DIABETIC RETINOPATHY

Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar (glucose) in the blood. Diabetes can affect children and adults.

What is diabetic retinopathy?

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in adults. It is caused by changes in the blood vessels of the retina.
In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.
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.

What are the stages of diabetic retinopathy?

Diabetic retinopathy has four stages:

1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.
2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
3. 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.
4. 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.

Symptoms of diabetic retinopathy

Most often, diabetic retinopathy has no symptoms until the damage to your eyes is severe.

Symptoms of diabetic retinopathy include:

• Blurred vision and gradual vision loss
• Floaters
• Shadows or missing areas of vision
• Difficulty seeing at nighttime

Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams

Signs and tests to diagnose diabetic retinopathy

In nearly all cases, the doctor/ophthalmologist 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

Who is at risk for diabetic retinopathy?

All people with diabetes--both type 1 and type 2--are at risk. 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 its progression.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

What can I do to protect my vision?

If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:

• Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for 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.
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.
This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.
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.

How is diabetic retinopathy treated?

During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.

Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.
Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.
If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.

How is a macular edema treated?

Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved.

What happens during laser treatment?

Both focal and scatter laser treatment are performed in your doctor's office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.
The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable. You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.
For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.
Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

What is a vitrectomy?

If you have a lot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.
A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.
You will probably be able to return home after the vitrectomy. Some people stay in the hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eyedrops to protect against infection.

Complications of diabetic retinopathy

• Blindness
• Glaucoma
• Retinal detachment
  

  
  

  Expectations (prognosis)

  
  

  

  You can improve your outcome by keeping good control of your blood sugar and blood pressure.
  Both treatments are effective at reducing vision loss. They do not cure diabetic retinopathy or reverse the changes that have already occurred.
  Once proliferative retinopathy occurs, there is always a risk for bleeding. You will need ongoing monitoring, and you may need more treatment.
  

  
  

  Prevention of Diabetic Retinopathy

  
  

  
  

  

  
  

  
  

  Tight control of blood sugar, blood pressure, and cholesterol is very important for preventing diabetic retinopathy.
  Do not smoke. If you need help quitting, ask your doctor or nurse.
  You may not know there is any damage to your eyes until the problem is very bad. Your doctor can catch problems early if you get regular exams. You will need to see an eye doctor who is trained to treat diabetic retinopathy.
  Begin having eye examinations as follows by an eye doctor skilled in the treatment of diabetic retinopathy:
  

  • Children older than 10 years who have had diabetes for 3 - 5 years or more
  • Adults and adolescents with type 2 diabetes soon after diagnosis
  • Adolescents and adults with type 1 diabetes within 5 years of diagnosis
  • After the first exam, most patients should have a yearly eye exam.

  If you are beginning a new exercise program or are planning to get pregnant, have your eyes examined. Avoid resistance or high-impact exercises, which can strain already weakened blood vessels in the eyes.
  If you are at low risk, you may need follow-up exams only every 2 - 3 years. The eye exam should include dilation to check for signs of retinal disease (retinopathy).
  
  
  

  

  
  

  Please Note;

  Call for an appointment with an eye doctor (ophthalmologist) if you have diabetes and you have not seen an ophthalmologist in the past year.
  Call your doctor if any of the following symptoms are new or are becoming worse:
  

  • You cannot see well in dim light.
  • You have blind spots.
  • You have double vision (you see two things when there is only one).
  • Your vision is hazy or blurry and you cannot focus.
  • You have pain in one of your eyes.
  • You are having headaches.
  • You see spots floating in your eyes.
  • You cannot see things on the side of your field of vision.
  • You see shadows.