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Diabetic Retinopathy

What is diabetic retinopathy?

Within the structure of the eye, there is a very delicate tissue that lines the inside of the eye. This fragile lining is called the retina. The retina receives light and transmits images to the brain. Diabetes causes damage to small blood vessels throughout the body, including the retina. In diabetic retinopathy, damage from deteriorating blood vessels can cause visual problems.

What are the symptoms of diabetic retinopathy?

During a dilated eye examination, the doctor will be able to look into the back of the eye to monitor the condition of the blood vessels. With diabetes, leaking or bleeding vessels may be visible even before the patient notices any effect on their vision. Blurry vision may indicate a swelling in the retina. When bleeding occurs, vision may become very cloudy or be completely lost.

Is there more than one type of diabetic retinopathy?

Yes, there are two types of diabetic retinopathy.

• Background Diabetic Retinopathy (BDR)
  BDR is caused by hemorrhages from the retinal blood vessels. Some of the smaller blood vessels narrow or even close, while others enlarge and form balloon-like sacs. When these vessels leak, they cause swelling and the formation of deposits called exudates. Any or all of these changes can cause decreased vision.
• Proliferative Diabetic Retinopathy (PDR)
  PDR often times starts out like BDR. Closed blood vessels and the development of new abnormal blood vessels cause PDR. When these new, fragile vessels form, they grow on the retina's surface or in the vitreous gel. The gel is a substance that fills the inside of the eyeball. If one of these new vessels leaks or breaks, the leakage enters into the vitreous gel.

How does the physician evaluate the potential problems?

During the dilated eye examination, the physician is able to see the vessels and will determine if additional testing should be ordered. A special test, called a fluorescein angiography, is often times ordered so that careful monitoring of the eye can be obtained. This test involves injecting a water-soluble dye into a small vein on the hand or arm and taking a series of high-speed, specially filtered photographs of the blood vessels in the retina. These results help to evaluate the areas of leakage or new vessel formation. They also are valuable if it is determined that a laser procedure is needed.

If a laser can be used, what other treatment options are available for this condition?

Today, the mainstay of treatment involves laser surgery. This procedure utilizes a powerful beam of laser light energy on the retina. Selective destruction and sealing blood vessels of damaged areas of the retina can be achieved. Laser treatment is often helpful in maintaining the present vision and lowering the chance of future vision loss for as long as possible. This treatment involves no incisions and is often performed at the doctor's office.

Photodynamic Therapy (PDT) is the latest treatment for Choroidal Neovascular Membranes (CNVM), which are leaky vascular structures under the retina in the "wet" form of macular degeneration. PDT is able to treat the CNVM without doing damage to the nearby retina or other ocular structures.

In PDT, a photosensitive dye is administered intravenously and allowed to perfuse the CNVM as well as the remainder of the body. The physician treats the CNVM with a red laser of a specific wavelength for about 90 seconds. The non-thermal laser light activates the dye, producing an active form of oxygen that both coagulates and reduces the growth of abnormal blood vessels. This, in turn, inhibits the leakage of fluid from the CNVM.

A vitrectomy is a surgical procedure that is performed when bleeding has occurred in the vitreous gel, or if scar tissue is pulling on the retina. This type of surgery is usually performed after other methods of treatment have already been attempted.

Diabetics are 25 times more likely to lose their sight than non-diabetic patients. This risk can be dramatically reduced with careful monitoring by your eye care specialist. It is recommended that diabetics get a yearly routine exam to detect any changes that may be occurring before any vision is lost.

For more information, please contact the patient advisor by phone at 330-747-2733 or by email at info@eyecareassociates.com.