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Diabetic Retinopathy

What is diabetic retinopathy?

Diabetes is a consistently abnormally high level of sugar in your blood. The prevalence of diabetes across all age groups is increasing. This is a reflection of the dramatic increase of obesity. Diabetes is now one of the leading causes of blindness in the United States. Diabetic retinopathy is the complication of long-standing or poorly controlled diabetes. All patients with diabetes, insulin dependent and non-insulin dependent, are at risk for diabetic retinopathy. From 30 to 40% of diabetic patients have some form of diabetic retinopathy.

How does diabetes affect the retina?

The blood vessels that nourish your retina are extremely small and delicate. Elevated sugar levels in your blood can damage these vessels. Damaged vessels may leak blood and other fluids onto the retina. Damaged vessels could block blood flow, depriving the retina of oxygen and other essential elements of nourishment.

Are there different types of diabetic retinopathy?

There are two types of diabetic retinopathy – background diabetic retinopathy and proliferative diabetic retinopathy. Background diabetic retinopathy is the early stage of diabetic eye disease. Proliferative diabetic retinopathy is the advanced stage.

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What is background diabetic retinopathy?

The tiny blood vessels of the retina leak blood and fluid. These retina hemorrhages form deposits in the retina called exudates. Sometimes, blood and fluid enter the center of the retina. This area, called the macula, is where precise, sharp visual details appear when you are focused on objects directly in front of you. The presence of exudates reduces visual clarity. This condition is called macular edema.

What is proliferative retinopathy?

Proliferative diabetic retinopathy is a serious complication of diabetes affecting the eyes. Blood vessels, damaged by chronic, elevated blood sugar levels, interrupt the flow of nutrients to the retina. Some blood vessels may close completely. An undernourished retina will signal the brain to restore the damaged vessels. Diabetics frequently have low levels of nitric-oxide, an important chemical in the body’s ability to mend these vessels.

In response to a perceived repair delay, a diabetic patient will generate new blood vessels in the retina. This condition is called proliferative retinopathy because new blood vessels quickly proliferate in the retina. Unfortunately, these new vessels are abnormal and do not supply the retina with adequate blood flow. If these new, abnormally fragile blood vessels break and leak fluid inside the eye, a condition known as vitreous hemorrhage may occur. Many of these new vessels are accompanied by scar tissue that may cause additional warping and wrinkling of retinal tissue. This can cause retinal tears or, worse yet, detachment of the retina.

What are the symptoms of diabetic retinopathy?

Most patients with background diabetic retinopathy experience no symptoms unless they develop macular edema. Vision loss associated with macular edema may be mild to severe. Peripheral vision remains unaffected.

Only an ophthalmologist can see impairment in the early stages of retinopathy. That is why immediate eye examinations for patients recently diagnosed with diabetes and annual exams for all diabetic patients are essential.

Patients who have proliferative diabetic retinopathy may experience vision loss from macular edema. They may also suffer severe visual loss from vitreous hemorrhage or retinal detachment from proliferative abnormal blood vessels and scar tissue.

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What can diabetics do to prevent the possibility of blindness?

Obviously, controlling blood sugar levels is critical. People with slightly elevated glucose levels experience much less diabetic retinopathy than patients with high readings. Another critical avenue of prevention is to prevent high blood pressure. Not unlike blood sugar, high blood pressure causes tissue to swell and fragile blood vessels to hemorrhage and leak fluid on the retina. That is why it’s extremely important that people with elevated blood sugar have an examination by an experienced ophthalmologist. They need to control their blood sugar and blood pressure and follow their doctor’s recommendations regarding their medication and their diet.

When should I schedule a diabetic eye examination?

Diabetics should be examined annually by an ophthalmologist. More frequent examinations may be recommended following a diagnosis of diabetic retinopathy. Pregnant women with diabetes should be examined no less than once per trimester because retinopathy can progress rapidly during pregnancy.

What if I can’t afford the fee for a diabetic eye examination?

The American Academy of Ophthalmologists has established a Diabetes Eye Care Program that refers qualified diabetics to volunteer ophthalmologists for a free examination. The goal of the program is to preserve vision through early diagnosis and treatment of diabetic retinopathy.

What are the qualifications for these free exams?

You may qualify if you are age 65 or older, a U.S. citizen or legal resident, do not belong to an HMO or receive VA benefits, and have not seen an ophthalmologist in 3 years or more. You may call (800) 272-3937 for more information. A representative of the Diabetes Eye Care Program will make arrangements for an examination by an ophthalmologist.

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What can a diabetic patient expect from an eye examination?

Patients receive a painless, comfortable, comprehensive eye examination with special attention directed toward the retina. Their pupils may be dilated with eye drops possibly requiring arrangements for a driver.

What are the latest treatments for diabetic retinopathy?

Laser surgery is recommended for patients with macular edema and the proliferation of abnormal blood vessels in the retina. This procedure is often performed with local anesthesia in the ophthalmologist’s office.

Vitrectomy is necessary for patients with vitreous hemorrhage or retinal detachment. This is a microsurgical procedure performed in an operating room. The blood inside the vitreous is removed or the detached retina is repaired.

What is the latest research for treatment of diabetic retinopathy?

The most promising treatment research revolves around drugs that strengthen the retinal blood vessels and, most importantly, drugs that inhibit the growth of quick hemorrhaging vessels - especially in and around the retina, macula and the vitreous gel.

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