Diabetic Retinopathy
Diabetic retinopathy is the most widespread diabetic eye disease and primary cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. Some people with diabetic retinopathy, blood vessels may enlarge and leak fluid. In others, abnormal new blood vessels grow on the exterior of the retina. The retina is the light-sensitive tissue in the back of the eye, and in order to obtain good vision a healthy retina is necessary.
For diabetics who have diabetic retinopathy, changes to vision may not be noticed at first. But over time, diabetic retinopathy can worsen and lead to vision loss.
Symptoms
As the condition progresses, diabetic retinopathy symptoms may include: dark spots in your vision, blurred vision, dark or empty areas in your vision, vision loss and difficulty distinguishing colors.
Who Is At Risk?
People with type 1 and type 2 diabetes are at risk for developing diabetic retinopathy. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy; an average of 40 to 45 percent of Americans with diabetes has some stage of diabetic retinopathy. An excess of sugar in the blood can damage the small blood vessels that nourish the retina, and may even block them off completely. As more and more blood vessels become blocked, the blood supply to the retina is discontinued. This can lead to vision loss. Due to the lack of blood supply, the eye attempts to grow new blood vessels, however, these new blood vessels do not develop correctly and can easily leak. Leaking blood vessels can cause a loss of vision, and scar tissue may also form, which can put pressure on the retina; sometimes making the retina detach.
Pregnancy may also be a risk for developing diabetic retinopathy in women with diabetes. To care for vision, every pregnant woman with diabetes should have a full dilated eye exam as early as possible.
Stages
Mild Nonproliferative Retinopathy, the earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.
Moderate Nonproliferative Retinopathy, the disease progresses, some blood vessels that nourish the retina are blocked.
Severe nonproliferative Retinopathy, more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
Advanced stage, the signals sent by the retina for nourishment triggers the growth of new blood vessels; this condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.
Treatments
Focal laser treatment, also known as photocoagulation, can stop or slow the seepage of blood and fluid in the eye. It's done in the doctor's office or eye clinic. During the procedure, leaks from abnormal blood vessels are treated with laser burns. Focal laser treatment is usually done in one session. Blurred vision for about a day after the procedure is expected as well as small spots in the visual field; these usually disappear within weeks. If you had blurred vision from swelling of the central macula before surgery, however, you may not recover completely normal vision. But, in some cases, vision does get better.
Scatter laser treatment, also known as panretinal photocoagulation, can reduce the size of the abnormal blood vessels. It's also done in your doctor's office or eye clinic. During the procedure, the areas of the retina away from the macula are treated with spread laser burns. The burns cause the irregular new blood vessels to shrink and scar. Scatter laser treatment is usually done in two or more sessions. Your vision will be blurry for about a day after the procedure, but some loss of peripheral vision or night vision after the procedure is possible.
Vitrectomy procedure can be used to remove blood from the middle of the eye (vitreous) as well as any scar tissue that's tugging on the retina. It's done in a surgery center or hospital using local or general anesthesia. During the procedure, the doctor makes a tiny incision in your eye. Scar tissue and blood in the eye are removed with delicate instruments and replaced with a salt solution, which helps maintain your eye's normal shape. Sometimes a gas bubble must be placed in the hollow space of the eye to help reattach the retina. If a gas bubble was placed in your eye, you may need to remain in a facedown position until the gas bubble dispels, which can take several days. You'll need to wear an eye patch and use prescription eye drops for a few days or weeks.
