About Diabetic Retinopathy

Diabetic retinopathy is a diabetes complication that affects the eyes. It is caused by damage to the blood vessels of the light sensitive tissue, which is placed at the back of the retina. Diabetic retinopathy may not have any symptoms or mild visions but it eventually can cause blindness. Diabetic retinopathy can occur in patients with type 1 or type 2 diabetes. The longer and less controlled diabetic patients are more likely to develop diabetic retinopathy. There may be no symptoms in the early stages of diabetic retinopathy but as the condition progresses the symptoms may occur that include:

  • Floaters (spots or dark strings floating)
  • Fluctuating vision
  • Blurred vision
  • Impaired color vision
  • Dark or empty areas in the vision
  • Vision loss

Diabetic retinopathy generally affects both of the eyes. In time too much sugar in the blood can lead to a blockage of the tiny blood vessels that nourish the retina and cut off its blood supply. As a result the eye attempts to grow blood vessels but they won’t develop properly and leak quite easily. There are two types of retinopathy

Early Diabetic Retinopathy – also called nonproliferative diabetic retinopathy (NPDR). The walls of the blood vessels in the retina of patients with NPDR weaken. Little bulges (microaneurysms) protrude from the vessel walls of the smaller vessels and sometimes leak fluid and blood into the retina. Larger retinal vessels can begin to dilate and they become irregular in diameter. NPDR is able to progress from mild to severe as the number of blood vessels blocked increase. Nerve fibers in the retina may begin swelling and in some cases the central part of the retina (macula) begins swelling (macular edema) which also requires treatment.

Advanced Diabetic Retinopathy – is a more severe type of diabetic retinopathy, which is also called proliferative diabetic retinopathy. Damaged blood vessels close off causing the growth of new abnormal blood vessels in the retina and they can leak into the vitreous (clear substance which fills the center of the eye). Scar tissue stimulated from the growth of new blood vessels can cause the retina to detach from the back of the eye. If the new blood vessels are interfering with the flow of fluid out of the eye, the pressure may increase in the eyeball and this can damage the nerve, which carries image from the eye to the optic nerve and cause glaucoma.

Every person with diabetes can develop diabetic retinopathy but the risk of developing a diabetic retinopathy can increase because of

  • Duration of diabetes
  • Poor control of the blood sugar levels
  • High blood pressure
  • High cholesterol
  • Pregnancy
  • Tobacco

Diabetic retinopathy is diagnosed best with a dilated eye test (Fluorescein Angiography). During the test eye drops will be placed in the eye to dilate the pupils to allow for a better view of inside the eyes. During the test the ophthalmologist will search for

  • Abnormal blood vessels
  • Swelling, blood or fat deposits in the retina
  • Growth of new blood vessels and scar tissue
  • Bleeding in the vitreous
  • Retinal detachment
  • Abnormities in the optic nerve

The ophthalmologist will also test

  • The vision
  • The eye pressure to test for glaucoma
  • Evidence of cataract

The ophthalmologist may also request an OCT (optical coherence tomography) test. This is an imaging test that provides cross sectional images of the retina. This shows the thickness of the retina that helps to determine if fluid is leaked into the retinal tissue. The OCT tests can also be used to monitor how the treatment is working.

Diabetic Retinopathy Procedure

Treatment depends on the type of diabetic retinopathy that the patient has and how severe it is.

Early Diabetic Retinopathy – if patient has mild or moderate nonproliferative diabetic retinopathy, treatment may not be needed straight away. When diabetic retinopathy is at a mild or moderate state, having a good sugar control can slow down the progression.

Advanced Diabetic Retinopathy – if patient has proliferative diabetic retinopathy or macular edema, then surgical treatment is needed. Depending on the situation of the retina the types of surgery available is

Focal Laser Treatment – also known as Photocoagulation. It can stop or slow the leakage of blood and fluid in the eye. During the procedure leaks from the abnormal blood vessels are treated with laser burns. Focal laser treatment is done in a single session.

Scatter Laser Treatment – also called Panretinal Photocoagulation (PRP). This can shrink the abnormal blood vessels. During the procedure the area of the retina away from the macula is treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar. This can be done in two or more sessions.

