DIABETIC RETINOPATHY PATIENT EDUCATION LITERATURE, LEAFLET Abstract: Awareness regarding Diabetic Retinopathy is so less in country like India,

, that the related blindness is enomously high.The lack of awareness regarding this problem has lead to lack of treatment which further increase the diabetic retinopathy related blindness. Awareness should be increased in the general public. One of the methods for education is with education literature. This literature should be in plain and simple language , It should highlight the importance of screening. It should at times warn the public too. Here is a such education literature on Diabetic Retinopathy, which is being used since past 8 years to educate the public. Objective: to bring out a literature script which should improve the awareness among the general public regarding Diabetic Retinopathy, and thus increase the timely laser treatment, and thus decrease the Blindness related to Diabetes. Methods: this literature written by the first author utilises the common examples which will be easily understood by the not so educated public. Results: This material has been in circulation since past 8 years, and it has increased the awareness which is reflceted by the number of screening examinations and LASER treatments done. Conclusion: the literature is an essential tool in bringing the awareness among the laymen about the Diabetic Retinopathy and its prevention. Practice Implications: Its a simple tool and can be distributed to all the nearby population or to the netizens.More and more physicians should utilise such leaflets to increase the awareness and thus reduce the blindness related to Diabetic retinopathy.

Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

DIABETIC RETINOPATHY - Patient Education

DIABETES Our body is made up of several trillion cells. Every cell receives its energy from glucose. Glucose reaches all the cells through blood. In optimal amounts, this glucose is life giving to all the cells. But if this glucose increases in blood, it acts like poison and damages all parts of the body. This condition, where in the blood glucose levels rise to abnormal levels, is called diabetes. Insulin is a hormone which regulates the blood sugar level. Due to either decrease in this insulin or its improper functioning, the sugar levels rise. These are Type I and Type II diabetes. Diabetes damages almost all the organs in the body. The most affected parts are retina (Diabetic retinopathy), Foot (Diabetic foot) and kidneys (Diabetic nephropathy).

DIABETIC RETINOPATHY Our eyes are Living Cameras. They continuosly take images and send them to brain for printing. Infact camera was invented based on our eyes. The following figure compares a camera and our eye:

Just like a film in camera, our eye too has a thin film in the back of its inside. This film is called as retina. This is thin wafer like, and is spread like a plastic sheet over the inner surface of eye ball. Retina is the most important part of eye. Imagine a camera without film.

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Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

As all parts of our body, retina too needs blood supply for its survival. The blood vessels which supply blood to retina are called as Retinal blood vessels. These blood vessels are arranged in branching and sub-branching fashion , just like the roots of a big tree. These are like pipes which carry blood.

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Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

High sugars in diabetes, weaken these blood vessels and punctures them at certain sites. This leads to leakage of blood and damage to retina. This weakening ,leaking and damage caused by diabetes to the retina is called as Diabetic Retinopathy. This leak starts in a small manner and grows gradually to bursting of vessel with severe bleeding and loss of eye sight. This is similar to rusting of iron water pipes. Rusted water pipe does not explode immediately. It initially starts leaking drop by drop. If not corrected , it will start leaking in streamlike fashion. If not corrected even in this stage, the pipe will break up leading to a gush of water explosion. Similarly , in diabetic retinopathy, in initial stages there will be droplet like leaks. These will increase over time, to a stage where the blood vessels burst leading to a gush of bleeding and loss of sight. Any material present in the blood can leak out of blood vessels. It can be water leak, which is called as Edema, or the fatty material leak which are called exudates. Or the whole blood can leak which are called as haemorrhages. This disease progresses in stages and leads to severe bleeding in last stages. Patient loses sight in this last stage. Till then patient does not have any symptoms in his eyes. His sight and eyes will be perfectly normal. Patient has no clue regarding the damage which is happening in his eyes. If patient waits till he gets symptoms, it would be too late and he may remain blind life long. The only way to prevent such blindness is to treat it with laser at the right time. The right time is decided by a retina specialist after some tests. This laser treatment will stop the progression of disease, it does not cure the disease. It means, blindness can be prevented but not cured in most of the situations. Diabetic retinopathy is like a bomb in the eye. It does not produce any effects till it explodes. You can only prevent it from exploding. Once it explodes very little can be done. All diabetics should undergo regular retina screening. When necessary laser treatment should be taken. Strictly following this protocol is the only method to prevent blindness in diabetics.

