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Diabetic Retinopathy

Diabetic retinopathy (DR) is caused by; you guessed it high blood sugar.

This complication has four stages or types and can be progressive. This is the leading cause of blindness in the US. This complication can progress with no noticeable symptoms, so you should get your eyes examined at least once per year. If you already have diabetic retinopathy you will probably require more frequent exams.

DR affects both type 1 and type 2 diabetics. At least 40% of diabetics are likely to develop retinopathy and 5 out of 40 could also develop glaucoma. The US Centers for Disease Control and Prevention state: in 2005 5.5 million people over 40 years old suffer from retinopathy, and this number is expected to triple by 2050. The four stages of diabetic retinopathy are:

Mild nonproliferative retinopathy. Micro aneurysms occur, they are small balloon-like swelling of the retinas tiny blood vessels.

Moderate nonproliferative retinopathy. Some blood vessels that supply nourishment to the eye are blocked.

Severe nonproliferative retinopathy. More blood vessels of the retinal area are blocked. This deprives the retina of blood. When this happens the areas that are blocked send signals to the body to build new blood vessels for continuous blood supply.

Proliferative retinopathy. New blood vessels are grown, these new vessels are usually thin walled, weak and can rupture easily. Alone these vessels do not cause vision loss or symptoms, but if they leak blood, vision loss and blindness can occur. When this occurs you will see spots floating in your vision.

When not treated diabetic retinopathy can cause cataracts, glaucoma and macular edema.

Cataracts; clouding of the eye lens.

Glaucoma; fluid pressure increase inside the eye that can lead to irreversible optic nerve damage and blindness.

Macular edema; fluid leak into the macula, these causes swelling of the macula blurring vision.

Treatment

During your yearly exam the optometrist will do a visual acuity test (reading a chart). In the next step he will put drops into your eyes to dilate your pupils. Once they are dilated he will be able to see the interior more easily and spot any problems. Also he will do a test to measure the pressure of the interior of your eyes, called Tonometry.

The most common method currently used by ophthalmologists to detect retinopathy is a fluorescein angiography, an injection of dye into retinal veins used to spot leaks. This moderately invasive technique can cause nausea and vomiting and, in rare cases, severe allergic reactions.

Proliferative Retinopathy is treated by scatter laser treatment. Your doctor places 1000 to 2000 laser burns in areas of the retina away from the macula to shrink abnormal blood vessels. This may require two or more sessions to complete. Some loss of side vision, color vision and night vision may occur, but it helps to save the rest of your sight.

Macular Edema is treated by focal laser treatment. Your doctor places several hundred laser burns in the area of retinal leakage. This reduces blood leakage into the vitreous gel of the eye. More sessions may be needed.

These treatments increase your chances of not loses your sight to 90%.

If your have a lot of blood in the vitreous gel of one or both of your eyes, you may require a vitrectomy. This procedure will usually be done on one eye at a time several weeks apart. In this procedure your doctor will remove the vitreous gel that is clouded with blood, then it is replaced with a salt solution. You will notice no change between the normal vitreous gel and the salt solution. Afterwards your eye will be red and sensitive. You will need to wear an eye patch for several days to a few weeks to protect your eye.

Prevention

Keep your blood sugar levels and cholesterol levels as close to normal as possible. Have your eyes examined at least once per year. The earlier problems are detected, the more treatment options you have and you increase your chances of not losing your sight.

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