Diabetic Retinopathy Treatment in Iran: All you need to know
Diabetic retinopathy is a complication of diabetes that causes damage to the delicate blood vessels of the retina. Diabetic retinopathy can develop if patients have type 1 or 2 diabetes. This condition may start out with only mild vision problems. However, it can eventually cause blindness if it is left untreated.
What causes diabetic retinopathy?
Diabetic patients suffer from high level of sugar in the blood, which can lead to the blockage of the tiny blood vessels that provide the retina with nutrients. As a result, the eye tries to create new blood vessels. However, these new blood vessels may not develop properly and might leak, which causes diabetic retinopathy.
How many types of diabetic retinopathy are there?
The two main types of diabetic retinopathy are the following.
Early diabetic retinopathy
This type is more common than the advanced type. Patients who have this type suffer from weakened blood vessels walls in the retina, which causes leakage of blood and other fluids into the retina. Furthermore, larger retinal vessels can start to be irregular in diameter as well.
Early stage of diabetic retinopathy can develop from mild to severe when more blood vessels are blocked. As a result, retina’s nerve fibers and its central part (macula) may begin to swell, causing a condition that requires immediate treatment.
Advanced diabetic retinopathy
Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. At this stage, damaged blood vessels become completely closed, making new abnormal blood vessels grow in the retina. Blood can leak into the clear, jelly-like substance that fills the center of your eye (vitreous), which causes retina detachment causing pressure to raise in the eyeball. Then this damages the nerve that carries images from your eye to your brain (optic nerve), causing glaucoma.
Who is at risk of diabetic retinopathy?
Anyone with type 1 diabetes or type 2 diabetes is potentially at risk of developing diabetic retinopathy. However, people with certain health conditions are at a greater risk than others. These conditions include:
- Being a diabetic patient for a long period of time
- Having a persistent high blood sugar (blood glucose) level
- Having high cholesterol level
- Being of Afro-Caribbean or Asian background
- Constant Tobacco use
What are the complications of diabetic retinopathy if not treated?
Diabetic retinopathy involves the abnormal growth of blood vessels in the retina, which can lead to serious vision problems if not treated, including:
- Vitreous hemorrhage: The new blood vessels may bleed into the vitreous humour, which causes dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision. In most cases, vitreous hemorrhage does not cause permanent vision loss, as the blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision may return to its previous clarity.
- Glaucoma: Pressure caused by this symptom can damage the optic nerve, as the new blood vessels growing in the front part of the patient’s eye may interfere with the normal flow of fluid out of the eye. This symptom develops into glaucoma.
- Retinal detachment: This symptom may cause spots floating in your vision, flashes of light or severe vision loss, as the abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye causing retinal detachment.
- Blindness: Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.
How can we prevent diabetic retinopathy from occurring?
There is no certain way to completely prevent diabetic retinopathy. However, in most cases, patients can prevent severe vision loss by having regular eye exams, keeping blood sugar and blood pressure under control. Moreover, there are common tips patients can do to reduce the risk factors of getting diabetic retinopathy, including:
- Take control of your diabetes. Maintain healthy life style where eating healthy food and doing exercises such as walking is a part of your everyday life, in addition to taking the insulin shots prescribed by the doctor in its right time.
- Keep a close eye on your blood sugar level. Make sure of checking and recording your blood sugar level several times a day, and more frequently in cases of illness or being under stress.
- Keep your cholesterol and blood pressure under control. Working out regularly in addition to eating healthy foods can help in controlling blood pressure and cholesterol.
- Avoid smocking or using tobacco. Smoking increases the risk of developing different diabetes complications, such as diabetic retinopathy.
- Pay close attention to any change in your vision. Notify your eye doctor immediately if you experience any sudden vision changes or if your vision becomes hazy, spotty, or blurry.
What are the symptoms of diabetic retinopathy?
Diabetic retinopathy has no obvious symptoms and signs at its early stages, which means you will not be able to notice it at early stages. However, at advanced stages of diabetic retinopathy, patients might suffer from:
- Gradually worsening vision.
