Diabetic Retinopathy
What is diabetic retinopathy and what causes it? It is a very serious complication of the retina in the eye which often occurs in those who have diabetes. It can happen with any diabetic whether they have Type-1 or Type-2 diabetes. It usually occurs in diabetics who do not maintain control of their blood glucose levels or who have had diabetes for many years.
Normally as diabetic retinopathy first begins, there are usually no problems noticed or the symptoms are very mild. This is the reason that anyone who has diabetes needs to schedule regular appointments with an eye doctor to have a complete eye exam including dilation of eyes, because by the time there are symptoms, the disease may already be out of control.
As this condition progresses, these are some of the symptoms that can develop:
- Vision that is blurred
- Dark spots or strings may be noticed floating in the vision field– these are commonly known as “floaters”.
- Empty or dark areas in vision field.
- Fluctuating vision
- Color vision impaired
- Night vision is poor
- Vision loss
These symptoms usually affect both eyes.
The cause of this complication happens because of too much glucose in the blood system which damages the smallest blood vessels in the body called capillaries. These capillaries deliver nutrition to the retina in the eye. When the levels of glucose remain high over a long period, the lenses in the eye will swell causing vision to be blurred.
Diabetic retinopathy normally is classified in two stages – early and advanced.
Early diabetic retinopathy
Diabetic retinopathy known as non-proliferative is the common form of this eye disease. Further it is described as being mild, moderate, or severe. With this condition, the walls in blood vessel which are smallest in the retina weaken. Bulges begin to project out from the walls of these vessels which often leak or ooze fluid and blood into the retina. As the disease continues, smaller blood vessels will close and then the larger veins in the retina can start to dilate with their diameters becoming irregular. The nerve fibers in the retina may also begin to swell. Often the center of the retina called the macula will also begin to swell. This swelling is called macular edema.
Advanced diabetic retinopathy
This is proliferative diabetic retinopathy is a much more severe form of diabetic retinopathy. At this time, blood vessels which are abnormal start to grow in the retina. The new vessels often leak in the jelly substance in the center of the eye called the vitreous. The blood vessels which are new often cause scar tissue to grow on the retina which can causes detachment of the retina from the back of the eye. Pressure can begin to build in the eyeball which causes glaucoma. This also can damage the nerve which carries the images from the eye to brain (optic nerve).
Further complications can lead to serious vision problems:
Vitreous hemorrhage
The blood vessels which are new can bleed into the substance in the center of the eye, which is a clear, jelly substance. If it is slight, you will probably only see a few floaters or spots which are dark. In severe cases, the blood may fill up the vitreous cavity and will completely block vision. Unless the retina is damaged, vitreous hemorrhage can clear on its own in a few week or months.
Retinal detachment
This is when the abnormal blood vessel causes scar tissue to grow; this can cause the retina to detach from the eye in the back. This can cause vision with floating spots in the vision, light flashing, or even severe vision loss.
Glaucoma
These blood vessels which are new can grow in the front of the eye and interfere with normal fluid flow out of the eye. This can cause pressure in the eye to build up which is known as glaucoma. The pressure can damage the optic nerve.
Blindness
Diabetic retinopathy coupled with glaucoma eventually can cause total loss of vision.
Proliferative retinopathy which is the last stage in the disease of diabetic retinopathy can be treated by surgery with laser. This process is known as a scatter laser treatment. This treatment will help shrink the blood vessels which are abnormal. Your doctor will place 1000 – 2000 burns of the laser in the regions in the retina in areas away from the macular. This will cause the abnormal shrinking of the blood vessels. Due to a large number of burns needed, two or so treatments are needed to finish therapy. You may have a loss of side vision but this laser treatment will save the remainder of the eyesight. But there may be a slight reduction of color vision as well as some of the ability to see well at night.
Scatter laser treatment seems to work better before fragile blood vessels which are new begin to bleed. This is why a total eye exam which includes dilated eyes is so vital to have regularly. But, even if the retinal bleeding has already begun, this treatment will still be probable. This depends on the amount of bleeding.
If there is severe bleeding, you could need a surgery process knows as a vitrectomy. Thru the vitrectomy, blood can be eliminated from the eye.
Macular edema is also treated by laser surgery. This treatment is known as focal laser treatment. The surgeon will place several hundred small burns from the laser in the locales of retinal seepage around the macula. These laser burns will slow the leaking of fluid as well as also reduce the fluid amount in the retina. Surgery is usually done in just one session but other treatments may be needed.
The diabetic could need laser surgery several times in order to control the fluid which is leaking. If macular edema is in each eye and you need laser surgery in both, they usually will only treat one eye each time, 2-3 weeks apart.
To prevent these problems with the eye, it is important to have regular complete eye exams with your eye doctor. This includes having your eyes dilated so that the doctor is able to examine the blood vessels in the eye. It is also important in preventing diabetic retinopathy to manage you the blood glucose levels daily. For a diabetic, this is a lifelong commitment to maintain and manage your chronic disease.
