Diabetic Retinopathy Demystified: Insights from Dr. Ashish Markan (Part-2)

Welcome to part 2 of our conversation with Dr. Ashish Markan (MedBound Handle: @markan0601).

Priya Bairagi: What are the preventive measures can be taken to slow the diabetic retinopathy?

Dr. Ashish Markan: The only preventive measure to significantly reduce the progression of diabetic retinopathy or prevent it from happening is to control your blood sugars. We emphasize this to our patients repeatedly, yet many of them seem to have a misconception that their diabetes is not the cause of diabetic retinopathy. It's a common scenario we often encounter, and they frequently ask us.

As doctors, we consistently stress the importance of keeping their blood sugars under control. However, some patients will show me a report and say, "Doctor, my sugar levels are normal now." But that's not the whole story. What really matters is your long-term control. Fluctuating sugar levels, where today your sugars are normal but the next day they are uncontrolled or rising with spikes in insulin, can contribute to the worsening of diabetic retinopathy.

So, maintaining long-term blood sugar control is crucial.

Dr. Ashish Markan: Indeed, this is a crucial point to consider, and there are several factors at play. Firstly, the duration of diabetes is highly significant. The longer a person has had diabetes, the greater the chances of developing diabetic retinopathy in their eyes. For instance, individuals who have been living with diabetes for 20 years have a much higher risk compared to those who were recently diagnosed with the condition, say, within the last five years.

Secondly, various comorbidities play a role, such as hypertension, nephropathy (kidney disease), and anemia. These factors also contribute to an increased progression of diabetic retinopathy.

In summary, diabetic retinopathy is a multifactorial disease. While diabetes and blood sugar levels are the primary culprits, other comorbidities and factors can significantly contribute to its progression.

Dr. Ashish Markan: Lifestyle practices indeed play a crucial role in managing diabetic retinopathy, and they have a positive impact not only on the body but also on eye health. Engaging in regular physical exercises is beneficial for your overall well-being, and it can also benefit your eyes. The more you incorporate physical activity into your daily routine, coupled with good dietary habits, the better it is for your eye health.

Additionally, adopting healthy eating practices is a must. Avoiding smoking and limiting alcohol intake are also essential factors to consider. These lifestyle choices can help in preventing the progression of diabetic retinopathy.

Priya Bairagi: What are the available treatments for diabetic retinopathy, and what is their effectiveness?

Dr. Ashish Markan: There are various treatment modalities available for diabetic retinopathy, and the choice depends on the stage of the condition and the specific pathology in the eye. For instance, when a patient is dealing with diabetic macular edema (often abbreviated as DME), there are several anti-VEGF (vascular endothelial growth factor) injections available. VEGF is a molecule in the eye responsible for causing macular edema. These injections come in various forms, including biosimilars and original molecules. Patients receive these injections on a monthly basis, and the frequency may vary depending on the severity of the disease. To determine the need for injections, we often use OCT scans (Optical Coherence Tomography), which provide detailed information about the extent of macular edema.

Another treatment option is laser therapy. If a patient doesn't respond well to injections, we can consider grid laser or focal laser treatment. In cases where new blood vessels develop, increasing the risk of vitreous hemorrhage, retinal photocoagulation, which is a form of laser therapy, can be performed.

The third modality is surgery. Surgery is typically reserved for end-stage disease when there is significant bleeding or retinal detachment. In such cases, surgical management becomes necessary as injections or laser treatments may not be effective.

In summary, there are three main treatment modalities for diabetic retinopathy: anti-VEGF injections, laser therapy, and surgery. The choice of treatment depends on the specific condition and its stage.

Himani Negi: How can we effectively raise awareness about diabetic retinopathy among individuals and communities, especially those with a family history of diabetes, to encourage regular eye check-ups and early detection?

Dr. Ashish Markan: It seems that the primary issue leading to patients arriving late for treatment lies in the miscommunication between patients and their primary physicians, such as endocrinologists or diabetes specialists. It is the primary physician's responsibility to ensure timely referrals to ophthalmologists, eye doctors who can assess and manage diabetic retinopathy.

In today's healthcare landscape, many endocrinologists and physicians have access to fundus cameras. When patients visit their clinics, these doctors can capture fundus photographs, enabling them to detect abnormalities early. Subsequently, they can promptly refer these patients to ophthalmologists for necessary interventions.

Apart from the logistical challenges, patients often face emotional distress upon learning of their diabetes diagnosis. Having to commit to long-term diabetes medications can be overwhelming. If a patient is also aware of having diabetic retinopathy, it adds an additional layer of concern. Therefore, the primary responsibility for addressing these issues lies with the endocrinologist or the patient's primary doctor overseeing their diabetes treatment."

Priya Bairagi: Are there any innovative or experimental treatments or emerging technologies in development for diabetic retinopathy?

Dr. Ashish Markan: There are numerous imaging modalities available in the field of ophthalmology, especially in the realm of retinal examination. We have Optical Coherence Tomography (OCT), OCT angiographies, and fluorescent angiographies. Angiography is a technique used to study the blood vessels in the retina. We also have wide-field angiographies that can capture the entire network of retinal blood vessels in a single screenshot.

What makes retinal examination unique is that it is the only organ in the body where we can directly visualize the blood vessels. In other parts of the body, such as beneath the skin, vessel problems remain hidden from sight. The eye is exceptional in this regard. If an issue is occurring within the retinal vessels, it often indicates a problem in another part of the body as well. This underscores the importance of ocular imaging for disease assessment, monitoring, diagnosis, and providing appropriate treatment. Ocular imaging plays a crucial role in these aspects of patient care.

Priya Bairagi: What are some practical tips and strategies for maintaining good eye health and preventing eye-related issues?

Dr. Ashish Markan: When it comes to diabetic retinopathy, the most important advice I can give is to focus on controlling your diabetes. There's no limit to the number of injections or laser treatments we can administer, and some patients may believe that a magical injection can instantly improve their vision. However, it doesn't work that way. Blood sugar control is paramount. If your blood sugar levels are consistently high, exceeding 300 or 400, giving injections becomes risky due to the potential for eye infections.

My primary suggestion to all these patients is to maintain good blood sugar control, adopt a healthy lifestyle, and engage in regular physical exercise. There's no specific eye tip, eye exercise, eye drop, or Ayurvedic medicine that can miraculously improve your vision if you have diabetic retinopathy. The condition is primarily driven by the systemic disease, which is diabetes, so diabetes control is the key.

If you're interested in learning more about diabetes, you can visit the website drcr.net. It focuses on diabetic retinopathy research and is funded by the National Institute. However, please note that the information there may be quite advanced and not easily understandable for the average person.

Himani Negi: What final message or advice would you like to convey to society to emphasize the importance of eye care and maintaining good eye health?

Dr. Ashish Markan: One crucial piece of advice I'd like to emphasize is the importance of visiting your ophthalmologist regularly. Even if you notice a slight drop in your vision, do not delay your appointment with the ophthalmologist. If you have diabetes, it's essential to undergo annual screenings with a retina specialist and maintain regular follow-ups with your doctors. Avoid the temptation to rely on Ayurvedic medicines, a common practice in India. Many patients believe in quick fixes and often approach us with devices or remedies suggested by Babas or unverified sources, claiming to improve vision miraculously. In reality, these remedies seldom work.

Please resist these shortcuts and place your trust in evidence-based medicine. Doing so will not only help you preserve your vision but also safeguard the vision of your loved ones.