Diabetic Retinopathy

Who is at risk for this disease?
What are its symptoms?
How is it detected?
Stages of Diabetic Retinopathy
How is it treated?

All people with diabetes are at risk—those with Type I diabetes (juvenile onset)

and those with Type II diabetes (adult onset). During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.  

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What are its symptoms?

Normal vision

The same scene as it might
be viewed by a person with
 diabetic retinopathy.

As new blood vessels form at the back of the eye, they can bleed (hemorrhage)
and blur vision. The first time this happens it may not be very severe.
In most cases, it will leave just a few specks of blood, or spots, floating in your vision.
They often go away after a few hours.

These spots are often followed within a few days or weeks by a much greater
 leakage of blood. The blood will blur your vision. In extreme cases, a person
will only be able to tell light from dark in that eye. It may take the blood anywhere
from a few days to months or even years to clear from inside of your eye.
In some cases, the blood will not clear. You should be aware that large
hemorrhages tend to happen more than once, often during sleep.

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How is it detected?

Diabetic retinopathy is detected during an eye examination that includes:

Visual acuity test:
This eye chart test measures how well you see at various distances.
Pupil dilation:
The eye care professional places drops into the eye to
widen the pupil. This allows him or her to see more of the retina and look for
signs of diabetic retinopathy. After the examination, close-up vision may
remain blurred for several hours.
Ophthalmoscopy:
This is an examination of the retina in which the eye care professional: (1) looks through a device with a special magnifying lens that provides a narrow view of the retina, or (2) wearing a headset with a bright light, looks through a special magnifying glass and gains a wide view of the retina.
Tonometry:
A standard test that determines the fluid pressure inside the eye.
Elevated pressure is a possible sign of glaucoma, another common eye problem
in people with diabetes.
 

Your eye care professional will look at your retina for early signs of the disease,
such as: (1) leaking blood vessels, (2) retinal swelling, such as macular edema,
(3) pale, fatty deposits on the retina—signs of leaking blood vessels,
(4) damaged nerve tissue, and (5) any changes in the blood vessels.

In this test, a special dye is injected into your arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows your doctor to find the leaking blood vessels.

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Stages of Diabetic Retinopathy

The early stage of this disease is called nonproliferative diabetic retinopathy. In this stage blood vessels swell and sometimes bulge or balloon (aneurysm). The vessels may leak fluid that can build up in the retina and cause swelling. This condition is called macular edema, and it changes the vision of individuals with the disease. The blurriness is sometimes compared to trying to look through water.

The fluid deposits that build up in the retina may clear up on their own, but fatty deposits sometimes remain that can affect vision. Later, vessels may begin to bleed inside the retina.

In many cases when the small blood vessels close down, new, unhealthy blood vessels grow. These unhealthy blood vessels are not able to feed the retina. This stage of the disease is known as proliferative diabetic retinopathy.

The unwanted blood vessels can grow on the back of the vitreous. Vitreous is the clear jelly-like fluid that fills most of the eyeball. vessels may also bleed into the vitreous. This bleeding may cause dark spots (floaters), strands that look like cobwebs, or clouded vision.

As vessels heal, scar tissue may also grow. The scar tissue sometimes pulls the retina away from the back of the eye. As a result, the retina can tear or come completely loose from the eye. A detached or torn retina may result in serious loss of sight or even blindness.

		Description: In nonproliferative retinopathy, a slight deterioration in the small blood vessels of the retina, portions of the vessels may swell and leak fluid into the surrounding retinal tissue.
		Description: Proliferative retinopathy, an advanced form of diabetic retinopathy, occurs when abnormal new blood vessels and scar tissue form on the surface of the retina.
		Description: Diabetic macular edema (abnormal accumulation of fluid, fat and proteins in the macular part of the retina).

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How is it treated?

There are two treatments for diabetic retinopathy. They are very effective in reducing vision loss
from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of
keeping their vision when they get treatment before the retina is severely damaged.
These treatments are:

Laser Surgery :
Doctors will perform laser surgery to treat severe macular edema and
proliferative retinopathy.

Macular Edema :
Timely laser surgery can reduce vision loss from macular edema by half.
But you may need to have laser surgery more than once to control the leaking fluid.

Rather than focus the light on a single spot, your eye care professional will make hundreds of small laser burns away from the center of the retina.
This is called scatter laser treatment.
The treatment shrinks the abnormal blood vessels.

You will lose some of your side vision after this surgery to save the rest of your sight.
Laser surgery may also slightly reduce your color and night vision.

Laser surgery is performed in a doctor's office or eye clinic. Before the surgery, your ophthalmologist will: (1) dilate your pupil and (2) apply drops to numb the eye. In some cases, the doctor also may numb the area behind the eye to prevent any discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of bright green or red light.
These flashes may eventually create a stinging sensation that makes you feel a little uncomfortable.

You may leave the office once the treatment is done, but you will need someone to drive you home.
Because your pupils will remain dilated for a few hours, you also should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. Your eye may also hurt a bit.
This is easily controlled with drugs that your eye care professional suggests.

Vitrectomy :
If you have a lot of blood in the vitreous, you may need an eye operation called a vitrectomy to restore sight. It involves removing the cloudy vitreous and replacing it with a salt solution.
Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous.

Vitrectomy is often done under local anesthesia (using drops to numb the eye).
This means that you will be awake during the operation. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye. It removes the vitreous and inserts the salt solution into the eye.

You may be able to return home soon after the vitrectomy. Or, you may be asked to stay
in the hospital overnight. Your eye will be red and sensitive. After the operation, you will need to wear an eyepatch for a few days or weeks to protect the eye. You will also need to use medicated eye drops to protect against infection.

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