Diabetic Retinopathy


	Diabetic Retinopathy Diabetes is a disorder of sugar utilization and storage which cause damage to blood vessels throughout the body. When the blood vessels in the eye are affected this is known as Diabetic Retinopathy. Diabetic retinopathy is the leading cause of blindness in patients 20 to 74 years of age. There are two types of diabetic retinopathy: nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). A less common ocular complication of diabetes is rubeosis, which will also be discussed. Nonproliferative Diabetic Retinopathy (NPDR) In NPDR, the retinal blood vessels which are normally watertight may begin to leak. This causes blood, serum and lipid to collect in the retina. If the leakage is excessive, fluid builds up in the retina, causing it to swell. This is called Macular Edema. Serum and lipid which leak may cause the formation of solid deposits in the retina called exudate. A patient with macular edema may not have any visual symptoms. However, if the swelling involves the central macula, vision will become blurred, distorted or darkened. In advanced NPDR, central vision may be permanently lost, although side vision usually remains intact.
	Evaluation of NPDR In addition to frequent thorough eye exams, Fluorescein Angiography may be used. During this test a dye is injected into a vein in the arm. Special photographs are taken of the retina as the dye passes though the eye. The abnormal blood vessels leak the injected dye and become detectable to the physician. Treatment of NPDR When macular edema affects or threatens vision, laser therapy is frequently recommended. Laser treatment for macular edema is a painless in-office procedure. Laser light is applied to the areas of leakage. The goal of laser treatment is to decrease the amount of leakage and therefore stop the loss of vision. Most, but not all, patients show beneficial response to laser treatment. In some patients multiple laser treatments are required. Even when laser treatment successfully seals the leaking vessels, new areas of leakage may arise later. New medicines which are placed next to or into the eye are being developed to treat macular edema. These treatments make the retinal blood vessels less leaky and may be beneficial in preventing vision loss from diabetic retinopathy.

		Laser Treatment for Macular Edema

Proliferative Diabetic Retinopathy (PDR) Proliferative diabetic retinopathy is the more advanced form of diabetic retinopathy. In PDR abnormal blood vessels begin to grow from the surface of the retina into the vitreous cavity. This is called neovascularization. These abnormal blood vessels are harmful to the eye and can cause loss of vision. The abnormal vessels can break and bleed into the vitreous cavity, causing a Vitreous Hemorrhage. Symptoms of a vitreous hemorrhage usually include the appearance of spots, strands, or a curtain in the vision. The abnormal blood vessels may also cause scar tissue to form. Scar tissue can block light from reaching the retina, or pull on the retina causing a Traction Retinal Detachment. Either of these problems may lead to severe visual loss. A person with PDR can also have macular edema, as in NPDR.
Evaluation of PDR In addition to frequent thorough eye exams, Fluorescein Angiography may be used. During this test a dye is injected into a vein in the arm. Special photographs are taken of the retina as the dye passes though the eye. The abnormal blood vessels leak the injected dye and become detectable to the physician. Treatment of PDR Laser surgery or vitrectomy surgery may be required, depending upon the stage of PDR. Laser surgery is used to treat abnormal blood vessels. Laser surgery causes the abnormal vessels to shrink and lessens the likelihood of vitreous hemorrhage, or formation of scar tissue. Patients who receive appropriate laser treatment for PDR reduce their risk of severe visual loss bu 50%. Laser treatment for PDR is an in-office procedure, and if often carried out over sever sessions.

Laser Repair of PDR	Angiogram of PDR Before Laser Surgery	Regressed PDR After Laser Treatment (Same Eye)
Vitrectomy surgery is used when PDR causes scarring, a traction retinal detachment, or persistent vitreous hemorrhage. Vitrectomy is a microsurgical procedure in which the vitreous gel, along with any scar tissue and blood that may have accumulated in it, are removed from the vitreous cavity. Removing the vitreous is not harmful to the function of the eye. Vitrectomy surgery is an outpatient procedure usually performed under local anesthesia.

PDR Before Vitrectomy	Vitrectomy Surgery	PDR After Vitrectomy Surgery
Rubeosis Rubeosis is a condition in which abnormal blood vessels grown on the iris or colored part of the eye between the cornea and the lens. These abnormal blood vessels can block the flow of fluid from the eye and result in severe glaucoma. This is called Neovascular Glaucoma and can cause pain or rapid loss of vision. Prompt laser treatments and sometimes surgery is required to control neovascular glaucoma. The Patient’s role in Diabetic Retinopathy The best treatment of diabetic retinopathy is prevention. Good control of blood sugar, blood pressure, and cholesterol will significantly reduce your risk of vision loss. It is recommended that you take an active role in managing your blood sugar and try to keep you A1C at a level of less than 6.5%. Your relationship with your primary care physician is vital to your eyesight and overall health. It is important to realize that diabetes may damage the retina without causing any noticeable visual symptoms. For this reason you should receive dilated eye exams regularly. With proper screening, follow-up and treatment, the majority of patients with diabetic retinopathy maintain useful vision and avoid severe visual loss.

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