- Sudden vision loss.
- Shapes floating in your field of vision (floaters).
- Blurred or patchy vision.
- Eye pain or redness.
- Blurred vision.
- Fluctuating vision.
- Impaired color vision.
- Dark or empty areas in your vision.
- Vision loss.
What is diabetic retinopathy screening?
Since diabetic retinopathy does not cause any symptoms at early stages, it can cause permanent blindness if not diagnosed and treated promptly. For this reason, screening is done, as it can detect problems in your eyes before they start to affect your vision and these symptoms can be healed to prevent or reduce vision loss from its early stages.
The detection test involves examining the back of the eyes and taking photographs. Depending on the screening result, you may be advised to return for another appointment a year later, attend more regular follow up appointments, or have an advanced eye exam and discuss treatment options with a specialized doctor.
How can diabetic retinopathy be treated?
Usually, diabetic retinopathy does not require treatment unless it reaches an advanced stage that may pose a threat to your vision. In most cases, treatment is mainly offered if patients have already developed symptoms caused by diabetic maculopathy, or if regular diabetic screening detects stage three (proliferative) retinopathy. However, in early stages of diabetic retinopathy, patients can only manage their diabetes by:
- Controlling their blood sugar, blood pressure and cholesterol levels
- Taking their diabetes medication as prescribed
- Attending all their screening appointments
- Getting medical advice quickly if they notice any changes to their vision
- Maintaining a healthy weight by following a healthy balanced diet, and exercising regularly.
What are the best treatments for advanced diabetic retinopathy?
For advanced levels of diabetic retinopathy that are life threatening and affecting your eye-sight, the main treatments are:
1. Laser treatment
Laser treatment is used in advanced stages of diabetic retinopathy to treat weak new blood vessels at the back of the eyes that tend to often cause bleeding into the eye. Laser treatment helps stabilize your vision changes caused by your diabetes and stop your vision from worsening. However, in many cases, this treatment will not improve your sight.
During this procedure, laser beams will be directed into your eyes. Despite the fact that laser diabetic retinopathy treatment is not painful, patients will be given local anesthetic drops to numb their eyes, as well as eye drops used to widen their pupils, and special contact lenses which are used to hold their eyelids open so that the laser can be focused onto your retina.
This procedure typically takes around 20-40 minutes. Also, after the surgery, the patient can go back home without staying in the hospital overnight. However, patients may be required to go to a laser treatment clinic more than once.
What are the side effects of laser treatment?
There are many temporary side effects for this treatment, which are usually felt for few hours after the treatment. These side effects include:
- Blurred vision, which may prevent you from doing activities such as driving, so it is highly advised to have a friend or a relative with you the day of the procedure.
- Photophobia (increased sensitivity to the light).
- Feelings of pain and discomfort, which can be treated with ordinary painkillers.
Are there any possible risks and complications for this procedure?
As in any other medical procedure, possible complications may occur. These potential complications include:
- Reduced peripheral vision.
- Reduced night vision.
- Internal eye bleeding.
- Seeing floaters.
- Seeing the pattern made by the laser on the back of your eye for a couple of months.
- A permanent small blind spot close to the vision’s center.
2. Eye injections
Eye injections are used to treat severe maculopathy that is threatening your vision. In some cases of diabetic retinopathy, doctors prevented new blood vessels from forming at the back of the eyes by giving injections of a medicine named anti-VEGF into the patient’s eyes. Also, doctors used to prescribe medications called aflibercept (Eylea) and ranibizumab (Lucentis) to stop the patient’s vision from worsening, as well as improving their vision.
Before starting the treatment, the skin around the eyes will be covered with a sheet after being cleaned. Afterwards, small clips will be used to keep the eyes open. During this procedure, patients will be under local anesthesia to prevent them from suffering eye pain. Eventually, the surgeon uses a fine needle and guides it carefully into the patient’s eyeball and then gives the injection.
