Adult-Diabetic Retinopathy

Diabetic Retinopathy–an Emerging Epidemic

India is deemed the world’s capital of diabetes.

The diabetic population in the country is close to hitting the alarming mark of 69.9 million by 2025 and 80 million by 2030.

A diabetic patient is 25 times more vulnerable to the possibility of becoming blind compared to a healthy individual.

Diabetic retinopathy is often symptomless in the early stages, so screening for diabetic retinopathy in all diabetics is of utmost importance.

What causes Diabetic Retinopathy?

Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy. The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or haemorrhage (bleed), distorting vision. In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina.

Diabetic Retinopathy may progress through Four Stages

Mild non-proliferative retinopathy: Small areas of balloon-like swelling in the retina’s tiny blood vessels, called microaneurysms, occur at this early stage of the disease. These microaneurysms may leak fluid into the retina. Moderate non-proliferative retinopathy: As the disease progresses, blood vessels that nourish the retina may swell and distort. They may also lose their ability to transport blood. Both conditions cause characteristic changes to the appearance of the retina and may contribute to diabetic macular oedema (DME). Severe non-proliferative retinopathy: Many more blood vessels are blocked, depriving blood supply to areas of the retina. These areas secrete growth factors that signal the retina to grow new blood vessels. Proliferative diabetic retinopathy (PDR): At this advanced stage, growth factors secreted by the retina trigger the proliferation of new blood vessels, which grow along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye. The new blood vessels are fragile, which makes them more likely to leak and bleed. Accompanying scar tissue can contract and cause retinal detachment—the pulling away of the retina from underlying tissue, like wallpaper peeling away from a wall. Retinal detachment can lead to permanent vision loss.

Combating Diabetic Retinopathy

Most general ophthalmologists across India lack the necessary equipment to detect diabetic retinopathy in its crucial early stages, when the disease is most sensitive to treatment.

As diabetic retinopathy is often symptomless in the early stages, lots of cases remain undetected. This is also because there are only few tertiary level care centres that have diagnostic tools such as a slit lamp, ultrasound and procedures such as fluorescein angiography.

What is DME?

DME is the build-up of fluid (oedema) in a region of the retina called the macula. The macula is important for the sharp, straight-ahead vision that is used for reading, recognising faces, and driving. DME is the most common cause of vision loss among people with diabetic retinopathy. About half of all people with diabetic retinopathy will develop DME. Although it is more likely to occur as diabetic retinopathy worsens, DME can happen at any stage of the disease.

Who is at risk for Diabetic Retinopathy?

People with all types of diabetes (type 1, type 2, and gestational) are at risk for diabetic retinopathy. Risk increases the longer a person has diabetes. Between 40 and 45 per cent of Americans diagnosed with diabetes have some stage of diabetic retinopathy, although only about half are aware of it. Women who develop or have diabetes during pregnancy may have rapid onset or worsening of diabetic retinopathy.

What are the symptoms of Diabetic Retinopathy and DME?

Diabetic retinopathy typically presents no symptoms during the early stages.

The condition is often at an advanced stage when symptoms become noticeable. On occasion, the only detectable symptom is a sudden and complete loss of vision.

Signs and symptoms of Diabetic Retinopathy may include:

• 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 usually affects both eyes. It is important to make sure that the risk of vision loss is minimised.

Decoding Diabetic Retinopathy

• It has the potential to cause severe vision loss and blindness
• It involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision
• It is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults
• It can be treated with several therapies, used alone or in combination
• DME is a consequence of diabetic retinopathy that causes swelling in the area of the retina called the macula
• Controlling diabetes-by taking medications as prescribed, staying physically active, and maintaining a healthy diet-can prevent or delay vision loss
• Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year
• Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss

How is DME Treated?

DME can be treated with several therapies that may be used alone or in combination.

Anti-VEGF Injection Therapy

Anti-VEGF drugs are injected into the vitreous gel to block a protein called vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessels to grow and leak fluid. Blocking VEGF can reverse abnormal blood vessel growth and decrease fluid in the retina. Available anti-VEGF drugs include Avastin (bevacizumab), Lucentis (ranibizumab), and Eylea (aflibercept). Lucentis and Eylea are approved by the US Food and Drug Administration (FDA) for treating DME. Avastin was approved by the FDA to treat cancer, but is commonly used to treat eye conditions, including DME.

Most people require monthly anti-VEGF injections for the first six months of treatment. Thereafter, injections are needed less often; typically three to four during the second six months of treatment, about four during the second year of treatment, two in the third year, one in the fourth year, and none in the fifth year. Dilated eye exams may be needed less often as the disease stabilises.

Focal/Grid Macular Laser Surgery

In focal/grid macular laser surgery, a few to hundreds of small laser burns are made to leaking blood vessels in areas of oedema near the centre of the macula. Laser burns for DME slow the leakage of fluid, reducing swelling in the retina. The procedure is usually completed in one session, but some people may need more than one treatment. Focal/grid laser is sometimes applied before anti-VEGF injections, sometimes on the same day or a few days after an anti-VEGF injection, and sometimes only when DME fails to improve adequately after six months of anti-VEGF therapy.

