DIABETIC RETINOPATHY

• Diabetic retinopathy (DR) is a vascular disease of the retina affecting individuals with long standing diabetes mellitus. Diabetic retinopathy is a leading cause of blindness
• Loss of vision is typically insidious and occurs in most patients 20-30 years after the onset of DM, but acute loss of vision may occasionally occur as a result of retinal detachment, vitreous haemorrhage, or macular oedema

Classification

Non-proliferative diabetic retinopathy (NPDR)

• Mild NPDR
• Moderate NPDR
• Severe NPDR
• Very severe NPDR

Proliferative diabetic retinopathy (PDR)

Diabetic maculopathy

Advanced diabetic eye disease (ADED)

Risk factors

• Chronic duration of diabetes
• Early age of onset of diabetes also acts as a risk factor
• Poor metabolic control
• Heredity
• Pregnancy

The following symptoms in uncontrolled diabetic patients might be a developing diabetic retinopathy

• Blurred vision
• Impairment of colour vision
• Floaters, or transparent and colourless spots and dark strings that float in the patient’s field of vision
• Patches or streaks that block the person’s vision
• Poor night vision

• Sudden and total loss of vision

• Diabetic retinopathy typically presents no symptoms during the early stages

Non-proliferative diabetic retinopathy (NPDR)

Ophthalmoscopic features of NPDR include:

• Microaneurysms
• Retinal haemorrhages
• Retinal oedema
• Hard exudates
• Cotton-wool spots- are small whitish fluffy superficial lesions on the retina

Proliferative diabetic retinopathy (PDR)

• The occurrence of neovascularization is the hallmark of PDR. New vessels may proliferate in the plane of the retina or spread into the vitreous as vascular fronds. Later on results in the formation of Fibro vascular epiretinal membrane formed due to condensation of connective tissue around the new vessels
• Vitreous detachment and vitreous haemorrhage may occur in this stage

Diabetic maculopathy

• Changes in the macular region may be associated with non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR). The diabetic macular oedema (DME) occurs due to increased permeability of the retinal capillaries

Advanced diabetic eye disease

It is the result of uncontrolled proliferative diabetic retinopathy. It is marked by complications such as:

• Persistent vitreous haemorrhage
• Tractional retinal detachment
• Neovascular glaucoma

Screening for diabetic retinopathy

• Urine examination - Blood sugar estimation, 24-hour urinary protein
• Renal function tests
• Lipid profile
• Haemogram
• Glycosylated haemoglobin (HbA1C)
• Fundus fluorescein angiography - to elucidate areas of neovascularization and capillary non-perfusion
• Optical coherence tomography (OCT) - to study detailed structural changes in diabetic maculopathy

• Metabolic control of diabetes mellitus and associated risk factors including dietary habits
• Intravitreal anti vascular endothelial growth factor (VEGF) drugs
• Intravitreal steroids
• Laser therapy
• Surgical treatment
• Strict regular eye check-up, ophthalmoscopy etc.
• Advice to avoid heavy weight lifting especially in PDR cases

Ayurvedic Treatment

Internal medicines

• Nisakatakadi kashaya
• Guduchyadi kashaya
• Patoladi kashaya
• Chandraprabha vati
• Siva gutika
• Kaisora guggulu
• Patoladi gritha

Procedures

Measures to control bleeding

• Netraseka - Yasti + Darvi ksheera kashaya , Mridweekadi kashaya , Manjistadi ksheera kashaya ,
• Seka - Ajaksheera + Yashti (in Haemorrhagic conditions)
• Jaloukavacharana – forehead and eyelid
• Virechana - Avipathi Choorna
• Nasya - Durva gritha
• Pratimarsa nasya - Durva gritha
• Anjana – Chandanadi
• Tala – Asana manjishtadi + Kachooradi
• Shirodhara/ Siroabyanga with Asana Manjistadi kera
• Tarpana - Jeevaneeya gana gritha
• Putapaka