When discussing complications and risks that diabetes patients face when it comes to the health of their eyes, the most common warnings are usually retinopathy, cataracts, refractive errors and dry eyes. However, people with diabetes also have a risk of developing another serious condition, known as retinal detachment.
The retina is the light-sensitive layer in the back of the eye that is responsible for the conversion of light into signals that are sent to the brain via the optic nerve. A retinal detachment occurs when the retina separates from its supporting layers. This can lead to complete loss of vision if it is not treated immediately.
A common form of retinal detachment in diabetic patients is called diabetic tractional retinal detachment1. This advanced form of retinal disease usually occurs in cases of proliferative diabetic retinopathy, as a result of extensive abnormal vessel growth, which in turn leads to the forming of fibrous scar tissue within the vitreous (jelly-like substance within the eye)1. The retina has a risk of detaching when this scar tissue contracts and pulls, and could also lead to the formation of retinal tears or holes1.
Symptoms of retinal detachment
This is not a painful condition, but it is an ocular emergency and requires urgent assistance in order to prevent total visual loss. When you see any of the following symptoms, it is crucial to get to your ophthalmologist as soon as possible:
- Flashing lights2
- Sudden occurrence of floaters (dark floating spots that look like threads or flecks)2
- Black curtain-like appearance over visual field1
Risk factors
Although diabetic patients have a risk of retinal detachment, there are also several other risk factors that could lead to retinal detachment even in people who don’t have diabetes. This includes the following:
- Severe myopia (near sightedness)2
- Injury to the eye2
- Cataract surgery2
- Family history of retinal detachments2
- In the case of diabetic patients, uncontrolled blood sugar levels is a big risk factor1
Treatment
There are several different treatment options that can be used to repair a retinal detachment, depending on the severity of the tear. With a full retinal detachment, surgery is most definitely required. Surgery will ensure that the retina gets placed back in its proper position, in order to recover full function of the retina3. The surgery method to be used will depend on the nature and characteristics of the tear3. Different types of retinal detachment surgeries include:
Scleral buckling surgery
With this surgery, a flexible band (made from silicone or rubber2) gets placed around the eye, counteracting the force that is pulling the retina out of place3. This method of surgery flattens the retina by pushing or ‘buckling’ the sclera towards the middle of the eye2. This allows the tear to settle against the wall of the eye2. This procedure will most likely be done in conjunction with cryopexy (extreme cold) or diathermy (heat) or laser photocoagulation to seal the retina to the bottom layers2. This is a same day procedure that gets done in theatre under local or general anaesthesia, and proves to be successful in retaining vision, especially when the macula was not affected by the detachment2.
Vitrectomy
A vitrectomy entails the removal of the vitreous where the abnormal blood vessels are growing1. The scars left by the abnormal blood vessels will then be microscopically dissected and laser therapy will be performed to prevent further vessels from forming1. A gas or silicone oil is then placed in the eye to keep the retina in place. A vitrectomy involves serious risks, such as cataracts; bleeding into the vitreous; increased pressure inside the eye; and infection2. It does, however, restore some of the vision and prevent the detachment from getting worse2.
Pneumatic retinopexy
This procedure combines the insertion of a gas bubble into the eye with laser therapy or cryopexy to flatten out the retina2. The patient must then keep their head at a certain angle for one to three weeks after the procedure, to keep the gas bubble in place2. This procedure is generally considered when a single break or tear caused the detachment or when the detachment is located in the upper part of the retina2. This is an effective surgical method to repair a retinal detachment but has an extensive recovery period.
Your ophthalmologist will discuss the treatment options with you and choose the suitable treatment for your specific case.
Last thought
It is important to maintain a HBA1C (long-term measure of blood glucose control) level of 7,0 or less. Although diabetic retinopathy can’t be prevented, maintaining proper blood glucose levels together with yearly visits to your ophthalmologist will go a long way to maintain the severity and progression of the condition. Constant self-monitoring and quick response to any of the abovementioned symptoms plays a key role when it comes to retinal detachments, so keep your ophthalmologist on speed dial if you know you might be at risk.
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