Corticosteroids

Corticosteroids, either injected or implanted into the eye, may be used alone or in combination with other drugs or laser surgery to treat DME. The Ozurdex (dexamethasone) implant is for short-term use, while the Iluvien (fluocinolone acetonide) implant is longer lasting. Both are biodegradable and release a sustained dose of corticosteroids to suppress DME. Corticosteroid use in the eye increases the risk of cataract and glaucoma. DME patients who use corticosteroids should be monitored for increased pressure in the eye and glaucoma.

Why Kokilaben Hospital

We have a state of the art Ophthalmology Department equipped with the most advanced equipment to treat retinal diseases. We are equipped with a Zeiss Fundus Camera for retinal angiography, 532 Zeiss Green Laser for retinal lasers in OPD and during surgeries, ultrasonography—and most importantly the most advanced Alcon CONSTELLATION® vitrectomy surgery machine which is used for 23 and 25 gauge minimal access retinal surgeries.

Increased VEGF (vascular endothelial growth factor) levels in the vitreous are the major culprits in diabetic retinopathy. Anti-VEGF intravitreal injections have become the most important tool in stabilising and reversing diabetic macular oedema as well as controlling proliferative diabetic retinopathy bleeding.

At our hospital we provide the best Anti-VEGF intravitreal injections like Ranibizumab (Accentrix or Lucentis, Razumab) and Aflibercept (Eylea).

What is hypertension?

Hypertension is the medical term for high blood pressure. This means that the blood applies too much force against the walls of the blood vessels. Medical guidelines define hypertension as blood pressure higher than 130 over 80 millimeters of mercury (mmHg).

Important facts about high blood pressure:

• High blood pressure may be linked to a higher risk of dementia.
• Young people can have high blood pressure, too.
• 1 in 5 adults are unaware of their high blood pressure.
• Women face pregnancy complications due to high blood pressure.

Risk factors

A number of risk factors increase the chances of having hypertension.

• Age: Hypertension is more common in people aged over 60 years.
• Ethnicity: Some ethnic groups are more prone to hypertension.
• Size and weight: Being overweight or obese is a key risk factor.
• Alcohol and tobacco use: Consuming large amounts of alcohol regularly can increase a person’s blood pressure, as can smoking tobacco.
• Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and high cholesterol levels can lead to hypertension, especially as people get older.
• Hereditary factors: A family history of high blood pressure and poorly managed stress can also contribute.

Signs

Blood pressure can be measured by a sphygmomanometer, or blood pressure monitor. Having high blood pressure for a short time can be a normal response to many situations like stress or intense exercise. For this reason, a diagnosis of hypertension normally requires several readings that show high blood pressure over time.

Symptoms

A person with hypertension may not notice any symptoms, and it is often called the "silent killer." Regularly checking your blood pressure is vital, as there will usually be no symptoms to make you aware of the condition.

It is maintained that high blood pressure causes sweating, anxiety, sleeping problems, and blushing. If blood pressure reaches the level of a hypertensive crisis, a person may experience headaches and nosebleeds.

Complications

Hypertension and heart disease are global health concerns. The World Health Organization (WHO) suggests that the growth of the processed food industry has impacted the amount of salt in diets worldwide, and that this plays a role in hypertension.

Long-term hypertension can cause complications through atherosclerosis, where the formation of plaque results in the narrowing of blood vessels. This makes hypertension worse, as the heart must pump harder to deliver blood to the body.

Hypertension-related atherosclerosis can lead to:

• Heart failure and heart attacks.
• An aneurysm, or an abnormal bulge in the wall of an artery that can burst, causing severe bleeding and, in some cases, death.
• Kidney failure.
• Stroke.
• Amputation.
• Hypertensive retinopathies in the eye, which can lead to blindness.

Hypertension in India:

According to data from the National Health Profile (NHP) 2018, more people were diagnosed with hypertension than diabetes in India in 2017. The prevalence of hypertension among 18-25 years-old was higher than that estimated by the World Health Organization and in fact than any other country in the world.

Prevent Hypertension:

Your age, along with a family history of hypertension and ethnicity are among the hypertension risk factors that are out of your control. To avoid a hypertension diagnosis, make these healthy lifestyle choices:

1. Maintain a healthy weight. When it comes to hypertension prevention, your weight is crucial. Obesity increases your chances of getting hypertension.
2. Eat a balanced diet. Consider following the DASH diet which stands for Dietary Approaches to Stop Hypertension. The DASH diet emphasizes vegetables, fruits and low-fat dairy foods — and moderate amounts of whole grains, fish, poultry and nuts which are rich in potassium, calcium and magnesium.
3. Cut back on salt. For many people, eating a low-sodium diet can help keep blood pressure normal. The higher the sodium intake, the higher the blood pressure.
4. Exercise regularly. Get moving to prevent hypertension. Physical activity is crucial. The more exercise you get, the better, but even a little bit can help control blood pressure. Moderate exercise for about 30 minutes three times a week is a good start.
5. Limit alcohol. Drinking too much alcohol can lead to high blood pressure. For women, that means no more than one drink a day, and for men, no more than two.
6. Monitor your blood pressure. Make sure that you have your blood pressure measured regularly, either at your doctor’s office or at home.
7. Avoid stress. Learn to manage your stress better to help control your blood pressure control.
8. Smoking can raise blood pressure. Giving up smoking reduces the risk of hypertension, heart conditions, and other health issues.

