Diabetic retinopathy

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Definition:
Diabetic retinopathy is a complication of diabetes that results from damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, however, diabetic retinopathy can result in blindness.

Diabetic retinopathy can develop in anyone who has type 1 diabetes or type 2 diabetes. The longer you have diabetes, and the less controlled your blood sugar is, the more likely you are to develop diabetic retinopathy.

Symptoms :
Itas possible to have diabetic retinopathy and not know it. In fact, itas uncommon to have symptoms in the early stages of diabetic retinopathy.

As the condition progresses, diabetic retinopathy symptoms may include:
a Spots or dark strings floating in your vision (floaters)
a Blurred vision
a Fluctuating vision
a Dark or empty areas in your vision
a Poor night vision
a Impaired color vision
a Vision loss Diabetic retinopathy usually affects both eyes.

Cause:
Too much sugar in your blood can damage the tiny blood vessels (capillaries) that nourish the retina. This can result in diabetic retinopathy and vision loss. Elevated blood sugar levels can also affect the eyesa lenses. With high levels of sugar over long periods of time, the lenses can swell, providing another cause of blurred vision.

Diabetic retinopathy is usually classified as early or advanced.
a Early diabetic retinopathy a Nonproliferative diabetic retinopathy (NPDR) is the most common type of diabetic retinopathy. It can be described as mild, moderate or severe. When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the vessel walls, sometimes leaking or oozing fluid and blood into the retina. These bulges are called microaneurysms. As the condition progresses, the smaller vessels may close and the larger retinal veins may begin to dilate and become irregular in diameter. Nerve fibers in the retina may begin to swell. Sometimes the central part of the retina (macula) begins to swell, too. This is known as macular edema.
a Advanced diabetic retinopathy a Proliferative diabetic retinopathy (PDR) is the most severe type of diabetic retinopathy. When you have PDR, abnormal blood vessels grow in the retina. Sometimes the new blood vessels grow or leak into the clear, jelly-like substance that fills the center of your eye (vitreous). Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure may build up in the eyeball, causing glaucoma. This can damage the nerve that carries images from your eye to your brain (optic nerve).

Risk factors
Diabetic retinopathy can happen to anyone who has diabetes. The risk is greater if you: -
a Have poor control of your blood sugar level
a Have high blood pressure
a Have high cholesterol
a Are pregnant
a Are black or Hispanic
a Smoke The longer you have diabetes, the greater your risk is of developing diabetic retinopathy.

Complications:
Diabetic retinopathy involves the abnormal growth of blood vessels in the retina. Complications can lead to serious vision problems:
a Vitreous hemorrhage. The new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots or floaters. In more severe cases, blood can fill the vitreous cavity and completely block your vision. Vitreous hemorrhage by itself usually doesnat cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision may return to its previous clarity.
a Retinal detachment . The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss.
a Glaucoma. New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).
a Blindness. Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.

Tests and diagnosis
Diabetic retinopathy is best diagnosed with a dilated eye exam. For this exam, your eye doctor will place drops in your eyes that make your pupils open widely for several hours. This allows your doctor to get a better view inside your eye. The drops may cause your close vision to be blurry until they wear off.

During the exam, your eye doctor will look for:
a Presence or absence of a cataract
a Abnormal blood vessels
a Swelling, blood or fatty deposits in the retina
a Growth of new blood vessels and scar tissue
a Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)
a Retinal detachment
a Abnormalities in your optic nerve In addition, your eye doctor may:
a Test your vision
a Measure your eye pressure to test for glaucoma.

Fluorescein angiography a As part of the eye exam, your doctor may do a retinal photography test called fluorescein angiography. First, your doctor will dilate your pupils and take pictures of the inside of your eyes. Then your doctor will inject a special dye into your arm. More pictures will be taken as the dye circulates through your eyes. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid.
Optical coherence tomography a Your eye doctor also may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working.

Treatments and drugs in Ayurveda
After the diagnosis, the doctor sets out to treat the patient in a very systematic manner. This would include a set of appropriate Panchakarma treatments and Rasayana therapies .

The Panchakarma Treatments are meant to flush out the toxins, They are classified as pre-purification, main purification and post purification phases and include various types of therapies like oil massages, fermented liquid massages, medicinal enemas, herbal purification methods.

After body purification rasayana therapies along with Netra Kriya-kalpaas were started, such as:
1.Sekam :- An eye wash using medicated kashayam.
2.Anjanam :- An application of medicine in the form of paste to he eye.
3.Aschotanam :- An adminestration of eye drops to the eye.
4.Tharpanam :- Keeping medicated ghee over the eye for a stipulated period, making concentric boundary around the orbit.
5.Puttapakam :- Keeping medicaments prepared out of plant extracts,Fats & certain minerals over the eye for a stipulated period, making concentric boundary around the orbit.

*In all the above kriya-kalpa different types of drugs are selected by your doctor according to the doshas involved.

Oral medication :
The oral medicine used for treating the disease will be extracts of pure medicinal herbs, leaves, spices etc. These are prepared specifically to restore the lost balance and to provide the needed inputs to improve the condition of patient. kashayams and Arishtam a herbal decoctions and fermentations lehyams a semi solid formulation are commonly prescribed.

Diet :
Rice, Potato, food product containing sugar, Brinjal, Lady finger, Jackfruit, Curd, Pickles, Lemon, Oily-Spicy food should be avoided .
a Choose healthy fats. Healthy unsaturated fats, such as the fats found in olive oil, may help protect your vision. Choose these healthy fats over saturated fats, such as butter, and trans fats, such as partially hydrogenated oils found in packaged foods.
a Choose whole grains over refined grains. Choose whole grains, such as whole-wheat bread, over refined grains, such as white bread.
a Add fish to your diet. Fish contain omega a 3 fatty acids that may help reduce the risk of vision loss related to macular degeneration. Fish that contain high levels of omega-3 fatty acids include salmon, sardines and tuna. Omega-3 fatty acids can also be found in supplements and nuts, such as walnuts.

Prevention
If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:
a Make a commitment to managing your diabetes . Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.
a Monitor your blood sugar level. You may need to check and record your blood sugar level several times a day a more frequent measurements may be required if youare ill or under stress. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Ask your doctor how often you need to test your blood sugar.
a Ask your doctor about a glycosylated hemoglobin test . The glycosylated hemoglobin test or hemoglobin A1C test reflects your average blood sugar level for the two- to three-month period before the test. For most people, the A1C goal is to be under 7 percent. If youave been meeting your blood sugar goals, your doctor will likely perform this test twice a year. But, if your A1C is higher than your goal, more frequent testing is recommended. Remember, keeping your blood sugar level as close to normal as possible slows the progression of diabetic retinopathy and reduces the need for surgery.
a Keep your blood pressure and cholesterol under control . High blood pressure and high cholesterol increase the risk of vision loss. Eating healthy foods, exercising regularly and losing excess weight can help. Sometimes medication is needed, too.
a If you smoke or use other types of tobacco , ask your doctor to help you quit . Smoking increases your risk of various diabetes complications, including diabetic retinopathy. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.
a Pay attention to vision changes. Yearly dilated eye exams are an important part of your diabetes treatment plan. Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy. Remember, diabetes doesnat necessarily lead to poor vision. Taking an active role in diabetes management can go a long way toward preventing complications.
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