Background Retinopathy
Early changes are subtle and only slightly different from normal. Some of the retinal blood vessels gradually enlarge; some become irregular in size and develop some tiny weak spots (microaneurisms), which is the hallmark of this condition. They begin to leak exudates (fluids, fat, and protein) and blood. At first, vision may be normal or only slightly affected, depending on where the leaks are located.
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.
Back to Top
Proliferative Retinopathy
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 they 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 brow, 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 leading to blindness.
Back to Top
Symptoms
In its early stages, background retinopathy does not cause any symptoms. Later, it can produce blurring of vision (from retinal leakage and swelling) that glasses cannot help. The early stages of proliferative retinopathy may also produce no visual symptoms; but later, bleeding can cause a sudden appearance of floaters, blurring, or even almost total loss of vision.
Neither type, on its own, is likely to cause pain, but the proliferative form is sometimes associated with other eye problems that can cause eye pain.
Back to Top
Examination
As part of the history-taking, 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. Depending on the type of tonometer used, 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 you have a test called fluorescein angiography, 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.
Back to Top
Treatment
For background retinopathy or even for minimal proliferative retinopathy, you may not need any treatment other than keeping your diabetes under good control.
If the condition is more serious and is threatening your vision, laser treatment may be recommended. Laser beams may be used for "focal treatment," to stop discrete retinal leakages, or for PRP (pan-retinal photocoagulation) - to create hundreds of tiny burns in the retina that, by some unknown mechanism, seem to reduce retinal swelling and congestion and the number of dangerous, abnormally proliferating blood vessels, thus reducing the risk of internal bleeding. More than one series of laser treatments may be needed, but all can be done on an outpatient basis and are usually painless.
Laser treatment may not help severe cases and sometimes lasers cannot be used at all, such as when the abnormal blood vessels, scars and blood are too dense to let the laser beam shine through to the retina. Then, a major eye operation called vitrectomy may be suggested, 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.
Diabetic retinopathy is one of the major causes of defective vision and blindness in our country today. Although it is not totally preventable, its course may be made far less severe by diagnosing any eye problems early and then keeping a close watch for progression so that early treatment can be instituted when necessary. If you have diabetes, make sure you have a thorough eye exam at least every year (more frequently in advanced cases), and you should always take the best possible care and control of your diabetes.
Back to Top
Home
| About us | Your
Eyes | Services | Privacy
Policy | Patient Info | Doctors
| News | Contact
Us | Laser Video | LASIK
| Links
South
Texas Eye Consultants
5402 S. Staples
Corpus
Christi, TX 78411
Phone:
361.992.9400
