What
is Diabetic Retinopathy?
Diabetic
retinopathy is a disease of the retina
that can lead to vision loss. It develops
in diabetics, when high blood sugar
levels cause blood vessels on the
retina to leak. The fluid from the
leaking vessels collects inside the
eye, clouding the victim’s vision.
The
earliest form of diabetic retinopathy
is called non-proliferative. In this
early stage of the disease, diabetes
weakens the natural blood vessels
in the retina, causing them to leak
fluid and protein. Fluid collects,
deposits form, and blood ceases to
flow to various parts of the retina
– usually with no impairment
of vision. However, if the center
of the retina becomes swollen (macular
edema), the patient’s central
vision can become blurred.
Progression
into proliferative diabetic
retinopathy is marked by the formation
of new, fragile blood vessels on the
surface of the retina, which is called
neovascularization. These blood vessels
then break and bleed, leaking into
the vitreous humor, which is the fluid
in the center of the eye. The vitreous
humor becomes murky, creating spots
or haziness in the patient’s
vision and possibly leading to complete
blindness. Additionally, the damage
to the retina from the broken vessels
may cause scar tissue to form, which
in turn can cause the retina to pull
away from the back of the eye. This
is called retinal detachment, and
it too can lead to blindness if left
untreated.
What
are the symptoms of diabetic retinopathy?
There
are rarely any early diabetic retinopathy
symptoms. The first indications are
usually vision problems, which may
include:
- Blurred vision
- Dark spots or flashes of light
- Generally hazy vision
When
diabetic retinopathy is identified
early, it is typically because a diabetic
is committed to receiving tests for
the disease. It is usually discovered
through a test called a fluorescein
angiography. In this test, the patient
is injected with a yellow dye that
dissipates throughout the bloodstream,
making the blood vessels – including
those in the eyes – more prominent.
The doctor then takes images of the
eyes that show new blood vessel growth.
What
are the treatments for diabetic retinopathy?
Although
there is no cure for diabetic retinopathy,
there are two surgical procedures
that have proven effective in pushing
back the advance of the disease. These
procedures are laser photocoagulation
and vitrectomy.
If
the disease has not progressed too
far, the primary choice is usually
laser photocoagulation. For this outpatient
procedure, the surgeon usually uses
anesthetic eye drops, though the procedure
may require a local anesthetic or
sedative as well. The laser photocoagulation
surgeon has two lasers at his or her
disposal to combat the effects of
diabetic retinopathy. The first is
the focal laser, which is used to
seal blood vessels on the retina.
The laser is applied in short bursts
to specific blood vessels. The surgeon
usually concentrates on the blood
vessels within one small area –
often near the macula. The other beam
is the pan-retinal laser, which makes
sears in a scattered pattern across
the retina to slow the growth of the
abnormal blood vessels. In the case
of retinal detachment, the pan-retinal
laser can also seal the tear and reconnect
the retina to its supporting structure.
After laser photocoagulation, the
patient’s eyes may be blurry
and may hurt for a few days.
Vitrectomy is the surgical replacement
of the vitreous humor. During the
procedure, the eye surgeon uses microsurgical
instruments to remove the blood-filled
vitreous body and insert a clear (either
saline or silicon oil) solution in
its place. Depending on the patient’s
circumstances, the procedure may be
performed outpatient or inpatient,
using either a local or general anesthetic.
It is usually performed to clear out
blood in the vitreous humor that has
not cleared out on its own. It can
also be used in conjunction with other
surgical techniques – such as
laser photocoagulation – to
provide the surgeon better access
to the retina. The surgery usually
leaves the patient feeling some discomfort
at first, and an eye patch must be
worn for a few days. The risks of
vitrectomy include elevated intraocular
pressure, fluid collection in the
cornea (corneal edema), and the growth
of new blood vessels on the iris.
This last condition is called rubeosis
iridis, and can eventually lead to
a severe form of glaucoma.
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