Eye injections are typically applied once a month to begin with. Once the vision starts to be stabilized, they will be applied less frequently or stopped. In some cases, steroid injections may be given instead of anti-VEGF injections if they couldn’t help.
What are the risks and side effects of eye injections?
Some of the most common risks and side effects of anti-VEGF injections include:
- Eye bleeding.
- Watery eyes.
- Developing Floaters.
- Eye irritation.
- Dry itchy eyes.
- In rare cases, blood clots may form and might lead to a heart attack or stroke.
- Eye pressure may increase due to steroid injections.
3. Diabetic retinopathy surgery
Diabetic retinopathy surgery is done to remove scar tissues or blood from the eye if laser treatment is not possible because retinopathy is too advanced. This surgery may also be done in order to remove the vitreous humour (transparent, jelly-like substance) from the eye.
Eye surgery for diabetic retinopathy is mostly needed if an extensive scar tissue is most likely to cause rental detachment. It is also necessary if a large amount of blood has accumulated in the eye.
During this procedure, the surgeon makes a small incision in the eye before removing any scar tissue, as well as some of the vitreous humour. He/she uses a laser to prevent additional degradation of the patient’s vision.
This procedure is usually carried out under local anesthesia and sedation, which means that patients will not be aware of the surgery being performed nor suffer any pain.
What are the recovery stages after the procedure?
- Patients can return home on the same day or the day after surgical procedure.
- For the first couple of days after the surgery, the patient may be required to wear a patch over the treated eye, as activities such as watching television and reading can quickly tire their eyes.
- Blurred vision is expected after the procedure. However, the vision should improve gradually, and it may take several months to fully return to normal.
What are the risks and side effects of this procedure?
Risks and complications that might accompany vitreoretinal surgery may include:
- Developing cataract.
- Eye Infection.
- Eye Bleeding.
- Retinal detachment.
- Fluid accumulation in the cornea.
In some cases, patients required further retinal surgery afterwards. However, the surgeon will explain the risks.
Diabetic retinopathy vs. hypertensive retinopathy
High blood pressure may increase the risk of developing diabetic retinopathy, as this condition is a complication of diabetes, while hypertensive retinopathy is mainly caused by high blood pressure. On the other hand, both conditions may lead to blindness if left untreated, as they both cause damage to the retina at the back of the eye.
Diabetic retinopathy vs. macular degeneration
Diabetic retinopathy (DR) is a disease that occurs as a result of damage to the retina blood vessels in people who have diabetes. On the other hand, age-related macular degeneration (AMD) is a degenerative eye disease that gradually damages the macula causing progressive loss of central vision.
Furthermore, these two conditions have different symptoms, for example:
- People with diabetic retinopathy suffer from poor night vision, impairment of color vision, patches or streaks that block the person’s vision.
- Patients with macular degeneration suffer from extra sensitivity towards glare, inability to see or read in dim and faint light, “Fuzzy” or blurred vision, abnormal blood clotting, distorted vision, wavy or blurred lines.
In terms of complications, if diabetic retinopathy is left untreated it may cause vitreous hemorrhage, bleeding in the eyes, retinal detachment, glaucoma, and blindness. This is while macular degeneration causes anxiety or depression, decreased contrast sensitivity, decreased visual acuity, metamorphopsia, and central scotoma if left untreated.
When it comes to treatment, diabetic retinopathy can be treated with photocoagulation, pan retinal photocoagulation, vitrectomy, or eye Injections, depending on the conditions. On the other hand, there are many treatment options for macular degeneration, such as laser photocoagulation, anti-VEGF therapy, anti-angiogenic drugs, laser therapy, photodynamic laser therapy, in addition to medications.
How can I arrange my trip to undergo diabetic retinopathy treatment in Iran?
All you have to do to get this process started is to contact AriaMedTour through WhatsApp using number provided on the website, or you can simply hit the “Get a Free Consultation” Button, fill a form, and you are good to go.
By deciding to have diabetic retinopathy treatment in Iran with AriaMedTour, your entire trip will be arranged and scheduled according to your preferences, and all you need to do is to focus on your treatments.