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 nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels, but these new blood vessels do not develop properly and can leak easily causing 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 begin to dilate and become irregular in diameter as well.
Early stage of diabetic retinopathy can progress from mild to severe, as more blood vessels become blocked. As a result, nerve fibers in the retina may begin to swell, and in some cases, the central part of the retina (macula) begins to swell (macular edema) causing a condition that requires immediate treatment.
Advanced diabetic retinopathy
Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off causing the growth of new, abnormal blood vessels in the retina. Blood can leak into the clear, jelly-like substance that fills the center of your eye (vitreous), which causes the retina to detach from the back of your eye causing pressure to build up in the eyeball, which then damages the nerve that carries images from your eye to your brain (optic nerve) resulting in 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 time
- Having a persistent high blood sugar (blood glucose) level
- Having high blood pressure
- Having high cholesterol level
- Being of Asian or Afro-Caribbean 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:
- Manage your diabetes. Make sure you have a healthy life style where eating healthy food and doing exercises such as walking is a part of your daily routine, in addition to taking the insulin shots prescribed by the doctor in its right time.
- Keep a close eye on your blood sugar level. Check and record your blood sugar level several times a day, and more frequently in cases of illness or being under stress.
- Keep your blood pressure and cholesterol under control. Eating healthy foods, exercising regularly and losing excess weight can help in controlling blood pressure and cholesterol.
- Avoid smocking or using any types of tobacco. Smoking increases your risk of various diabetes complications, including diabetic retinopathy.
- Pay attention to vision changes. Contact your eye doctor immediately if you experience sudden vision changes or if your vision becomes blurry, spotty or hazy.
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 only requires specific treatment when it reaches an advanced stage and there is a risk to your vision. In most cases, treatment is typically offered if diabetic eye screening detects stage three (proliferative) retinopathy, or if you already have symptoms caused by diabetic maculopathy. 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 new blood vessels at the back of the eyes. This is done because the new blood vessels tend to be very weak and often cause bleeding into the eye. This treatment can help stabilize the changes in your eyes caused by your diabetes and stop your vision from getting any worse. However, in most 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 normally takes around 20-40 minutes, and it is usually carried out on an outpatient basis, which means you will not need to stay in hospital overnight. However, this procedure may require more than one visit to a laser treatment clinic.
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 night or peripheral (side) vision.
- Bleeding into the eye or seeing floaters.
- Being able to “see” the pattern made by the laser on the back of your eye for a few months.
- A permanent small blind spot close to the center of your vision.
2. Eye injections
Eye injections are used to treat severe maculopathy that is threatening your vision. Also, in some cases of diabetic retinopathy, injections of a medicine called anti-VEGF may be given directly into the patient’s eyes to prevent new blood vessels from forming at the back of the eyes. However, the main medicines used are called ranibizumab (Lucentis) and aflibercept (Eylea), which can help stop the problems in your eyes from getting worse and may also lead to an improvement in your vision.
Before starting the treatment, the skin around the eyes will be cleaned and covered with a sheet, and small clips will be used to keep your eyes open. During this procedure, patients will be given local anesthetic drops to numb their eyes. Afterwards, a very fine needle is carefully guided into the patient’s eyeball and the injection is given.
The injections are usually given once a month to begin with, and once the vision starts to stabilize, they will be stopped or given less frequently. In some cases, injections of steroid medication may be given instead of anti-VEGF injections, or if the anti-VEGF injections do not help.
What are the risks and side effects of eye injections?
Possible risks and side effects of anti-VEGF injections include:
- Eye irritation or discomfort
- Bleeding inside the eye
- Floaters or a feeling of having something in your eye
- Watery or dry itchy eyes
- In rare cases, blood clots may form which could 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 carried out to remove some of the vitreous humour (transparent, jelly-like substance) from the eye.
Eye surgery for diabetic retinopathy is mostly needed If a large amount of blood has collected in the eye, or if there is an extensive scar tissue that is likely to cause, or has already caused, retinal detachment.
During this procedure, the surgeon makes a small incision in the eye before removing some of the vitreous humour and removing any scar tissue and uses a laser to prevent further deterioration in your vision.
This procedure is usually carried out under local anesthesia and sedation, which means that patients will not experience any pain or have any awareness of the surgery being performed.
What are the recovery stages after the procedure?
- Patients will be able to go home on the same day or the day after surgery.
- For the first few days after the surgery, patients may need to wear a patch over their 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?
Possible risks of vitreoretinal surgery include:
- Developing a cataract
- Bleeding into the eye
- Retinal detachment
- Fluid build-up in the cornea (the outer layer at the front of the eye)
- Infection in the eye.
There is also a little chance that you will need further retinal surgery afterwards. Your surgeon will explain the risks to you.
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.