalmologist at Dr Agarwals Eye Hospital, Sundakatte, Bengaluru. 

 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.