Diabetic retinopathy


Diabetic Retinopathy

Description, Causes and Risk Factors:

Alternative Name: Fundus diabeticus.

The eye works in much the same way as camera. The front parts of the eye (the cornea, pupil, and lens) are clear and allow light to pass through. The light also passes through the large space in the center of the eye called the vitreous cavity. The vitreous cavity is filled with a clear, jelly-like substance called the vitreous gel. The light is focused by the cornea and the lens onto a thin layer of tissue called the retina, which covers the back inside wall of the eye. The retina is like the film in a camera. It is the seeing tissue of the eye. When the focused light hits the retina, a picture is taken. Messages about this picture are sent to the brain through the optic nerve. This is how we see.

Diabetic retinopathy

Diabetic retinopathy is an eye problem that can cause blindness. It occurs when high blood sugar damages small blood vessels in the back of the eye, called the retina. All people with diabetes are at risk for this problem. An estimated 18 million American children and adults have diabetes, 75 percent will have some degree of diabetic retinopathy.

Types may include: Nonproliferative diabetic retinopathy and proliferative diabetic retinopathy.

The most common form of Diabetic Retinopathy is called or “nonproliferative diabetic retinopathy”. It is seen most often in patients who develop Type 2 or adult-onset diabetes.

In this form of the disease, high blood sugar levels cause weak spots in the walls of the tiny blood vessels that supply blood to the retina. These thin walled sacs break and bleed creating tiny hemorrhages. They also leak fluid creating swelling in the surrounding retinal cells. The higher your blood pressure, the more pressure there is to push fluid out of the leaky vessels. This might blur your vision. Visual blurring caused by nonproliferative retinopathy can't be corrected with glasses and long-term swelling can permanently reduce your central vision.

Proliferative retinopathy can occur in any diabetic but is most common in diabetics who develop the disease as children (known as “Type 1” or “juvenile onset diabetics”). It can occur alone or at the same time as non-proliferative disease.

In this advanced stage of the disease, the retina triggers the growth of abnormal blood vessels that grow into the vitreous gel in the center of the eye. Over time, the blood vessels contract forming fibrous bands that can tear the retina off the back of the eye.

As the blood vessels within the bands contract, they may bleed filling the vitreous gel with blood. A hemorrhage of this type can rapidly reduce vision and may take weeks or months to clear. Additionally, the fibrous bands may continue to contract pulling the retina off the back of the eye. A retinal detachment of this type can severely affect the central vision. Retinal tears of this type often cannot be fixed with surgery.

Risk Factors:

    Diabetic Retinopathy is caused by elevated blood sugar levels. Too much sugar in your blood damages the tiny blood vessels (capillaries) that supply the retina. This results in Diabetic Retinopathy.

  • Other factors that may increase your risk of developing Diabetic Retinopathy include high blood pressure, pregnancy, a family history of the condition, kidney disease, high cholesterol, and a history of smoking.

  • Macular edema -- the macula is the area of the retina that provides sharp vision straight in front of you. If fluid leaks into this area, your vision becomes more blurry.

  • Retinal detachment -- scarring may cause part of the retina to pull away from the back of your eyeball.

  • Glaucoma -- increased pressure in the eye is called glaucoma. If not treated, it can lead to blindness.

  • Cataracts.

Symptoms:

Symptoms of diabetic retinopathy may includeblurred vision, changes in central vision,floating spots, and even sudden vision loss.The first two symptoms are caused by swelling(edema) of the macula, the part of the retinathat gives us sharp central vision.

Floating spots are droplets of blood fromleaky blood vessels growing into the eye'sjelly-like center (vitreous body). When thesevessels bleed heavily,vision may become completely blocked.

Diabetic retinopathy can also cause a retinaldetachment; this sometimes looks like abillowy curtain.

Diagnosis:

In nearly all cases, the health care provider can diagnose diabetic retinopathy by dilating the pupils with eye drops and then carefully examining the retina. A retinal photography or fluorescein angiography test may also be used.

Treatment:

The following are very important for preventing diabetic retinopathy tight control of blood sugar (glucose), blood pressure, and cholesterol, and stop smoking.

Laser surgery can be very helpful for the treatment of diabetic retinopathy. Essentially, the major purpose of laser surgery is to prevent further visual loss. The laser beam is a high energy light that turns to heat when it is focused on the parts of the retina to be treated.

In Nonproliferative Diabetic Retinopathy (NPDR), the laser heat either seals the leaking blood vessels of the macula or reduces their leakage and allows the macula to dry.

If you have the more severe Proliferative disease, this may be treated with Pan-Retinal Photocoagulation, a procedure performed with a laser. The laser intentionally destroys the peripheral unhealthy tissue that is stimulating abnormal blood vessel growth. The procedure helps to preserve and protect your central vision - the vision that allows you to continue to both read and drive. After the procedure your vision will be blurry for about a day. Some loss of peripheral or night vision may occur.

Vitrectomy: If you have blood in the vitreous gel or if there traction on the retina, a vitrectomy may be performed to surgically remove the vitreous gel from the center of your eye. In this procedure, the surgeon cuts and removes any fibrous bands that may be pulling the retina out of its normal position. Additionally, abnormal blood trapped in the vitreous gel is removed. This procedure alleviates traction on your retina caused by fibrous bands that are found in proliferative disease. This procedure is performed by skilled retina/vitreous surgeons and is reserved for patients who are experiencing or at risk for severe vision loss.

Preventive Measures:

    If you can keep your fasting blood sugar and your Hemoglobin A1c in the normal range you will probably be able to maintain good vision throughout your life.

  • Keep blood sugar levels near normal by eating a diet that spreads carbohydrate intake throughout the day.

  • Monitor your blood sugar levels frequently.

  • Get regular physical exercise.

  • Take your diabetic medications as prescribed.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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