Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy is a potential problem for all people with diabetes. It occurs when the tiny, delicate blood vessels in the retina become weak and damaged. The blood vessels can leak and reseal, and new vessels are weaker than those which came before. These can happen anywhere in the retina, but if they occur near the macula, or fovea, the leakage is referred to as macular edema; resealing near the fovea can starve the area of oxygen, resulting in cotton wool spots. If damage is discerned in the periphery of the eye, it can mean that the vitreous is pulling on new blood vessels, resulting in the loss of side vision.

The two common types of diabetic retinopathy are nonproliferative retinopathy and proliferative retinopathy, both which involve the breaking and resealing of blood vessels in the eye. Proliferative retinopathy allows for the growth of new vessels, while nonproliferative is the resealing of leaking blood vessels, leading to additional complications such as traction, or bleeding into the vitreous. Both types can occur simultaneously.

The conditions are simple to detect -- the eye doctor uses a variety of instruments to evaluate the retina, where any damage will be apparent. Having regular checkups will allow any potential problems to be detected before they affect your vision.

You may be asked to take eyedrops so that your pupils dilate, and allow a better view of the retina. A slit lamp magnifies the area, and the doctor can look more closely for symptoms of retinopathy or other problems such as cataracts. If there is bleeding and the retina is blocked, and ultrasound may be done. Florescein angiography is done to take a photograph of the retina. They may be done with every appointment, so that patterns and changes from one angiogram to the next may be discerned.

No one really knows what causes diabetic retinopathy, but controlling diabetes through control of blood sugar levels, blood pressure, healthful eating and frequent exercise seem to slow down the progress of the disease. And since this and other eye problems can suddenly get worse without warning, regular checkups -- at least annually -- with an eyecare professional are imperative. Pregnancy is known to increase the risk of retinopathy, so an eye exam is needed if pregnancies are being planned.


Possible Treatments

1) LASER TREATMENT

Laser Treatments can halt or lessen the progress of retinopathy by reducing swelling, removing closed or damaged vessels, sealing weak vessels and reducing the growth of new vessels. The three treatments are termed focal treatment, used to treat macual edema; grid treatment, where diffuse leakage results in macular edema; and panretinal treatment, used to treat preproliferative and proliferative retinopathy.


The Procedure

Laser treatment may be given at the doctor's office, a surgical center or a hospital. To prevent discomfort and eye movement (it is important that your head and eye be absolutely still), you may receive anesthetic drops for your eye, or a local anesthetic injection near the eye.

You will sit in front of a slit lamp, which, combined with a special contact lens, allows the doctor to focus and guide the laser ray accurately. To prevent the treated eye from moving, your untreated eye will be focused on a target, to give you something to concentrate on.

There should be minimal pain, though if there is, ask the doctor to stop, and to give you more anesthetic. You should she a bright light, which may blink, and hear clicking noises. Other than for pain, try not to speak, and to remain still.


After Treatment

You should make arrangements for someone to drive you home, or otherwise help you. Your doctor may place an eye shield or patch over the treated eye, and will tell you to relax for the remainder of the day. Other treatments or medications may be prescribed, if appropriate.


Possible Side Effects

Side effects of laser treatment for retinopathy are normally temporary, and include wateriness, blurring, double vision, dilation of pupils, mild headaches, glare, loss of peripheral vision or night vision. If you experience sudden pain or loss of sight, contact your doctor immediately.


2) VITRECTOMY

After other treatments have been attempted, a vitrectomy, or removal of the vitreous, may be done if bleeding continues into the vitreous or if the vitreous pulls away from the retina and results in scarring of the retina. The vitreous is replaced with saline or a gas bubble, to keep the retina in place against the back of the eye.


The Procedure

This is a surgery, and will be done in a hospital or on an outpatient basis. You will be given anesthetic, and can meet with the anesthesiologist or nurse anesthetist.

During surgery, a probe with a light source is placed in the eye, along with a vitrectomy instrument, which removes the vitreous and any scar tissue from the affected eye, and an infusion line feeds air or some other gas, or saline solution into the eye, keeping the retina snug against the back of the eyeball.


After Surgery

A eye shield or patch may be placed over your eye. Temporary or partial vision loss is expected, and can last from a few days to several weeks following surgery. Of course, you should not rub your eye with anything.


Possible Side Effects

Some side effects are expected, such as swelling of the eyelid, a watery and sometimes red discharge from the eye, or redness in the white of the eye. If there is persistent pain or if you have any concerns at all about continued vision loss, contact your doctor or surgical nurse. If bleeding occurs or the retina becomes detaches or tears, another surgery may be necessary.