Diabetic Retinopathy

One of the complications of Diabetes is Diabetic Retinopathy.�¯�¿�½ It occurs when the blood vessels of the retina are damaged due to diabetes, and may bleed or leak fluid and develop brush like branches and scar tissue. The images that are then sent from the retina to the brain become blurred and distorted. Some images may even appear to be partially blocked.

This condition causes vision loss in two ways:

1. When the abnormal blood vessels develop and leak blood into the center of the eye vision is blurred.�¯�¿�½ This is called proliferative retinopathy and is the most advanced stage of the disease.
2. Fluid can leak to the macula which is the center of vision. This fluid causes swelling or edema to the macula therefore causing the vision to blur.�¯�¿�½ This condition is called macular edema and can occur at any stage of diabetic retinopathy.

Diabetic Retinopathy is the leading cause of new blindness amongst adults in the United States; with risk rising the longer a person has had diabetes.�¯�¿�½ Each year 12,000 to 24,000 people lose their sight because of diabetes.�¯�¿�½�¯�¿�½ Nearly all Type 1 diabetics will develop some signs of retinopathy within 20 years of the initial diagnosis of diabetes.�¯�¿�½ Up to 21% of type 2 diabetics will have retinopathy when they are first diagnosed with diabetes; most will develop some degree of retinopathy in their lives. For those who have left their diabetes untreated they are 25 times more prone to blindness than the general population.

About 1/2 the people with proliferative diabetic retinopathy develop macular edema.

So, you may ask, what then are the warning signs and symptoms of diabetic retinopathy?Ã?¯Ã?¿Ã?½ Unfortunately there are no early warning signs that signal the beginning of diabetic retinopathy.Ã?¯Ã?¿Ã?½ Nor should one wait for some glaring symptom to signal the disease.Ã?¯Ã?¿Ã?½ With diabetes preventive care and a watchful eye are king, therefore it is important for all diabetics to have an annual diabetic exam with his or her Ophthalmologist whether or not visual changes are noted.Ã?¯Ã?¿Ã?½ A dilated exam allows the doctor to take a close look at your retina and optic nerve thus allowing her (him) to detect early signs of retinopathy or edema.Ã?¯Ã?¿Ã?½Ã?¯Ã?¿Ã?½ However if you do notice dark “floating” spots or patches in your vision contact your eye care professional immediately even if you’ve already had your annual exam.Ã?¯Ã?¿Ã?½ This could be indicative of bleeding and must be diagnosed and treated quickly.Ã?¯Ã?¿Ã?½ If left untreated bleeding could results in partial or complete loss of vision.Ã?¯Ã?¿Ã?½Ã?¯Ã?¿Ã?½ On the flip side, the earlier treatment begins the more effective the results.

Types of Diabetic Retinopathy

1.�¯�¿�½�¯�¿�½�¯�¿�½ Nonproliferative or Background Retinopathy: This is the earliest stage of diabetic retinopathy.�¯�¿�½ In this stage small balloon like swellings occur in the weakened blood vessels of the retina called microaneurysms.�¯�¿�½ It is a possibility that these microaneurysms could leak causing blood and fluid to spill into the retina. On occasion blood may leak into the macula which is known as the center of vision or the area responsible for fine detailed vision.�¯�¿�½ When this occurs swelling results or macular edema. As the Background Diabetic Retinopathy progresses patches of swollen nerve fiber may develop called cotton wool spots for their fluffy or wool like appearance.
2.Ã?¯Ã?¿Ã?½Ã?¯Ã?¿Ã?½Ã?¯Ã?¿Ã?½ Proliferative Retinopathy:Ã?¯Ã?¿Ã?½Ã?¯Ã?¿Ã?½ When blood vessels are blocked due to high blood sugars, new blood vessels (neovascularization) form in an attempt to nourish the retina. These new vessels form in the retina, optic nerve or even the vitreous.Ã?¯Ã?¿Ã?½ The new vessels are abnormal and fragile and may leak into the vitreous (the “jelly” that fills the eye), thus clouding or blocking the vision.Ã?¯Ã?¿Ã?½ Scarring due to neovascularization can cause traction on the retina which may result in a retinal detachment or blood vessels may grow on the iris (colored part of the eye) causing an increase in eye pressure and as a result a form of glaucoma.

Proliferative diabetic retinopathy requires treatment immediately.�¯�¿�½ The two main forms of treatment are:
1.�¯�¿�½�¯�¿�½�¯�¿�½ Photocoagulation which uses a laser to form burns across the retina to stop small leaks.�¯�¿�½ However even after photocoagulation leaks may still form, so it is important that further visits are kept with your Ophthalmologist.
2.�¯�¿�½�¯�¿�½�¯�¿�½ Vitrectomy:�¯�¿�½ A vitrectomy is performed when a vitreous hemorrhage does not clear on its own.�¯�¿�½ The blood filled vitreous is removed surgically and replaced with a balanced saline solution that maintains the shape and pressure of the eye.�¯�¿�½ By removing the blood vitreous, clear vision is restored.

It is important to talk with your Ophthalmologist who can discuss all treatments with you and discuss the proper course for you.�¯�¿�½ This article should not be used to replace your physician or her/his advice.�¯�¿�½ When dealing with Diabetes and your vision seeking the care of an Ophthalmologist on a regular basis is the only way to deter or prevent serious loss of sight.

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