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Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

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Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

DIABETIC RETINOPATHY- Frequently Asked Questions 1. How serious is diabetic retinopathy?

Ans. In last stages, this is as serious to sight, as a heart attack is for life. 2. What is good sugar control?

Ans. Fasting blood sugar of 110 mg% or less and Post lunch sugar of 150-160 mg% can be considered good. 3. Who has more chances of developing diabetic retinopathy?

Ans. a. long time diabetics. b. uncontrolled sugar levels. c. high fluctuations in sugar levels. d. people who along with diabetes have Blood pressure, kidney problems, anemia, heart problems etc.. 4. How do I detect diabetic retinopathy? Ans. Patient cannot detect it in early stages, as he has no symptoms. By the time he gets symptoms, the disease would have been in late stages. It can be detected only by dilated retinal examination (examination of retina after enlarging the pupil) by a retina specialist. Many diabetics are not aware of this fact. They dont consult a retina specialist till they get visual problems. By that time, the disease would have been in serious stage, with no treatment. Thats the reason , we have many diabetics who are blind. Spread of awareness regarding this disease can prevent many others from becoming blind. 5. What are the symptoms in diabetic retinopathy?

Ans. In early stages it has no symptoms. This disease has no early warning signs. In later stages patient may see some black spots in front of eyes (floaters), or he may suddenly lose his sight. These are seen after a severe bleeding in the eye. In macular edema (Water logging of the sensitive part of retina) patient has decreased vision. 6. What is pupillary dilatation?

Ans. Retina is situated like a spreadsheet in the back of eyeball. It can be compared to a cinema screen in the hall. The only route to see it is the pupil. Normally our pupil is small and does not allow total view of retina. If we enlarge it , we get a more fuller view of retina. E.g imagine yourself watching the movie screen from outside the hall, through the door gap. If the door is only slightly open , you get a smaller view of screen. If u wide open the door, u get the full view. Similarly, if pupil is widely opened, we get a fuller

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view of retina. The pupil is enlarged using eyedrops. This procedure is called pupillary dilatation. It takes half hour to hour. After the pupillary dilatation, patient has photophobia(inability to see light) and decreased vision for a couple of hours. These are very mild and transient.

7.

What is diabetic retinopathy screening?

Ans. Its the retinal examination done to detect the disease in early stages, before patient develops symptoms. 8. What is prevention?

Ans. If in screening, it is detected that patient has diabetic retinopathy in severe stage, it has to be treated with lasers to prevent further progression and blindness. This is called prevention. This can be compared with a bomb in bus stand. A bomb as such does not produce any effects until it explodes. Till then, it looks normal. You see a suspicious bag in bus stand. You call the police, and police call a bomb squad. The bomb squad do some tests to confirm, whether it is really a bomb. If it turns out to be a bomb they defuse it with some defusing techniques. Thus they prevent an explosion , which otherwise would have lead to severe property and life damage. But after the defusion do u expect any change in the busstand? No. it would be just like before. All the activities of police and bomb squad was only to prevent an explosion but not to improve existing bus stand. If diabetic retinopaty is a bomb, all diabetics are suspicious. Retina specialist is the bomb squad who diagnoses the bomb. The test used by him for this purpose is Retina screening. If the disease is detected, it is defused by laser treatment, which prevents an explosion and blindness. If patient doesnot follow the above protocol, he will end up in complicated stage. Bomb has exploded. In such situation, you can only do a damage control. Regaining normal vision is almost impossible. 9. What is retinal ischemia?

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Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

