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What is Diabetic Retinopathy?
Diabetic retinopathy is a serious complication of long-term uncontrolled diabetes resulting from persistently high blood sugar levels over the years. This condition affects the retina, the light-sensitive tissue at the back of the eye, impairing its ability to transmit clear images to the brain through the optic nerve.
How does the condition develop?
The retina relies on a network of blood vessels to supply essential oxygen and nutrients. Over time, consistently elevated blood sugar levels can damage these vessels, causing them to bleed, leak, or become blocked. This damage may lead to various forms of retinal impairment, including developing new, fragile blood vessels that can burst, resulting in blurred or lost vision. When the central area of the retina, known as the macula, is affected, the condition is known as Diabetic Maculopathy, a sign of more advanced disease. The risk of retinal damage increases significantly when high blood pressure is also present.
What are the different types?
- Non-Proliferative Diabetic Retinopathy: In its initial stages, NPDR often presents with minimal symptoms. The retina may show only slight changes, such as a few enlarged blood vessels, minor bleeding, or leakage. These subtle signs are typically identified during a comprehensive retinal examination by an ophthalmologist.
- Proliferative Diabetic Retinopathy: As the condition progresses, abnormal new blood vessels may form on the retina. These vessels are prone to bleeding, significantly impairing vision and potentially leading to retinal detachment. Laser treatment is frequently employed to prevent severe, long-term damage.
- Diabetic Maculopathy: This occurs when leakage from blood vessels causes swelling in the macula, severely affecting vision. Treatment options may include laser therapy, intravitreal injections, or surgery to manage the swelling and prevent further damage.
What are the causes of Diabetic Retinopathy?
Diabetic retinopathy is most common in individuals who have lived with diabetes for an extended period, mainly when blood sugar levels are not well controlled. This condition affects approximately 8 out of 10 patients with a 10 or more years of diabetes who experience some form of this eye condition. Damage to the retinal blood vessels is at the heart of the disease’s progression.
What are the Symptoms of Diabetic Retinopathy?
Early detection is key to effective management. Patients should be aware of symptoms that may include:
- Spots or dark strings floating in your vision (floaters)
- Blurred vision
- Fluctuating vision
- Impaired colour vision
- Dark or empty areas in your vision
- Vision loss
How is Diabetic Retinopathy diagnosed?
Diabetic retinopathy may be present even when vision appears normal. Comprehensive eye examinations by an ophthalmologist are crucial, often incorporating:
- Fundus Examination: A detailed evaluation of the retina.
- Optical Coherence Tomography (OCT): Imaging to assess retinal thickness and swelling.
- Fluorescein Angiography: A test to visualise the blood vessels in the retina and determine the extent of leakage or blockage.
How is Diabetic Retinopathy treated?
A range of treatment options is available for diabetic retinopathy, and sometimes a combination of treatments is used. These may include:
- Intravitreal injections of medications (anti-VEGF and/or steroids): Medications such as anti-VEGF drugs help reduce abnormal blood vessel growth and leakage, while steroids diminish macular swelling.
- Laser therapy: Lasers improve oxygen delivery to the retina and reduce the stimulus for the growth of new, abnormal blood vessels.
- Surgery: In advanced cases, surgical intervention may be necessary to remove non-clearing hemorrhages and fibrotic tissue that can lead to retinal detachment.
Tips for prevention:
- Maintain blood sugar levels: Consistently managing blood sugar prevents diabetic retinopathy. Regular monitoring and adhering to your diabetes management plan can significantly reduce the risk.
- Eat a healthy diet: A balanced diet of fruits, vegetables, whole grains, and lean proteins helps maintain blood sugar levels and overall eye health. Avoiding excessive sugar and processed foods can prevent complications.
- Exercise regularly: Regular physical activity helps control blood sugar levels, blood pressure, and cholesterol, which are essential in reducing the risk of exacerbating diabetic retinopathy.
- Routine visits to ophthalmologist: Regular eye exams are essential for early detection of diabetic retinopathy. Early diagnosis allows for timely treatment and better management of the condition.
- Manage Blood Pressure and Cholesterol: High blood pressure and cholesterol levels can exacerbate diabetic retinopathy. If necessary, monitoring and managing these factors through lifestyle changes and medication can help prevent retinal damage.
Early diagnosis of diabetes-related vision problems typically leads to better management and improved outcomes, making regular eye screenings important.
Diabetic Retinopathy Specialists
Dr. Fahd Quhill
Consultant Ophthalmologist in Medical Retina and Ocular inflammatory disease (Uveitis)Clinical Professor Of Ophthalmology (Adjunct)
Dr Fahd Quhill is a Consultant Ophthalmologist specialising in Medical Retina and Ocular inflammatory disease at Moorfields Eye Hospital Dubai in Dubai Healthcare City.
Dr Fahd specialises in the assessment and management of uveitis and inflammatory eye diseases (uveitis, infectious diseases, autoimmune diseases of the eye) as well as medical retinal disease, such as diabetes, macular degeneration, inherited retinal disease and retinal vascular disease.
