Diabetic retinopathy


Diabetic retinopathy is one of the leading causes of visual loss and blindness.

Diabetic retinopathy
in France

40 % of diabetics

1 million
patients

Patho physiology of diabetic retinopathy

Diabetes is a disease characterized by chronic hyperglycemia (abnormal levels in blood sugar). This hyperglycemia causes chronic inflammation of the retinal capillaries that results in their occlusion.

Widespread capillary occlusion leads to retinal ischemia due to insufficiency of blood supply in the retina.

Retinal ischemia, when advanced can lead to retina neovascularization (formation of abnormal vessels within the retina and vitreous). These neovessels are the cause of haemorrhage, retinal detachment or even neovascular glaucoma. These are dramatic complications and finaly they can cause blindness.

Diabetes can also affect the macula (the center of the retina). The macula is the area of the retina that can see a clear image and it is committed to central vision. At the macular level, diabetes can lead to an abnormal accumulation of fluid, which is called macular edema. Macular edema is the cause of vision loss.

Diagnosis

For a long time, diabetic retinopathy is asymptomatic. This is why it is essential for all diabetic patients to have their fundus periodically examined.

A necessary fundus check up

The fundus examination should be done as soon as the diabetes is discovered, and then at least once a year.

The diagnosis of diabetic retinopathy is usually based on fundus examination. Other examinations may be necessary to evaluate the severity of diabetic retinopathy such as OCT (optical coherence tomography), angiography or even OCT angiography.

OCT is today essential for the diagnosis of diabetic macular edema.

Optical Coherence Tomography: Aspect of diabetic macular edema.

Evolution

Diabetic retinopathy is classified into different stages:

  • Non proliferative diabetic retinopathy (NPDR): Mild, moderate or severe stage. Characterized by various degree of microaneurysms, haemorrhages and dilated and tortuous veins.
  • Proliferative diabetic retinopathy (PDR): presence of vitreo-retinal neovascularisation.
  • Diabetic ophthalmopathy: neovascular glaucoma, tractional retinal detachment, vitreous haemorrhage.
Color photography: aspect of diabetic retinopathy
Color photography: aspect of diabetic retinopathy
Fluorescein angiography: aspect of diabetic retinopathy.
Fluorescein angiography: aspect of diabetic retinopathy.

Therapy

A strict balance of glycaemic levels and of blood pressure are essential to avoid worsening of retinopathy and is beneficial in reducing disease progression rate.

  • Laser treatment (pan retinal photocoagulation) is a preventive treatment in case of severe non proliferative diabetic retinopathy or proliferative retinopathy. The goal is to induce regression of existing neovascular tissue by burning ischemic retinal area. Several sessions are necessary in accordancewith the severity of the disease.
  • A surgical treatment (vitrectomy) is indicated in case of intra-vitreous bleeding or in case of retinal detachment.

Regarding macular edema , intravitreal injections of corticosteroids or anti-VEGF are now the standard of care.

You can make an appointment with one of the Ophthalmologists of the department who provide specific care dedicated to this pathology:

Dr Francesca AmorosoFellow

Department: Clinical Research, Doctor
Specialty: Cataract surgery, Diabetic retinopathy, General Ophthalmology, Myopic maculopathy, Retinal Lasers, Retinal venous occlusive disease
Department: Doctor
Specialty: AMD, Angioid streaks, Cataract surgery, Diabetic retinopathy, General Ophthalmology, Glaucoma, Retinal Lasers, Retinal venous occlusive disease
Department: Doctor
Specialty: AMD, Diabetic retinopathy, Retinal venous occlusive disease, Retinopathy of prematurity
Department: Doctor
Specialty: AMD, Cataract surgery, Diabetic retinopathy, Glaucoma, Retinal Lasers, Retinal venous occlusive disease

Dr Ala El AmeenFellow

Department: Doctor
Specialty: AMD, Cataract surgery, Diabetic retinopathy, Glaucoma, Neuro-ophthalmology, Retinal venous occlusive disease, Uveitis

Dr Alexandra MiereFellow

Department: Doctor
Specialty: AMD, Diabetic retinopathy, Myopic maculopathy, Retinal Lasers, Retinal venous occlusive disease

Dr Sergio PiscitelloFellow

Department: Doctor
Specialty: AMD, Angioid streaks, Cataract surgery, Diabetic retinopathy, Glaucoma, Pachychoroid

Dr Daniel SeknaziFellow

Department: Doctor
Specialty: AMD, Cataract surgery, Children, Diabetic retinopathy, Myopic maculopathy, Retinal venous occlusive disease, Retinopathy of prematurity, Uveitis, Vitreoretinal surgery

Dr Setha Vo KimFellow

Department: Doctor
Specialty: AMD, Cataract surgery, Children, Diabetic retinopathy, Lacrimal duct, Orbit and eyelid, Retinal venous occlusive disease