DIABETIC RETINOPATHY

Diabetic Retinopathy is a complication of diabetes and is caused by changes in the blood vessels of the retina that can bring about severe loss of vision. Diabetic Retinopathy is the leading cause of new blindness among adults in the United States, and people with untreated diabetes are said to be 25 times more prone to blindness than the general population. However, with improved methods of diagnosis and treatment only a small percentage of those who develop Retinopathy experience serious problems with vision. Therefore, it is important that individuals with diabetes receive medical eye exams on an annual basis. In order to understand Diabetic Retinopathy, it is helpful to first understand the basics of how the eye works.

How the eye works
The retina is a thin layer of tissue which covers the back inside wall of the eye. The retina is like the film in a camera. It is the seeing tissue of the eye. The cornea, pupil and lens of the eye are clear and allow light to pass through. The light also passes through the large space in the center of the eye called the vitreous cavity.

The vitreous cavity is filled with a clear, jelly-like substance called vitreous or vitreous gel. The light is then focused on the retina. When focused light hits the retina, a picture is taken. Messages about this picture are sent to the brain through the optic nerve. This is how we see.

There are two kinds of Diabetic Retinopathy
In Diabetic Retinopathy the blood vessels of the retina become abnormal and cause the problems that diabetic patients have with their eyesight. Normally blood vessels in the retina do not leak. But with diabetes, the retinal blood vessels can develop tiny leaks. These leaks cause fluid or blood to seep into the retina. The retina then becomes wet and swollen and cannot work properly. The form of Diabetic Retinopathy caused by leakage of the retinal blood vessels is called Background Diabetic Retinopathy.

Another problem with the retinal blood vessels in diabetes is that they can close. The retinal tissue, which depends on those vessels for nutrition, will no longer work properly. The areas of the retina in which the blood vessels have closed then foster the growth of abnormal new blood vessels that can be very bad for the eye because they can cause bleeding and scar tissue that can result in a total loss of vision. This form of Diabetic Retinopathy is called Proliferative Diabetic Retinopathy.

Detection and Diagnosis
A comprehensive medical eye examination and appropriate treatment by an Ophthalmologist is the best protection against eye damage due to Diabetic Retinopathy. Serious Retinopathy can be present without symptoms and improve with treatment. Therefore, people with diabetes should be aware of the risks of developing visual problems and should have their eyes examined regularly. Periodic eye examinations are also advisable for apparently healthy people, because such examinations help detect the presence of diabetes and other diseases. To detect Diabetic Retinopathy, the Ophthalmologist dilates the pupils with eye drops and conducts a painless examination of the inner part of the eye using an instrument called an ophthalmoscope.

Fluorescein Angiography
If one or our doctors diagnoses Diabetic Retinopathy and feels that laser treatment might be helpful, a special test called fluorescein angiography may be done. To perform this test, dye is injected into a vein in the patient's arm. The dye travels throughout the body, including the eyes. With a special camera and a flash, a series of photographs of the retina is taken as the dye passes through it. The photographs will show what kinds of changes have occurred in the retina. Fluorescein angiography is necessary for the doctor to establish the level of Retinopathy and decide if the patient would benefit by laser treatment . The photographs will provide a kind of map which the doctor will use as a guide to the exact location and amount of laser treatment.

Treatment
The best treatment for Diabetic Retinopathy is prevention by control of diabetic disease. It is well known that patients whose A1C Hemoglobin never exceeds 7.0 will seldom show any Retinopathy. When Diabetic Retinopathy is diagnosed, the Ophthalmologist considers the patient's age, history, lifestyle, and the degree of damage to the retina before deciding on the most appropriate treatment or if further observation of the disease is advised. In many cases treatment is not necessary; in others it is recommended to halt the damage of Diabetic Retinopathy and improve sight wherever possible.

Laser Surgery
Laser surgery can be very helpful for the treatment of the Diabetic Retinopathy. The laser beam is a high-energy light that turns to heat when it is focused on the parts of the retina to be treated. In Diabetic Retinopathy, the laser heat either seals the leaking blood vessels of the macula or reduces their leakage and allows the macula to dry. In Diabetic Retinopathy, the laser destroys the diseased portions of the retina to stop the growth of new blood vessels. In both cases, laser treatment may not always be best or even possible. The decision to use laser depends mostly on the type of Diabetic Retinopathy, its severity, and a judgment regarding how well it may respond to such treatment. The doctor considers whether treating an eye with laser is more likely to prevent further visual loss over no treatment at all. Laser treatment may not always help. Even with laser treatment, patients may continue to lose vision. Because diabetes is a condition for which there is no cure, the diabetes may continue to damage the retina unless excellent control of the disease is practiced by the patient.

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