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Diabetic
Retinopathy
A Complication of
Diabetes Involving Abnormal Blood Vessels Which Nourish the Retina
of the Eye
Diabetic
retinopathy is the leading cause of blindness among adults. Approximately,
25% of current diabetics have some form of the disease. The risk
of developing diabetic retinopathy increases with the age of the
diabetic person and the duration of the disease. It is estimated
that 90% of diabetics may experience some form of diabetic retinopathy
over the course of their life. However, only a small percentage
of those developing diabetic retinopathy have serious vision problems
and even a smaller percentage become blind.
What is Diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes mellitus which
causes abnormalities in the tiny blood vessels nourishing the retina.
These vessels weaken, leak fluid and blood, and fail to provide
nutrients necessary for good health in the retina. Left untreated,
diabetic retinopathy can result in severe visual loss, including
blindness.
What is the retina?
The retina is a thin layer of delicate nerve tissue which lines
the back portion of the eye. Light enters the eye and is focused
by the lens through the transparent gel-like fluid (vitreous) onto
the retina. The retina then changes the image into electric impulses
which are carried to the brain by the optic nerve.
The retina has two main parts - the macula and the peripheral retina.
The macula is located in the middle portion of the retina close
to the optic nerve. The macula is responsible for central vision
and color vision. The peripheral retina is the outer region of the
retina and is responsible for side vision, as well as night vision.
What is background diabetic retinopathy?
Diabetic retinopathy can take two forms, background retinopathy
and proliferative retinopathy. During the early stage of the disease
(background retinopathy), small blood vessels in the retina leak
a clear fluid (serum) into the surrounding tissue which causes swelling.
Abnormal blood vessels may also hemorrhage or leak fats and proteins
which form deposits. If fluid collects in the macula, diminished
or blurred vision will result. However, if leakage or deposits occur
in the outer edges of the retina, no symptoms may be noticed.
Sight is not usually seriously affected in cases of background retinopathy.
In fact, the condition does not progress in 80% of patients. However,
background retinopathy is a warning sign and can progress into the
more serious stage of the disease, proliferative retinopathy.
What is proliferative diabetic retinopathy?
Proliferative diabetic retinopathy is the more advanced stage of
the disease. New abnormal blood vessels grow over the retina and
may grow into the clear vitreous. These new vessels bleed into the
vitreous, blocking light from reaching the retina and causing vision
to become cloudy. Connective tissue growing along with abnormal
blood vessels may contract, pulling the retina off its underlying
structures and toward the vitreous (retinal detachment).
Proliferative retinopathy affects approximately 5% of all diabetics
and becomes more likely with increased duration of diabetes. If
left untreated, proliferative retinopathy can lead to blindness.
What causes diabetic retinopathy?
The cause of diabetic retinopathy is not completely understood.
However, it is known that diabetes weakens small blood vessels in
various areas of the body, including the retina. Unfortunately,
the development of diabetic retinopathy cannot be prevented.
What are the symptoms of diabetic retinopathy?
Though vision may gradually become blurred, significant loss of
sight does not usually occur with background retinopathy. Since
the patient does not experience pain or external symptoms such as
blood-shot eyes or discharge, changes in the retina can go unnoticed
unless detected by an eye examination.
When bleeding occurs in proliferative retinopathy, the patient has
clouding or complete loss of sight. Connective tissue pulling on
the retina causes distortion and blurring. However, if abnormalities
occur in the peripheral retina, the patient may not experience any
symptoms.
How is diabetic retinopathy diagnosed?
A comprehensive eye examination is the best protection against the
progression of diabetic retinopathy. The disease can be detected
by viewing the retina with instruments which illuminate and magnify
the structures of the eye. If diabetic retinopathy is found, fluorescein
angiography is per-formed to determine the extent of blood vessel
leakage. In this procedure, a series of photographs are taken as
a dye travels through the retinal vessels. In some cases, ultrasound
equipment may be used to check for retinal detachment.
How is diabetic retinopathy treated?
Treatment of diabetic retinopathy depends on the location of the
disease and the degree of damage to the retina. If retinopathy occurs
in the peripheral retina, careful monitoring of the disease may
be all that is necessary. When retinopathy affects the macula and
central vision, laser treatment is usually necessary.
In cases of background diabetic retinopathy, lasers may be used
to seal blood vessels that have leaked serum. laser treatment may
not halt the disease entirely but can reduce further visual loss
by delaying the onset of proliferative retinopathy. The proliferative
stage of the disease is also treated with lasers to curtail the
growth of new abnormal blood vessels.
Laser treatment of diabetic retinopathy is usually done on an outpatient
basis in an office or outpatient center.
Prevention is the best medicine
 Early
detection and management of diabetic retinopathy is important to
arrest or slow the development of the more sight damaging stages
of the disease. Even when no symptoms are noticed, the diabetic
patient should have frequent eye examinations, as recommended by
their doctor. Non-diabetics should also have their eyes examined
periodically to help detect the presence of diabetes and other diseases.
With careful monitoring, treatment of diabetic retinopathy can usually
be started before sight is affected.
If you are experiencing the symptoms of diabetic retinopathy or
other vision problems, you should obtain a complete eye examination.
If you have diabetes mellitus, you should have a dilated eye examination
at least once a year for the rest of your life.
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