Vitrectomy – this procedure uses a tiny incision in the eye to remove blood from the vitreous as well as scar tissue that are tugging on the retina. It can be done under local or general anesthesia. The surgery can slow or stop the progression of diabetic retinopathy.

Suitable Patients for Diabetic Retinopathy

The surgery is suitable for both males and females who are

  • At a good health condition
  • Over the age of 18
  • Are healthy mentally and physically
  • Patients with diabetes type 1 or type 2

Before Diabetic Retinopathy

  • Patients must stop smoking a week before the surgery
  • Any medication and herbal supplements must not be used unless told by the ophthalmologist
  • Patients must arrange for someone to assist them before and after the surgery

After Diabetic Retinopathy

• Patients can return to work after 2 days of the surgery

• Patients must take great care controlling their sugar levels

• Patients must keep a healthy diet

• Patients must quit smoking

• Patients may need to wear an eye patch to protect the eye

Risks of Diabetic Retinopathy

Like every surgery there are some risks with diabetic retinopathy such as

  • Infection
  • Allergy to anesthesia if used
  • Bleeding

Definition

Retina – the inner coat of the eye

Blood Vessels – carries blood through the organs and tissues

Vitrectomy – surgery that removes all of or partly, the vitreous humor from the eye

Macula – area near the centre of the retina

Vitreous – clear substance in the eye

Incision – surgical cut made in the skin during surgery or treatment

Local Anesthesia – induces absence of sensation to a specific part of the body

General Anesthesia – variety of medications given to ensure unconsciousness, loss of control of reflexes. The patient is put to sleep to not feel any pain or discomfort.

First day of Diabetic Retinopathy

The patient will attend a consultation with the ophthalmologist and will be advised about the procedure and their condition. The patient will then be taken through a couple of tests that are required before the treatment. If desired, patients can spend the day to rest and attend the clinic the next day.

Second day of Diabetic Retinopathy

Diabetic Retinopathy surgery will be performed. The surgery will take around 30 minutes to perform on each eye. The surgery will be done using an OCT device to take cross sectional images of the retina and a PRP device will also be used. The use of anesthesia will depend on the kind of treatment performed and once the surgery ends an eye patch will be applied to protect the eye and once the patient is feeling better, then they can return to their settlement with someone accompanying.

Third day of Diabetic Retinopathy

Patients will attend a post surgery check up and consultation. If they are approved to be in a good, healthy condition and the surgery results were all successful; the patients are advised with post treatment care requirements and are ready to go back to their normal routine.

Notes

• Trip schedule may vary. medicTurkey patient relations will provide you a detailed trip schedule before the travel.

• For details on accommodation, transportation and other services, please check the SERVICES page.

What is Diabetic Retinopathy?

Diabetic retinopathy is a diabetes complication that affects the eyes. It is caused by damage to the blood vessels of the light sensitive tissue that is placed at the back of the retina.

How is the Diabetic Retinopathy done?

Treatment depends on the type of diabetic retinopathy the patient has and how severe it is.

There are various ways of treatment like

  • Advanced diabetic retinopathy
  • Focal laser treatment
  • Scatter laser treatment
  • Vitrectomy

How long does Diabetic Retinopathy take?

The surgery usually takes up to 30 minutes to perform on each eye.

When can I return to work?

Patients are able to return to work after a week from the surgery.

How long do I need to stay at hospital?

The surgery is done on an outpatient basis so the patient is sent home after a few hours from the surgery, however if there are any complications with the patient’s sugar levels then there may be a requirement for the patient to stay the night.

How long do I need to stay in Turkey?

The recommended stay in Turkey for Diabetic Retinopathy surgery is 2-3 days including consultation before the surgery and after the surgery.

Are there any risks of Diabetic Retinopathy?

Like every surgery there are some risks that are quite rare like

  • Infection
  • Bleeding
  • Allergy to anesthesia

Devices used in Diabetic Retinopathy Surgery

An OCT (optical coherence tomography) device is used to give cross sectional images of the retina. A Pan Retinal Photocoagulation (PRP) device is also used during the surgery.

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