He has broad experience in the diagnosis and management of complex inflammatory eye diseases, including the use of immunosuppression, as well as in treating retinal disease.
Dr. Fahd trained in Ophthalmology in the United Kingdom at Oxford, Birmingham and London, completing three Medical Retinal Fellowships in Birmingham, Wolverhampton and Moorfields Eye Hospital, London.
He has undertaken research and served as principal investigator in numerous macular degeneration, retinal vein occlusion and diabetic macular oedema trials. He has published 27 research papers on retinal and ocular inflammatory disease in leading journal/s such as Ophthalmology, British Journal of Ophthalmology and Eye, among others.
He is a member of several professional bodies, including the Royal College of Ophthalmologists.
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Dr. Luisa M. Sastre
Consultant Ophthalmologist in Medical Retina and Cataract SurgeryGCAA Approved Specialist Aeromedical Examiner
Dr. Luisa Sastre is a Consultant Ophthalmologist in Medical Retina and Cataract Surgery at Moorfields Eye Hospital Dubai in Dubai Healthcare City.
Dr. Luisa holds a Spanish medical degree from the Universidad Autonoma Medical School and completed her ophthalmology residency at Hospital Universitario Gregorio Maranon in Madrid, Spain . She is board certified in Intensive Care medicine and ophthalmology. She also holds a PhD from Universidad Autonoma de Madrid and a Master’s degree in Healthcare Organisation Leadership from ESADE Business School.
She has more than 20 years of combined regional and international experience in countries including Spain and UAE.
She has practised in leading medical institutions such as Hospital Universitario Fundación Jiménez Díaz and Hospital Universitario El Escorial, Madrid, Spain.
She has presented various papers in national and international congresses and journals and organised educational courses on cataract surgery and medical retina for peers and opticians.
She is a member of “Surgical Eye Expeditions International”, a nonprofit humanitarian organisation that hosts clinic sites worldwide. She is also a member of Sociedad Española de Oftalmologia (SEO).
In addition to her clinical work, Dr. Luisa volunteers in various charitable campaigns worldwide to treat patients suffering from cataracts who otherwise have difficulty accessing medical care.
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Prof. Ziad Bashshur
Visiting Consultant Ophthalmologist in Medical & Surgical Retina
Dr. Ziad Bashshur is a visiting Ophthalmologist specialising in Medical and Surgical Retina at Moorfields Eye Hospital Dubai in Dubai Healthcare City.
He holds a Doctor of Medicine Diploma from the American University of Beirut (AUB) in 1994. He has also completed an internship in internal medicine at Georgetown/VA medical center (1994-1995) followed by ophthalmology residency training at AUB (1995-1998) and a vitreoretinal fellowship at the University of Virginia, USA.
He has more than 22 years of regional/international experience in vitreoretinal diseases and surgery in countries including United States and Lebanon.
In his career, he has practiced in leading medical institutions such as American University of Beirut in Lebanon and University of Virginia in the US.
He is currently a tenured professor and vice-chairman of Ophthalmology at the American University of Beirut.
Dr. Bashshur has undertaken research in retinal diseases and has published over 50 research papers on macular degeneration, diabetic retinopathy, vascular diseases of the retina and retinal imaging in leading journals. In addition, he sits on several advisory boards within the medical industry.
He regularly speaks at professional meetings worldwide and serves on the review board of several renowned peer-reviewed ophthalmology journals.
He is a member of the American Society of Retina Specialists (ASRS), Retina Society and Alpha Omega Alpha Honor Society
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Dr. Avinash Gurbaxani
Visiting Consultant Ophthalmologist in Uveitis and Medical Retinal Diseases and Cataract Surgery
Dr. Avinash Gurbaxani is a visiting Consultant Ophthalmologist, specialised in Uveitis, Medical Retina & Cataract surgery at Moorfields Eye Hospital Dubai in Dubai Healthcare City.
Dr. Avinash specialises in the assessment and management of uveitis and inflammatory eye disease (uveitis, infectious diseases, autoimmune diseases of the eye) as well as medical retinal disease, such as diabetes, macular degeneration and retinal vascular disease. He has broad experience in the diagnosis and management of complex inflammatory eye diseases, including the use of immunosuppression, as well as in treating retinal disease. Dr Gurbaxani is also skilled in managing complex cataract surgery associated with these diseases.
Dr. Avinash trained in ophthalmology in Oxford and London, working at The Oxford Eye Hospital in Oxford, Kings College Hospital, St. Thomas’ Hospital and Moorfields Eye Hospital in London. He has worked at the prestigious Medical Eye Unit in London as well as completing a Uveitis Fellowship and Medical Retina Fellowship at Moorfields London and the Sydney Eye Hospital in Australia, before returning to Moorfields London as a locum consultant.
