Ophthalmology (Eye)

What is Retinopathy?

The term retinopathy covers various disorders of the retina, which can affect vision. Retinopathy is usually due to damage to the tiny blood vessels in the retina. Retinopathy is commonly caused by diabetes, but is sometimes caused by other diseases such as very high blood pressure. If you have diabetes, it is vital that you have your eyes checked regularly. Damage to the retina at the back of the eye (retinopathy) is a common complication of diabetes. If left untreated, it can get worse and cause some loss of vision, or blindness in severe cases. Good control of blood sugar (glucose) and blood pressure slows down the progression of retinopathy. Treatment with a laser, before the retinopathy gets severe, can often prevent loss of vision.

Diabetes mellitus (just called diabetes from now on) occurs when the level of sugar (glucose) in the blood becomes higher than normal. There are two main types of diabetes - type 1 and type 2.

What is Diabetic Retinopathy ?

The condition of diabetic retinopathy happens with those who have diabetes that results in progressive damage to the retina. The condition is due to the damaged caused to the small blood vessels responsible for nourishing the retina. Clouding of the vision and swelling of the retinal tissue is due to leaking of the blood and other fluids from these small blood vessels. Both eyes can get affected by this condition. There are more chances of diabetic retinopathy in those people who have been suffering from diabetes for a very long time. Diabetic retinopathy has been regarded as a serious sight-threatening condition. Diabetic retinopathy has four stages -

Mild Nonproliferative Retinopathy - at this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.

Moderate Nonproliferative Retinopathy - as the disease progresses, some blood vessels that nourish the retina are blocked.

Severe Nonproliferative Retinopathy - many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Proliferative Retinopathy - at this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Retinopathy can also cause swelling of the macula of the eye. This is called macular edema. The macula is the middle of the retina, which lets you see details. When it swells, it can make your vision much worse.

I can’t imagine the direction of the wind, but I can adjust my sails to alway search my destination.

When it’s dark enough, you can see the stars.

Once you choose hope, anything’s possible. Hope never abandons you, you abandon it.

The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.

Dear GOD, if today I lose my hope please remind me that your plans are better than my Dream.....

Causes and Symptoms of Diabetic Retinopathy

Most of the time, there are no symptoms of diabetic retinopathy until it starts to change your vision. When this happens, diabetic retinopathy is already severe. Having your eyes checked regularly can find diabetic retinopathy early enough to treat it and help prevent vision loss. Changes in vision can be a sign of severe damage to your eye. These changes can include floaters, pain in the eye, blurry vision, or new vision loss.

If you are not able to keep your blood sugar levels in a target range, it can cause damage to your blood vessels. Diabetic retinopathy happens when high blood sugar damages the tiny blood vessels of the retina. When you have diabetic retinopathy, high blood pressure can make it worse. High blood pressure can cause more damage to the weakened vessels in your eye, clouding more of your vision. This may result into swelling and hemorrhage of the retina.

Difficulty in seeing well at night

Seeing floaters or spots in the particular field of vision

Problem in seeing or having blurred vision

Empty or dark spot in the center of the vision

Cobwebs, tiny specks or spiders floating in the vision

Stages of Diabetic Retinopathy

Non-proliferative diabetic retinopathy (NPDR) - NPDR is the early state of the disease in which symptoms will be mild or non-existent. In NPDR, the blood vessels in the retina are weakened causing tiny bulges called microanuerysms to protrude from their walls. The microanuerysms may leak fluid into the retina, which may lead to swelling of the macula.

Proliferative diabetic retinopathy (PDR) - PDR is the more advanced form of the disease. At this stage, circulation problems cause the retina to become oxygen deprived. As a result new fragile blood vessels can begin to grow in the retina and into the vitreous, the gel-like fluid that fills the back of the eye. The new blood vessel may leak blood into the vitreous, clouding vision. Other complications of PDR include detachment of the retina due to scar tissue formation and the development of glaucoma. Glaucoma is an eye disease defined as progressive damage to the optic nerve. In cases of proliferative diabetic retinopathy, the cause of this nerve damage is due to extremely high pressure in the eye. If left untreated, proliferative diabetic retinopathy can cause severe vision loss and even blindness.

Diagnosis of Diabetic Retinopathy

Diabetic retinopathy can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on evaluation of the retina and macula, may include -

Patient history to determine vision difficulties experienced by the patient, presence of diabetes, and other general health concerns that may be affecting vision

Visual acuity measurements to determine the extent to which central vision has been affected

Refraction to determine the need for changes in an eyeglass prescription

Evaluation of the ocular structures, including the evaluation of the retina through a dilated pupil

Measurement of the pressure within the eye

Supplemental testing may include -

Retinal photography or tomography to document current status of the retina

Fluorescein angiography to evaluate abnormal blood vessel growth

Treatments for Diabetic Retinopathy

Glucose control - the Diabetes Control and Complications Trial found that intensive glucose control in patients with insulin-dependent diabetes mellitus (IDDM) decreased the incidence and progression of diabetic retinopathy. It may be logical to assume that the same principles apply in non-insulin-dependent diabetes mellitus (NIDDM).

Laser photocoagulation - this involves directing a high-focused beam of light energy to create a coagulative response in the target tissue. In nonproliferative diabetic retinopathy (NPDR), laser photocoagulation is indicated in the treatment of clinically significant macular edema.

Panretinal photocoagulation (PRP) is used in the treatment of PDR. It involves applying laser burns over the entire retina, sparing the central macular area.

Vitrectomy - this procedure can be used in PDR in cases of long-standing vitreous hemorrhage (where visualization of the status of the posterior pole is too difficult), tractional retinal detachment, and combined tractional and rhegmatogenous retinal detachment.

Cryotherapy - when laser photocoagulation in PDR is precluded in the presence of an opaque media, such as in cases of cataracts or vitreous hemorrhage, cryotherapy may be applied instead.