Diabetic Retinopathy

Diabetic retinopathy is the leading cause of blindness in the working population of the United States. Fortunately, over the last twenty years, ophthalmologists have been able to effectively treat many patients with diabetic retinopathy. These treatments which include laser photocoagulation as well as vitreous surgery have been able to stabilize and improve many patient’s vision with diabetic retinopathy. With these advances in treatment plus tight glucose control, most patients have been able to maintain useful vision with early diagnosis and treatment.

Diabetic retinopathy is divided into two categories: proliferative and non-proliferative. Non-proliferative diabetic retinopathy is the earliest stage of diabetic retinopathy. Tiny blood vessels called capillaries within the retina leak blood and fat (lipid). This leakage of fluid leads to swelling of the retinal tissue. The retina swelling (edema) will cause visual loss. Common symptoms include distortion and loss of detailed vision. As diabetes advances, capillaries may become so damaged that blood may no longer circulate within them. This is called capillary closure. If the capillary closure is in the area of central vision, then poor vision is the result. This loss of circulation is also called capillary non-perfusion.

Proliferative diabetic retinopathy is a more advanced stage of diabetic retinopathy. Proliferative diabetic retinopathy (PDR) is caused by poor perfusion of the retina and therefore a lack of oxygen to the retina. This leads to abnormal, new vessels (neovascularization) to grow on the surface of the retina and optic nerve. Unfortunately, these new abnormal blood vessels do not do a good job of providing nutrition to the retina. They can lead to scar tissue formation which in turn causes wrinkling and detachment of the retina. They can also break and bleed causing the vitreous (jelly-like substance in the eye) cavity to fill with blood. This results in a vitreous hemorrhage. Vitreous hemorrhage can lead to almost total loss of vision. Vitreous hemorrhage may be surgically removed if indicated.

Diagnosis of Diabetic Retinopathy

A detailed, dilated retinal examination by a trained professional using stereoscopic techniques is the best way to make the diagnosis of diabetic retinopathy. Fundus photography may be indicated in some cases. Once the diagnosis is made, a fluorescein angiogram (Appendix I) may also be needed to aid in the detection of subtle abnormalities in the retina. If only a small amount of damage is noted, the retina may not need any surgical treatment, but rather periodic examinations.

Treatment

Laser treatment (photocoagulation) has been found to be effective in the treatment of diabetic retinopathy. For the treatment of macular edema (swelling in the central vision area of the retina), focal laser photocoagulation is done in hopes of decreasing the rate of visual loss or rarely to improve vision. This treatment can be done in the office with typically no significant pain. Laser treatment is also indicated for the proliferative stage of diabetic retinopathy. Laser photocoagulation may consist of numerous sessions to treat proliferative diabetic retinopathy. After laser treatment is done, a follow-up visit will be indicated to assess the response to treatment. More than one laser photocoagulation session may be needed over a course of a few months. If a patient is unfortunate enough to develop a vitreous hemorrhage which does not clear, a vitrectomy may needed. A vitrectomy involves surgically entering the eye and removing the blood and jelly-like vitreous, that blocks the light as it travels to the retina. This surgery can be done as an outpatient and has a high degree of success.

Visual Loss is Preventable

Early detection of diabetic retinopathy is crucial. This can be done by a dilated retinal examination at certain intervals. Most patients should be seen at the time they are diagnosed with diabetes mellitus. Early examinations and appropriate follow-up will significantly lower your risk of visual loss. Also, strict medical control of your blood sugar will help maintain your vision over the long term.

The Retina Center

The Retina Center is equipped for the diagnosis and treatment of patients with diabetic retinopathy. The latest techniques and laser treatment as well as vitrectomy surgery are available by our board-certified, experienced staff.

Appendix I - Fluorescein Angiography

A fluorescein angiogram is a special study to evaluate the health of the retina and retinal vessels. The test involves taking sequential pictures of the retina using an advanced, state-of-the-art, specialized camera. Dye is injected into the patient’s hand or arm vein. The dye is derived from a bean and is relatively non-toxic. While the dye flows in the retinal vessels, photographs are taken. These photographs are then reviewed by the doctors to help with diagnosis, treatment, and prognosis.

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