Understanding Diabetic Retinopathy
Diabetic retinopathy is a disease that affects diabetic people and eventually leads to blurry, distorted vision and blindness. When people suffer with diabetes, they may often have unstable glucose levels and they are prone to circulation problems in the back of the eye, known as the retina. The retina is a very sensitive part of the eye that is responsible for interpreting the images that you see and then transmitting these images to the brain. A person with diabetes may experience a restriction on the flow of blood through the vessels within the retina. When this restriction occurs, swelling, bleeding and even hemorrhaging may result. Aside from the threat of blood, sometimes fluid can collect under the retina-this problem is known as macular edema.
Many diabetic patients can have diabetic retinopathy without knowing it. Usually, there is no pain and no outward sign. Over time, you may notice gradual blurring or some vision loss. Symptoms may come and go. If diabetic retinopathy is severe, you may have clouded vision or blindness. You should have regular eye exams to help your doctor detect changes in your eyes before your vision is damaged. Treatment may help slow the progress of diabetic retinopathy and sometimes can restore lost vision. Your treatment depends on your condition, but may include frequent exams to monitor your condition, laser treatment, surgery or other procedures.
Diabetic retinopathy is a complication of diabetes that weakens the blood vessels that supply nourishment to the retina (the light-sensitive lining in the back of the eye where vision is focused). When these weak vessels leak, swell or develop thin branches, vision loss occurs. In its advanced stages, the disease can cause blurred or cloudy vision, floaters and blind spots – and, eventually, blindness. This damage is irreversible.
Fortunately, diabetic retinopathy is preventable. People with diabetes are most susceptible to developing it, but your risk is reduced if you follow your prescribed diet and medications, exercise regularly, control your blood pressure, and avoid alcohol and cigarettes. Regular eye exams are an integral part of making sure your eyes are healthy.
Types of Diabetic Retinopathy
Non-Proliferative Diabetic Retinopathy
Patients with diabetes can develop serious ocular complications that can affect their vision. Over time, high blood sugar leads to damage to the retinal blood vessels. Several complications may develop, including macular edema (swelling in the central retina) and poor blood flow. Other findings in non-proliferative diabetic retinopathy include retinal hemorrhages.
Proliferative Diabetic Retinopathy
When diabetes has been present for several years, problems with the retina can develop. While the exact cause of diabetic retinopathy is not known, it appears that elevated blood sugar levels can cause damage to the blood vessels and red blood cells, reducing circulation to the retina. These problems can probably be minimized by good long-term control of blood sugar.
In proliferative diabetic retinopathy, abnormal blood vessels develop on the retina. These vessels can lead to visual loss through bleeding or scar tissue formation. The new abnormal blood vessels on the retina do not improve circulation; in fact, they are fragile and can bleed, causing vitreous hemorrhage, or bleeding, which can reduce vision. Sometimes the blood vessels release scar tissue, which can pull on the retina causing retinal detachment. Abnormal blood vessels in proliferative diabetic retinopathy can be detected in a routine exam by the ophthalmologist. Sometimes additional tests such as fluorescein angiography are used.
If changes are found, there are some useful treatments depending on the nature and severity of the diabetic retinopathy. These include: laser treatment, therapeutic injections of Avastin orLucentis, and if a hemorrhage has occurred into the eye, vitrectomy or surgical removal of the vitreous.
1. Laser Treatment for Diabetic Retinopathy
There are two types of laser treatment. The first is known as Panretinal Photocoagulation (PRP) and it consists of tiny laser spots being burned into a wide area across the retinal tissue to help decrease the blood vessels from growing and leaking. For this surgery, the patient’s eyes are dilated and numbed. The doctor then focuses the laser on the appropriate locations of the retina and places the laser spots. Sometimes the outer vision of one’s eye is destroyed but the treatment helps save the crucial center part of one’s vision. The patient will experience light flashes during the procedure. Since a laser is used, the patient will experience some discomfort but healing time is quick although a driver for the trip home is required.
2. Focal Laser Photocoagulation
During this procedure, the blood vessels of the eye are sealed and shrunken. This procedure feels the same as the first laser treatment, and the patient is given mild numbing drops. This is performed in earlier stages of diabetic retinopathy in order to eliminate leaky blood vessels.
Vitrectomy is a different kind of retinal surgical procedure that removes the vitreous so your surgeon can repair the damaged portion of your eye. Once the defect is repaired, the surgeon replaces the emptied cavity with a gas bubble. Since gas rises and the macula and retina are at the back of the eye, recovering patients must remain face down in order for the gas bubble to effectively apply pressure to the area in need of healing, allowing the macula or retina to re-bond to the eye wall and a new vitreous to eventually replace the gas bubble.
Although a vitrectomy is a relatively painless procedure with a strong, successful track record in improving vision, the recovery from vitrectomy is often more challenging because patients must contend with the monotony, stress and discomfort of a 23-hour-a-day facedown-postoperative position. Most vitreo-retinal ophthalmologists agree that a vitrectomy is most successful when patients fully comply with facedown recovery instructions.