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.

DIABETIC RETINOPATHY HAS FOUR STAGES:

MILD NONPROLIFERATIVE RETINOPATHY

At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.

MODERATE NONPROLIFERATIVE RETINOPATHY

As the disease progresses, some blood vessels that nourish the retina are blocked.

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.

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.

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.

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 here.


DIABETIC 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.

Diabetic Retinopathy Diagnosis

Your Visual Acuity will be assessed using the Snellen eye chart which measures how well each eye can see.  A detailed history of your blood sugar variations will be obtained.  Drops are put in your eye that help to widen (dilate) the pupils. Then, using a special magnifying lens, your eye doctor will look at your retina.

Specialized imaging tests may be ordered to better assess the health of the retina.  The Ocular Coherence Tomographer, (OCT) scans through your dilated pupil to assess the quality of the retinal tissue, reflecting areas damaged by diabetes.  In Fluorescein Angiography (FA), a special dye is injected into a vein in your arm and as the dye passes through the blood vessels in your retina, pictures are taken of the back of your eye. This test allows an eye doctor to see the circulation of the retina, which is critical to assessing the level of damage to the retina from diabetes.

DIABETIC RETINOPATHY TREATMENT OPTIONS

Careful observation of the diabetic patient on a regular basis by an eye doctor is crucial in detecting Diabetic changes. There often is no decrease in vision, though damage from diabetes may be occurring.

As with many diseases, the best treatment is prevention. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. Laser surgery is often recommended for people with Diabetic Macular Edema, Proliferative Diabetic Retinopathy, and Neovascular Glaucoma.

LASER SURGERY FOR MACULAR EDEMA

For Macular Edema, the laser is focused on the damaged retina near the macula to decrease fluid leakage. Some may see laser spots near the center of their vision following treatment; usually fade with time, but may not disappear. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement. The main goal of treatment is to prevent further loss of vision.

LASER SURGERY FOR PROLIFERATIVE DIABETIC RETINOPATHY

For Proliferative Diabetic Retinopathy, the laser is focused on all parts of the retina except the macula. This “pan retinal” photocoagulation treatment causes abnormal new vessels to shrink; often prevents them from growing again. Treatment decreases the chance that vitreous bleeding or retinal distortion will occur. Multiple laser treatments over time are sometimes necessary.

VITRECTOMY SURGERY

Vitrectomy Surgery for advanced Proliferative Diabetic Retinopathy is needed when the vitreous (white, gel-like substance in middle of eye) fills with blood. Performed in the operating room, this microsurgical procedure involves removing the blood-filled vitreous and replacing it with a clear solution. This invasive surgery often prevents further bleeding by removing abnormal vessels that caused bleeding, by additionally treating the eye with laser treatment.

NEW TREATMENTS

For certain patients, Anti-VEGF treatment (Avastin, Lucentis, Eylea and Beovu) is now a great treatment in controlling Macular Edema and Proliferative Diabetic Retinopathy. We help develop most of these new treatments. Call our office to find out if this treatment option may be right for you.

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