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Diabetic Retinopathy

Diabetic retinopathy is a serious complication of the eye due to diabetes mellitus. Diabetic retinopathy may result in poor vision or even blindness if it is not managed properly. Vision loss that accompanies this disease is caused by damage to the blood vessels that nourish the retina and is due to the high blood sugar levels associated with diabetes.

What Are the Symptoms of Diabetic Retinopathy?

In the early, most treatable stages of diabetic retinopathy, patients usually experience no visual symptoms or pain. The disease can even progress to an advanced stage without any noticeable changes in your vision.

Common symptoms are:

  • "Spiders," "cobwebs" or tiny specks floating in your vision
  • Dark streaks or a red film that blocks vision
  • Vision loss or blurred vision
  • A dark or empty spot in the center of your vision
  • Poor night vision
  • Difficulty adjusting from bright light to dim light

What Are the Types of Diabetic Retinopathy?

There are two types of diabetic retinopathy which usually affect both eyes similarly:

Nonproliferative diabetic retinopathy (NPDR)

Nonproliferative diabetic retinopathy, also called background diabetic retinopathy, is an early stage of the disease and is the most common type of retinopathy. Symptoms of NPDR are often mild or nonexistent. With NPDR, the walls of blood vessels in the retina are weakened and may begin to leak, oozing fluid and blood into the retina. As NPDR progresses, other signs of damage begin to appear including swelling of the larger retinal veins and patches of swollen nerve fibers, called cotton-wool spots, because of their wispy appearance. Vision problems tend to occur with severe NPDR and are usually the result of swelling of the central part of the retina - a condition called diabetic macular edema (DME). With DME, the retention of fluid in the macula reduces blood flow to retinal capillaries in that area and results in a decrease in central vision.

Proliferative diabetic retinopathy (PDR)

Proliferative diabetic retinopathy is the more advanced form of the disease and is characterized by new and abnormal blood vessel growth (angioneogenesis) in the retina or the optic disc. Blood vessels can even extend growth into the vitreous, which is the clear, jelly-like substance that fills the eyes. New blood vessel growth can cause widespread closing of capillaries in the retina and results in the loss of both central and peripheral vision. These newly formed blood vessels may also leak blood into the vitreous and cloud or even block the patient's vision. Other complications include detachment of the retina due to scar tissue formation and a form of neovascular glaucoma, which can cause severe damage to the optic nerve.

Blurred Vision with Diabetes

Diabetes sufferers may experience blurred vision due to rapid fluctuations in blood sugar/blood glucose levels. Moreover, prolonged periods of high blood sugar can cause sugar and its breakdown products to accumulate on the lens and uptake water. The increased water uptake causes the lens to swell and produces temporary nearsightedness for the patient. This nearsightedness (myopia) will subside once blood glucose levels are brought under control. Blurred vision can also be caused by macular swelling (edema), even when blood sugar levels are normal. Macular swelling may fluctuate during the day causing vision to change as well. This finding can be a cause for concern because macular edema often accompanies diabetic retinopathy. If blood vessels in the eye are hemorrhaging, fluid spots may float in your field of vision and impair vision. Larger spots may appear within days or weeks and is an indication that hemorrhaging has increased.

How Is Diabetic Retinopathy Treated?

The best treatment is prevention of diabetic retinopathy. Controlling one's blood sugar will help reduce the risk of vision loss by preventing the development or progression of the disease. If diabetic retinopathy has progressed beyond blood sugar control, there are other measures that can be taken:

  • Laser Treatment: Laser treatment is often recommended for people with macular edema, PDR, and neovascular glaucoma. For edema patients, the laser helps reduce fluid leakage and prevents further vision loss. For PDR patients, a technique known as panretinal photocoagulation is used, in which the laser is focused on all parts of the retina, causing abnormal blood vessels to shrink. Panretinal photocoagulation also helps to prevent future growth of blood vessels and decreases the likelihood of vitreous bleeding or retinal distortion.
  • Vitrectomy: Vitrectomies are recommended for those patients with advanced PDR. This procedure involves microsurgery in which the blood-filled vitreous is removed from the eye and replaced with a clear solution. This procedure prevents further bleeding by removing abnormal blood vessels within the vitreous.
  • Injection Therapy Clinical trials are now being done to determine whether new antiblood vascular growth medicines can reduce retinal vascular complications and improve vision.
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