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Diabetic Retinopathy
Diabetic retinopathy is a leading cause of
blindness in American adults. It is caused by changes in the blood vessels of
the retina. In some cases, blood vessels may swell and leak fluid. In other
people, abnormal new blood vessels grow on the surface of the retina. The blood
vessels may leak blood and cause a retinal detachment.
If you have diabetic retinopathy, at first you may not
notice changes to your vision. But over time, diabetic retinopathy can get
worse and cause vision loss. Diabetic retinopathy usually affects both eyes. |
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Diabetic retinopathy has
four stages:
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Mild Nonproliferative Retinopathy.
At this earliest stage, microaneurysms occur. They are small areas of
balloon-like swelling in the retina's tiny blood vessels.
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Moderate Nonproliferative Retinopathy.
As the disease progresses, some blood vessels that nourish the retina are
blocked.
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Severe Nonproliferative Retinopathy.
Many more blood vessels are blocked, depriving several areas of the retina with
their blood supply. These areas of the retina send signals to the body to grow
new blood vessels for nourishment.
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Proliferative Retinopathy.
At this advanced stage, the signals sent by the retina for nourishment trigger
the growth of new blood vessels. This condition is called proliferative
retinopathy. These new blood vessels are abnormal and fragile. They grow along
the retina and along the surface of the clear, vitreous gel that fills the
inside of the eye. By themselves, these blood vessels do not cause symptoms or
vision loss. However, they have thin, fragile walls. If they leak blood, severe
vision loss and even blindness can result.
The blood vessels become blocked, so sufficient oxygen doesn’t reach the retina. In other words, hypoxia develops. Remember, if hypoxia occurs to your brain, the result would be a loss of consciousness. Well, if hypoxia occurs to your retina, there will eventually be visual consequences. However, in response to the hypoxia, a signal is sent to release a chemical called vascular endothelial growth factor; aka VEGF. This substance is responsible for creating the new blood vessels that grow on the surface of the retina and along the vitreous gel inside the eye. The new blood vessels grow in order to feed the starving retina. Unfortunately, these are not normal or healthy blood vessels. The new blood vessels are formed in order to carry oxygen to the retina; however, unhealthy consequences can and usually occur secondary to their formation.
The new blood vessels are fragile, thus lending themselves to leaking and breaking easily. Additionally, not only do the vessels grow on the surface of the retina, but they also grow upward into the vitreous. As a result, a tugging can occur between the vitreous gel and the new blood vessels. Consequently, the new blood vessel is torn, and blood pours out into the vitreous gel and retina. As a result, the patient is likely to very poor vision to only light perception.
- Macular Edema.
There are different degrees of macular edema, but, what’s imperative is, macular edema is an accumulation of fluid in the most sensitive area of the eye. The longer the fluid stays there, the more likely vision will be permanently affected. Think of this analogy: pour water into a box of batteries, and let the batteries sit for 6 months. After 6 months, take the batteries out of the box, dry them off, and insert them into a remote controller. The likelihood of the batteries functioning correctly, if at all, is limited. Well, the same holds true for macular edema. The macula is composed of photoreceptors, and like batteries, the photoreceptors are cells. (photoreceptors-light cells, batteries-battery cells). The macula is composed of the cells responsible for fine detail viewing and near vision. If the fluid resides there too long, vision will be affected dramatically. In essence, the better you control you blood sugar levels, cholesterol and high blood pressure, the less likely your vision will be affected by diabetes.
All people with diabetes--both type 1 and type 2--are at
risk for developing retinopathy. That's why everyone with diabetes should get a
comprehensive dilated eye exam at least once a year. The longer someone has
diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to
45 percent of Americans diagnosed with diabetes have some stage of diabetic
retinopathy. If you have diabetic retinopathy, your doctor can recommend
treatment to help prevent vision loss.
Macular edema can develop without symptoms at any of the
four stages of diabetic retinopathy. You can develop both proliferative
retinopathy and macular edema and still see fine. However, you are at high risk
for vision loss. Your eye care professional can tell if you have macular
edema or any stage of diabetic retinopathy. Whether or not you have symptoms,
early detection and timely treatment can prevent vision loss.
If you have diabetic retinopathy, you may need an eye
exam more often. People with proliferative retinopathy can reduce their risk of
blindness by 95 percent with timely treatment and appropriate follow-up care.
Better control of blood sugar levels slows the onset and progression of
retinopathy. The people with diabetes who kept their blood sugar levels as close
to normal as possible also had much less kidney and nerve disease. Better
control also reduces the need for sight-saving laser surgery. Other
studies have shown that controlling elevated blood pressure and cholesterol can
reduce the risk of vision loss. Controlling these will help your overall health
as well as help protect your vision.
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Treatment for diabetic retinopathy is
based on the type of retinopathy present. At East Florida Eye Institute, we are
utilizing ground breaking therapies to treat this condition. To learn
more, click on the Advanced Treatment page.
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