Diabetic Retinopathy

Diabetes (sugar disease) is a chronic health problem that affects millions of people worldwide today and can lead to serious damage in many different organ systems. Our eyes are among the leading organs where this systemic disease causes the most destruction and reduces quality of life most rapidly.

What is Diabetic Retinopathy?

Diabetic retinopathy is a condition where the capillaries of the retina—the inner layer at the back of the eye that transmits visual signals to the brain—are damaged due to blood sugar remaining high and uncontrolled for a long time. The retina functions much like the film in a camera and requires a healthy blood flow for clear vision. Over time, diabetes weakens the walls of these delicate vessels, causing blockages, microaneurysms (ballooning), and leaks. As the disease progresses, the retina cannot receive enough oxygen and begins to produce abnormal, extremely fragile new blood vessels to compensate. If left untreated, this is a very serious condition that can lead to permanent vision loss and blindness.

Diabetic retinopathy is generally examined in two main stages:

1. Early Stage (Non-Proliferative Diabetic Retinopathy - NPDR)

This is the earliest stage of the disease where new blood vessels have not yet formed. Due to high blood sugar, the walls of the retinal vessels weaken. Blood and fluid leakage into the retina begins. Small bubbles called microaneurysms form. The leaking fluid causes swelling in nerve fibers and fatty protein deposits called exudates. At this stage, if the leakage does not reach the center of vision (macula), the patient may not notice any vision problems.

2. Advanced Stage (Proliferative Diabetic Retinopathy - PDR)

This is the most dangerous and advanced stage of the disease. Due to the blockages in the initial stage, the retinal tissue suffers from severe oxygen deprivation (ischemia). As a defense mechanism, the retina starts creating new but abnormal and very fragile blood vessels. These new vessels grow into the jelly-like fluid (vitreous) that fills the eye. Because of their fragile structure, they can bleed (vitreous hemorrhage) during slight changes in blood pressure or physical activity, leading to sudden and total vision loss. Furthermore, scar tissue formed by these vessels can pull on the retina, causing it to detach (Tractional Retinal Detachment).

Diabetic Macular Edema (DME)

This is the most common cause of vision loss and can be seen in both stages of diabetic retinopathy. Blood and fluid leaking from damaged vessels accumulate in the yellow spot (macula) area, which provides our sharp vision, causing edema (swelling). This situation can make it impossible for the patient to perform tasks requiring fine detail, such as reading, driving, and recognizing faces.

What are the Causes and Risk Factors of the Disease?

Anyone with Type 1 or Type 2 diabetes is at risk of developing diabetic retinopathy. The main factors that increase this risk and accelerate the progression are:

1. Duration of Diabetes: The longer you have diabetes, the higher your risk. Eye involvement begins in the majority of patients who have had diabetes for over 10 years.
2. Poor Blood Sugar Control: Sudden fluctuations in blood sugar and persistently high HbA1c levels are the biggest triggers of vascular damage.
3. Hypertension and Cholesterol: High blood pressure and high cholesterol increase pressure on already weakened retinal vessels, accelerating leaks.
4. Pregnancy: In women with diabetes, the pregnancy process can increase the risk of diabetic retinopathy or worsen the existing condition.
5. Smoking and Tobacco Use: Any habit that disrupts vascular structure directly exacerbates diabetic retinopathy.

What are the Symptoms of Diabetic Retinopathy?

The most insidious aspect of the disease is that it usually shows no symptoms in the early stages. However, as the disease progresses or macular edema develops, the following complaints begin:

1. Floating black spots, specks, or web-like lines (usually a precursor to intraocular bleeding).
2. Blurred central or peripheral vision.
3. Vision quality that changes or fluctuates throughout the day.
4. Perceiving colors as faded or different.
5. Dark or empty areas in the field of vision.
6. Sudden and total vision loss in advanced cases.

Early Diagnosis with Our Advanced Diagnostic Methods

It is vital for every individual diagnosed with diabetes to have a detailed fundus examination at least once a year, even if they have no complaints. In Specialist Dr. Ayşe Öner’s clinic, we can detect the disease at a cellular level:

1. Dilated Fundus Examination: Pupils are dilated with special drops, and the entire retina and optic nerves are examined with high-magnification lenses.
2. Optical Coherence Tomography (OCT): This radiation-free scan creates a 3D, microscopic map of the retina and macula, allowing for the detection of macular edema with millimetric precision.
3. Fluorescein Angiography (FFA): Fluorescent dye is administered through an arm vein to record images of the vessels at the back of the eye. This mapping precisely identifies blocked vessels and areas requiring laser treatment.

What are the Treatment Methods for Diabetic Retinopathy?

The goal of treatment is to stop the progression of the disease and preserve existing vision. The treatment plan is personalized by Dr. Ayşe Öner:

1. Intraocular Injection Treatments (Anti-VEGF and Steroids)

This is the first choice for treating Diabetic Macular Edema and preventing new vessel formation. Medications that block the proteins (VEGF) triggering abnormal vessel growth are injected into the eye. This painless procedure is performed in seconds using drop anesthesia and very fine needles.

2. Argon Laser Photocoagulation

Laser treatment is a cornerstone of management:

1. Focal/Grid Laser: Applied directly to leaking microaneurysms in the macula to dry the edema.
2. Panretinal Laser (PRP): In the proliferative stage, hundreds of small laser pulses are applied to the peripheral retina to stop the formation of new, bleeding-prone vessels.

3. Vitrectomy Surgery (Intraocular Microsurgery)

A high-tech micro-surgical operation performed in the most advanced stages, such as severe intraocular bleeding (vitreous hemorrhage) or Tractional Retinal Detachment. Dr. Ayşe Öner’s superior surgical experience provides high success rates in these complex surgeries.

Diabetic retinopathy can lead to irreversible results if not controlled. If you have diabetes, contact us without losing time to take the first step in protecting your vision quality.