Take a look at your lifestyle habits and decide where you can make changes to help prevent hypertension. Adopting these lifestyle changes can help prevent high blood pressure if your blood pressure is currently under control or lead to lower blood pressure if your numbers are already elevated.

Consult doctors at Kokilaben Dhirubhai Ambani hospital to manage Hypertension better. Please find below website link for more details:

https://www.kokilabenhospital.com/departments/clinicaldepartments/internalmedicine/hypertension.html

Are you travelling this summer with your family?

Whether travelling as a couple, with children or with elderly parents make sure you are prepared for the destination you are travelling. A few precautions and extra care before travel can make your holiday better.

Here are few general travel tips

1. Be proactive – Think about health in advance of your trip. If you have a chronic health problem, get a check-up before you leave. And find out as much as you can in advance about destination-specific health risks.

2. Pack a travel health kit – Expect the unexpected, always travel with a travel health kit equipped with the most basic medications.

3. Wash your hands – Good hygiene is the first line of defence against any viral or bacterial ailment, be it the common cold or any other infection. Especially wash your hands before and after meal times.

4. Drink and eat sensibly – Traveller’s diarrhoea is the most common ailment that hamper many vacations. Make sure you eat and drink at hygienic places. Always have hot food when in doubt.

5. Make exercise a priority – You always have ample time to exercise on a vacation, it is your choice to make it a part of your agenda.

Travelling with elders

Are you a group of senior citizens travelling this vacation ? Here are a few health tips to keep in mind:

1. Book for accessibility – Make comfort a top priority. Choose to book direct flights, check for elevators, wheelchairs, and ramps before booking hotel accommodation too.

2. Plan small itineraries – Skip long hours of sight-seeing and plan small excursions physically possible.

3. Pack light – Depending on the weather of your destination pack as light as you can. Make sure you carry only small bag packs for day excursions too.

4. Choose comfortable shoes – One thing you absolutely need to pack is a pair of good, sturdy walking shoes—especially if you plan to do any sightseeing on foot.

5. Carry a few accessories – Here are a few things which will make your trip more comfortable and prepare you for any health conditions:

• travel-sized heat and cold packs.
• an inflatable neck pillow, and seat cushion for long car, train, or airplane rides.
• Extra pair of specs if needed.
• a knee sleeve or elastic bandage to support and cushion sore knees.

6. Stock your medicines – Make sure you carry all your medicines in sufficient quantities. Bring along a prescription, as well as your doctor’s phone number, in case you do run out. Keep the medicines with you instead of in your bags where they could get lost.

7. Keep moving – During long airplane and car trips, try to get up and walk around for a few minutes at least once an hour to keep your joints moving. Staying active will prevent soreness and will maintain blood flow.

Travelling with children

Are you travelling with children this summer? Here are a few health tips to follow:

• Beat the heat – There are three easy things you need to remember about keeping children safe when it’s hot: Apply sunscreen regularly, give them plenty of drinks, and offer healthy, hydrating snacks.
• Be prepared for insect bites – If you are spending time on your summer vacation hiking or camping, you’re likely to encounter them. Use an insect repellent before stepping outdoors and wear full sleeved clothes.
• Watch out around water – Whether you are near a beach or a hotel swimming pool your kids need constant supervision at all times.
• Clean hands – While you’re travelling, make sure your children wash their hands with soap before eating whenever you can. Hand sanitizer or a pack of antibacterial wipes will work if the water is not available.
• Carry light snacks – Carry some high-calorie dry snacks like nuts, energy bars or fruits for your kids to snack during travel times
• Keep a well – stocked first aid kit – Be prepared for minor problems by packing a portable kit that includes over-the-counter pain medicine, antiseptic cream, a cold pack, tweezers, and bandages. If your child has any allergies or asthma, carry the medications. Keep your pediatrician’s phone number handy at all times.
• Boiled water – Water is the first thing that causes stomach infections. Make sure you offer your children only boiled clean drinking water at all times.
• Vaccines – Does your child need any preventive vaccinations? Consult our Travel Clinic.

Whether it is advice on vaccination, country-specific precautions or advice on your health conditions, we highly recommend an appointment with experts at our Travel Clinic. The Travel clinic at Kokilaben Dhirubhai Ambani Hospital offers comprehensive travel advice to make sure your trip is happy and healthy.