Ophthalmologist for diabetic retinopathy

This stage of illness is subdivided from mild to severe. Most diabetics have non-proliferative diabetic retinopathy. At this stage, vessel bulging (microaneurysms), retinal bleeding, fat deposits (hard exsudates), capillary damages as well as nerve fibre infarcts (so-called cotton-wool nests) may arise. At its initial stage, the illness does not need therapy apart from ideal blood sugar leveling and only needs control screening. These screenings must become more frequently, according to the course of illness. At an increase of pathological findings, laser treatment of the retina may be indicated.

At this stage, most patients don’t suffer any symptoms. The retina is damaged without any notice of the patient. Therefore, annual preventive screenings are so important.

When treated early, the progression of the disease can be stopped.

Proliferative diabetic retinopathy is more frequently among teenagers with type 1 diabetes than among those with type 2 diabetes. As a consequence of a lack of oxygene for the retina (retinal ischaemia), new vessels form (neovascularisation). Due to their modified wall structure, they leak, tend to bleed and let liquids ooze out into the retina. A sudden bleeding into the vitreous chamber can occur, causing a sudden severe visual loss up to blindness. In some cases, scar membranes may form on the retina which contract the retina and can cause a retinal detachment.

When not treated at all, new vessels may form on the iris and inside the iridocorneal angle (the structure where eye liquids can drain off). This may lead to a rising intraocular pressure.

The stage of proliferative diabetic retinopathy requires immediate treatment. The treatment consists mainly of panretinal laser coagulation (laser treatment of the whole retinal periphery). In case of macular edema, the therapy may be combined with intravitreal medicament application into the eye. When viteral haemorrhages without resorption or strong traction membranes threatening retinal detachment occur, surgery may be indicated.

At this stage, close treatment and monitoring is crucial.

Our ophthalmologist practice is specialised on diabetic retinopath and provides top-notch diagnostic and therapeutic instruments. If need be, we also conduct intravitreal injections.

Whenever diabetes-induced changes on the retina affect the macula, the point of sharpest vision, we speak of diabetic maculopathy. This often results in a leaking of liquids from the small vessels and a swelling at the central retina (macular edema). The macular edema affects the vision and, if not treated, may lead to a constant damage of the central retina with a permanent disorder of the eye.

Therefore, this stage, too, requires early treatment in any case.

The diabetic macular edema treatment consists of repeated intravitreal injections which we conduct ourselves.

Optical coherence tomography is a contact-free, non-invasive procedure for the representation of single layers of the central retina. Through this examination, the ophthalmologist can distinguish diagnostic findings that are impossible to make otherwise. For example, macular edema can be shown in all accuracy including the size as can be the whole course of illness. This is how we can identify the need for a new treatment.

OCT angiography is a modern non-invasive procedure to display the small retinal vessels around the macula area and the adjacent region of the retina. It enables us to show e.g. small vessel bulgings (aka microaneurysms), pathological forming of new vessels, as well as areas without any blood vessels (so-called ischaemic maculopathy), all of which can occur at diabetes-induced changes of the retina. The examination is conducted without any injection of colourants. This procedure is also very suitable for diabetic retinal disease follow-ups.

Fluorescene angiography is the procedure of choice, when a detailed statement on the retinal perfusion is wanted. This examination makes sense, for example, at the stage of proliferative diabetic retinopathy, for both diagnostics and progress monitoring. During the examination, a well-tolerated yellow colourant (fluorescene) is injected into the arm vein. The colourant is spread all across the body, finally reaching the vessels at the ocular fundus. Using a special camera, these vessels can be photographed over the course of time. Many pathological changes, such as new vessel forming at diabetic retinopathy, can be shown that way.

Wide-angle photography of the retina is executed with a special camera. The reproduction can be done in parts without a dilatation of the pupil. Many pathological changes, e.g. bleedings, can be documented in that way. The images are helpful later for progress monitoring, too.

Laser treatment is usually indicated when proliferative changes have occurred (forming of new vessels). But there are other pathological changes, too, that call for targeted and careful laser treatment.

Intravitreal injection therapy is required for a clinically significant diabetic macular edema. An early therapy provides for a better prognosis. Hence, patients with beginning diabetic vessel changes should be examined regularly, so a possible therapy can be started timely.