Dr. Avinash is experienced in initiating research projects and running clinical trials, and has regularly published and presented papers at national and international conferences. He is a member of several professional bodies including the Royal College of Opthalmologists (RCOphth), Royal College of Surgeons of Edinburgh (RCS) (Ed), American Academy of Ophthalmology (AAO).
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Dr. Wajiha Kheir
Visiting Consultant Ophthalmologist in Medical Retina and Ocular Oncology
Dr. Wajiha Kheir is a visiting Assistant Professor of Ophthalmology and Consultant Ophthalmologist, specialised in Medical Retina and Ocular Oncology at Moorfields Eye Hospital Dubai in Dubai Healthcare City.
Dr. Wajiha completed her undergraduate studies and medical education at the American University of Beirut, Lebanon. She was awarded the BSc degree in Biology (2009) with high distinction and the Penrose Award, and the MD degree (2013) with induction to the Alpha Omega Alpha (AOA) – Honor Medical Society. She then completed a year of Internal medicine Internship followed by three years of Ophthalmology residency at the American University of Beirut Medical Center (2017). Her subsequent sub-specialty training includes one year of Medical Retina fellowship and one year of Ocular Oncology with Clinical Pathology Concentration fellowship, both at the Duke Eye Center, Duke University School of Medicine.
She has more than five years of regional and international experience in Medical Retinal and Ocular Oncology in the United States and Lebanon. In her career, she has practiced in leading medical institutions such as Duke University Health System and the American University of Beirut Medical Center.
Dr. Wajiha has eighteen peer-reviewed journal articles and 10 book chapters published. To date, her research work has been presented in over twenty posters and/or paper presentations at regional and international conferences. Her research interests relate to age-related macular degeneration, ophthalmic oncology, radiation retinopathy as well as retinal degenerations and electrophysiology of vision.
She is a member of the AOA Medical Honor Society, the American Academy of Ophthalmology, the American Society of Retinal Specialists and the International Society of Ocular Oncology.
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Dr. Ammar Safar
Chief Medical Officer and Consultant Ophthalmologist & Vitreoretinal SurgeonGCAA Approved Specialist Aviation Medical Examiner
Professor of Ophthalmology (Adjunct)
Dr. Ammar Safar is an American Board-Certified Ophthalmologist specialising in vitreoretinal diseases and surgery at Moorfields Eye Hospital Dubai in Dubai Healthcare City.
He is currently an adjunct Professor of Ophthalmology at Mohammad Bin Rashed University and the Chief Medical Officer of Moorfields Eye Hospitals in the United Arab Emirates.
Dr. Safar undertook his medical training in Syria before moving to the United States for post-graduate training. He specialised in Ophthalmology at Georgetown University in Washington, DC, where he also served as a Chief Resident. He then acquired an additional 2-year fellowship training in Vitreoretinal Diseases & Surgery at the University of Texas, Southwestern Medical Center in Dallas, Texas, USA. Dr. Ammar then went on to hold the position of Assistant and later Associate Professor and Director of Vitreoretinal Surgery at the Department of Ophthalmology, Jones Eye Institute, the University of Arkansas for Medical Sciences, in the United States. He then relocated to the UAE, where he was a Consultant Vitreoretinal Surgeon and President of Medical Staff at a private general hospital in Dubai. In addition to his work in private practice, Dr. Ammar has undertaken research and clinical trials in areas such as diabetic retinopathy and age-related eye diseases and published and presented extensively. His research has also resulted in advances in retinal vascular diseases (discovering new management options for diabetic retinopathy and vascular occlusive disorders) and macular degeneration (new approaches for treating exudative macular degeneration).
Among his many honorary awards, Dr. Ammar was the inaugural recipient of The Martha Wood Bentley endowed Chair of Ophthalmology at the University of Arkansas. He is a member of several professional associations, including the American Academy of Ophthalmology, the American Society of Retina Specialists, the European Society of Retina Specialists, the American Society of Cataract and Refractive Surgery, The Association for Research In Vision and Ophthalmology (ARVO), Arab-American Medical Association, Research to Prevent Blindness, and a fellow of the American College of Surgeons.
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Dr. Ramzi Ghanem
Consultant Ophthalmologist in Medical Retina, Vitreoretinal and Cataract Surgery
Dr. Ramzi Ghanem is a Consultant Ophthalmologist with extensive experience in cataract surgery as well as medical and surgical retina including the full spectrum of vitreoretinal surgery, intravitreal drug injection and laser treatment.
Dr. Ramzi is a graduate of the University of Leipzig, Germany and completed his 2 doctoral thesis on anti-VEGF isomers in AMD (Age-related Macular Degeneration) at the University of Leipzig and predictors for short term visual outcome after anti-VEGF therapy of CSME due to CRVO at the University of Bern, Switzerland. He has more than 20 years of experience in Germany, Switzerland and UAE.
He has researched extensively, conducted clinical trials, published and lectured on his areas of expertise. He has been a HAAD consultant and examiner for licensure in ophthalmology.
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