Diabetic Retinopathy

Diabetic eye disease is caused by damage to the small retinal blood vessels from elevated sugar (glucose) levels in the bloodstream. The retinal blood vessels damaged by chronic high blood sugar levels may begin to leak fluid (diabetic macula edema) or cause small hemorrhages in the early stages. In more advanced stages, the retinal blood vessels become clogged leading to inadequate oxygen levels in the retina known as ischemia. The retina then sends out signals to grow new abnormal blood vessels called neovascularization. These new abnormal blood vessels have a tendency to bleed (vitreous hemorrhage), which may lead to a sudden onset of floaters. The new, abnormal blood vessels can also cause scar tissue which can pull on the retina leading to a retinal detachment in severe cases. Sometimes, neovascularization also grows in the front of the eye on the iris which can lead to a very severe form of glaucoma.

 Treatment of diabetic retinopathy

The first goal of diabetic retinopathy treatment is to control blood glucose. Good control of blood glucose levels help slow the development and progression of diabetic retinopathy, although is does not prevent the diabetic eye problems altogether.

Diabetic macular edema

• Laser Treatment--small burns are applied to the central part of the retina called the macula to reduce fluid leakage.
• Injections--Some eyes do not respond adequately to laser and are treated with medications, such as steroids or newer anti-VEGF drugs like Avastin or Lucentis. These intravitreal treatments must often be repeated to control the macular edema.
• Surgery--Persistent macula edema that does not respond to laser treatment or injections may sometimes require out-patient surgery to remove scar tissue

Proliferative diabetic retinopathy

• Laser Treatment--The primary treatment is laser photocoagulation where laser burns are placed in the peripheral retina. This helps to decrease the oxygen demands of the retina which causes the retinal and disc neovascularization to resolve or decrease. The laser procedures and intravitreal injections are typically performed in the office.

• Surgery--Some eyes which develop bleeding or a retinal detachments require a surgical procedure called a vitrectomy which is performed in an operating room.

The key to successful treatment of diabetic retinopathy is early detection so it can be treated at earlier stages rather than later stages.  Often vision loss from diabetic retinopathy can be prevented with appropriate and timely treatment

Useful Web Sites

• http://www.geteyesmart.org/eyesmart/diseases/diabetic-retinopathy.cfm

Warning symptoms

Many people with diabetic eye disease have normal vision, especially in the absence of bleeding or a retinal detachment. This is why regular eye examinations are essential since treatment is most effective before actual vision loss.

• Blurred vision
• Sudden onset of floaters

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