Ans. As said earlier there will be leakage of blood in the retina. Due to this and due to blockage of blood vessels , some areas of retina become devoid of blood supply. These areas without blood, become lifeless and are called ischemic areas. These ischemic areas are like weeds in a field. These by themselves are useless. Upon that they spoil the whole crop in the field, if left untreated. Similarly if the retinal ischemic areas are left unburnt, they will spoil the whole retina and cause blindness. The burning of these ischemic areas is done by laser treatment. 10. What is Fundus Fluorescein Angiography (FFA)? Ans. In retinal screening, we will know the effects of leakage, like bleeding etc. But the areas of leakage wont be known. Moreover ischemic areas are not well made out. These will be known by FFA. This will also give insight about macular edema and damage. The number of laser treatment sessions, will be decided after FFA. A dye is injected in the arm veins. Retina is examined or photographed to know the flow of dye. This is an OPD procedure. Needs at least 2 hours of empty stomach. This dye will cause the urine to become orange for couple of days. Some may experience nausea or even vomit. Very very rarely an allergic reaction can happen. Overall it is a safe procedure. 11. With whom should I undergo retina screening? Ans. A retina specialist is the best person for this. If he is not available, any ophthalmologist who has experience in retinal examination, and has equipment, can serve. 12. When should I undergo retinal screening ? how frequently should I undergo it? Ans. Type 2 diabetics should get their first retinal examination at the time of diagnosis of diabetes. Depending upon the retinal situation, retina specialist will decide about next visit. Usually yearly checkups are adviced. 13. With whom should I undergo laser treatment? Ans. Laser treatment is a complex procedure which requires training and experience. You should get it done with a retina specialist. 14. What is laser treatment? Is it an operation? Ans. No. laser is a type of light beam which is used to burn the ischemic areas in the retina. Laser beam is made to fall on the specific areas of retina with the help of special equipment. This will also handle the leakage spots. This is again an OPD procedure, and does not require any admission , nor injections. It takes 15 minutes to 45 minutes. This requires pupil dilatation. 15. Should I undergo any restrictions after laser treatment? Ans. No. For 15 minutes , your vision may be blurred. You can do your regular activities after two hours. 16. How many times should I undergo laser treatment? Page 7

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Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

Ans. Usually 3 to 4 sessions are required. For some macular problems, a single session is sufficient. The spacing is decided by the laser surgeon. Usually 3 days gap is adviced. 17. Does laser treatment improve my eyesight? Ans. No. it is only preventive. It only prevents the disease to grow further, which can lead to blindness. It does not get back the lost sight. 18. I am a diabetic since many years. I dont have any problem in my eyes. Do I still need to undergo retinal examination? Ans. Absolutely yes. If you wait for the problems to occur, then it would be too late to save your sight. You have to undergo regular retinal screening as per protocol. 19. I am a diabetic since many years. I never underwent retinal screening nor retinal laser treatment. I suddenly lost my vision yesterday. What should I do? Ans. You might have developed severe vitreous bleeding. You might be having a retinal detachment too. In such situations, a complex vitreoretinal surgery may be needed. The chances of regaining normal vision are very less especially if its a RD. 20. I underwent laser treatment thrice. Is there a necessity for me to still undergo retinal examination and do I require further laser treatment in the future? Ans. Yes. Even after laser treatment depending on your diabetic status, your diabetic retinopathy may still progress. So frequent retinal examinations are still necessary. Some people may need further sessions of laser too. As long as you have diabetes, Diabetic retinopathy stays with you. Just like u undergo regular sugar checkups, u need to undergo retinal examination too. 21. Regular retinal screening and timely laser treatment. Are these sufficient? Will they protect the retina for lifelong? Ans. Not totally. The laser treatment works properly only when the blood sugars are under total control. People with uncontrolled sugars, may still develop significant retinal damage inspite of retinal laser treatment. Apart from sugars, other bodily parameters too should be under control like BP, anemia (lack of blood), kidney problems, cholesterol problems etc. Bodily derangements show their effect on retina. 22. Whenever I go to my retina specialist, they instill eyedrops in my eyes, and make me wait for almost an hour. Why is that? Is it that necessary? Ans. Yes. A large pupil is very necessary for retinal examination. The eyedrops are to enlarge the pupil. Retinal examination without pupillary dilatation, will only give a partial view of retina, and the peripheral disease can be missed. 23. What is vitreoretinal surgery? When is it needed? Ans. Vitreoretinal surgery is the last option to save atleast some of retina. It is a complex surgical procedure, which requires special equipment and skills. It is usually required in complicated stages. It would be the last step. Usually adviced when all other Script by Dr. Murali Mohan Gurram. Page 8

Diabetic Retinopathy Patient education Script by Dr. Murali Mohan Gurram

doors are closed. The results are usually poor in many situations. It is better, not to get such a stage.

Diabetic Retinopathy blindness has no cure. Prevention is the only way. Regular retinal screening and Timely Laser treatment is the only way to prevent Diabetic blindness.

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