What are the best treatment options for diabetic retinopathy in Singapore?

Healthy eye

According to a 2016 report by the Singapore National Eye Centre, 1 in 12 Singaporeans that are in the age of 18 to 69 years have diabetic retinopathy. The report further says that the numbers may continue to climb in the coming years due to an increase in the incidence of obesity and sedentary lifestyle that can result in people developing diabetes.

What is Diabetic Retinopathy?

Diabetic Retinopathy is an eye disease that is caused by diabetes. This happens when the high sugar content in our blood shoots up and causes damage to the blood vessels in the retina. The result of the damage can be grave - it can lead to blindness when not kept in check or treated earlier. 

Diabetic Retinopathy

Symptoms of Diabetic Retinopathy

Diabetic retinopathy can be asymptomatic. Symptoms often show up when a patient’s condition is already going downhill. Signs that you may have a case of diabetic retinopathy are:

  • Blurry vision
  • Colours appear to be fading insight
  • Difficulty in seeing at night
  • An increasing number of floaters seen
  • Presence of dark or blank area in your vision
  • Sudden loss of vision

What are the stages of diabetic retinopathy?

Diabetic retinopathy has 2 stages:

  • Non-proliferative diabetic retinopathy (NPDR) - This is the earlier and milder stage of diabetic retinopathy. A majority of diabetic patients contract this as a result of their diabetes diagnosis. During this stage, the small parts of the blood vessels leak and cause inflammation to the retina (macular edema). This may result in blindness. Another scenario that may happen is the shutting of the retina’s blood vessels (macular ischemia). This causes the blood’s inability to reach the retina, which results in poor vision.  
  • Proliferative diabetic retinopathy (PDR) - This is the advanced and more critical stage of diabetic retinopathy. When the condition advances to this stage, the retina starts to develop new blood vessels. This occurrence is called neovascularization. Being new blood vessels, they are weak and have the tendency to leak into the vitreous. Symptoms of bleeding may be indicated by the increase of floaters seen or total blockage of vision.

Causes and risk factors involved in developing diabetic retinopathy

Generally, people who have been diagnosed with diabetes have a greater chance of developing this disease. Others risks that can lead to this condition are:

  • Having high cholesterol
  • High blood pressure tendencies
  • Pregnancy
  • Smoking

How is diabetic retinopathy diagnosed?

Diabetic retinopathy can be diagnosed based on the symptoms present. In case there are no obvious signs affecting your vision, a consultation with an ophthalmologist like Dr Claudine Pang at Asia Retina can be done for a health assessment. Ophthalmologists are able to detect these symptoms.

Some tests may be done to accurately diagnose the existence of diabetic retinopathy. These tests are:

  • Dilated eye exam
  • Fluorescein angiography
  • Optical coherence tomography (OCT)

Optical coherence tomography

Possible complications caused by diabetic retinopathy

Having diabetic retinopathy can further lead to complications, such as:

  • Detached retina
  • Glaucoma
  • Vitreous haemorrhage

What are the best treatments for diabetic retinopathy?

Diabetic retinopathy treatments will differ depending on the severity of the condition. It is important that the sugar level of a person is kept low in order to avoid the development or, in the case that the condition is already present, diabetic retinopathy will not progress. Normally, patients with non-proliferative diabetic retinopathy (NPDR) are closely monitored by their doctor without administering any treatment.  

Medical prescriptions may be given to suppress the continuous development of diabetic retinopathy. Doctors may prescribe anti-vascular endothelial growth factor (anti-VEGF) medications in order to help in the reduction of the macula’s swelling and delay vision loss. This may also improve vision. Steroids may also be another treatment recommended by your doctor. Both anti-VEGF and steroid medications are administered to the eyes using injections.

For more severe cases, a surgical procedure may be needed. The procedure may either be:

  • Pan-retinal photocoagulation - you may have heard about this treatment, another commonly used name for it is a scatter laser treatment, this procedure uses a laser device that works to burn, shrink, and close off new abnormal blood vessels located in the retina (far from the macula) to avoid them from leaking.
  • Photocoagulation - also known as focal laser treatment, this procedure uses a laser device to burn and stop leakage from the abnormal blood vessels.
  • Vitrectomy - This procedure entails the removal of the eye’s vitreous humour. The removed vitreous will then be replaced with the use of a clear liquid or gas substance to keep the retina in place.

Prevention of diabetic retinopathy

Unfortunately, this condition is inevitable for patients with diabetes, although its progress to a more severe condition may be prevented by maintaining low blood sugar levels. The following can be done to reduce the risk of acquiring or progressing diabetic retinopathy:

  • Keep a healthy diet - follow your doctor’s advice or get a nutritionist’s help
  • Exercise regularly
  • Manage the intake of alcohol
  • Monitor and maintain a healthy body weight
  • Quit smoking
  • Take antihypertensive medications as prescribed by your doctor (for patients hypertensive patients or those with high blood pressure)
  • Visit the doctor regularly to keep your condition in check