Diabetic Eye Care

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Diabetic Retinopathy: Changes in the Blood Vessels of the Retina

Diabetic retinopathy is an eye condition that damages the retina in some diabetic patients. The retina, which is the light-sensitive nerve tissue that lines the back of the eye, is vital for vision.

Diabetic retinopathy is one of the major causes of defective vision and blindness in our country today. Although it is not totally preventable, its progression can be slowed with early diagnosis and treatment.

If you have diabetes, have a thorough eye exam at least every year (more frequently in advanced cases) and take proactive measures to control your diabetes through diet and exercise.

Diabetic Retinopathy Symptoms

There are usually no early warning symptoms and no pain.In the more advanced stages, the condition can lead to:

  • Blurred vision (from retinal leakage and swelling) that glasses cannot help
  • Spotty or hazy vision
  • Sudden appearance of floaters or blurring
  • Total loss of vision

Two Forms of Diabetic Retinopathy

  • Background retinopathy (the milder form)
  • Proliferate retinopathy (more serious form)

Background Retinopathy

Background retinopathy progresses slowly and will eventually causevisual disturbance or develop into the more serious proliferative stage. Hallmarks of this condition include:

  • Retinal blood vessels can gradually enlarge
  • Retinal blood vessels can become irregular in size and develop some tiny weak spots (microaneurysms)
  • Retinal blood vessels can begin to leak fluids, fat, protein and blood

The condition varies over time, sometimes getting better for a while and then worse, but tending to slowly worsen. As it advances, some of the smaller retinal blood vessels gradually become obstructed, resulting in a patchy loss of retinal nourishment. In some patients this leads to the development of proliferative retinopathy.

Cause of Background Retinopathy

The exact cause of background retinopathy or why it changes to proliferative retinopathy is not known. However, it is related to the length of time you have had diabetes and it is more common in insulin-dependent diabetes than in diabetes that can be controlled by diet or with oral medications.

Proliferative Retinopathy

In this advanced stage, new abnormal blood vessels begin to grow (proliferate) over the surface of the retina and optic nerve, the "telephone wire" that transmits images from the eye to the brain. It is thought that they form in an attempt to nourish the patches of "starving" retina. Unfortunately, these blood vessels are fragile and they frequently break and bleed.

If the new blood vessels bleed into the vitreous (into the center of the eyeball) vision can become clouded from the blood. At first the blood is rapidly absorbed, so vision tends to clear in a few weeks. But eventually, with re-bleeding, vision may not clear so rapidly or even at all.

As more new blood vessels grow the risk for more bleeding increases. Scars form and may tug on or even tear the retina, which can lead to a retinal detachment. All of these developments have the potential for blindness.

Diabetic Retinopathy Testing

During an eye exam, you will be asked some important questions, such as how long have you had diabetes, how are you controlling it and how well is it being controlled.

A complete vision examination will be done with your pupils dilated (enlarged).

  • An ophthalmoscope will be used to study the inside of your eyes.
  • The pressure inside your eyes will be checked with a painless test called tonometry (you may be given anesthetic eyedrops).
  • Photographs may be taken of your retinas. Pictures are useful in determining the extent of the problem and evaluating its progression.
  • If the doctor decides to performthe fluorescein angiography test, a greenish dye will be injected into a vein in your arm. Then a rapid series of retinal photographs will be taken as the dye travels through the eye's blood vessels. By identifying the position and extent of any abnormal blood vessels and any leakages, the angiogram provides important guidance for treatment.

Diabetic Retinopathy Treatment

For some diabetic retinopathy patients, the only treatment necessary is to keep your diabetes under good control.

If the condition is more serious and is threatening your vision, one or more painless laser treatments may be recommended. Laser beams may be used for:

  • “Focal treatment" to stop discrete retinal leakages
  • PRP (pan-retinal photocoagulation) to create hundreds of tiny burns in the retina in order toreduce retinal swelling, congestion and the number of dangerous, abnormally proliferating blood vessels; this will reduce the risk of internal bleeding

If the abnormal blood vessels, scars and blood are too dense to let a laser beam shine through to the retina, a vitrectomy surgery may be recommended. This procedure is done to attempt removal of the scars and cloudy or bloody tissue. If this procedure is successful in clearing up the cloudy material inside the eyeball, laser treatment may then become possible.

Vision improvement does not always follow a vitrectomy, but when it does it can be dramatic. However, vitrectomy has a high risk of serious complications, including more bleeding, retinal tears and detachment, so it is used only for the most advanced cases of diabetic retinopathy that are otherwise untreatable.

If you have diabetes in Corpus Christi, TX, your risk of minor eye conditions increases. Routine eye exams can help keep those conditions minor. If they develop into larger problems, we’ll help you understand your treatment options and start them immediately. Contact us today to schedule an eye exam.