DIABETIC RETINOPATHY

All Diabetics, non insulin dependent, insulin dependent and pregnancy related must be examined at least once per year.  Depending on the state of change or damage, an ophthalmologist will recommend more frequent re-examinations!!!

Diabetic retinopathy  is nonspecific changes manifested in the retina as a direct result of  DIABETES which can eventually lead to decreased vision and complete blindness

It is an ocular manisfestation of diabetes, a systemic disease, which affects up to 80 percent of all patients who have had diabetes for 10 years or more.  Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there were proper and vigilant treatment and monitoring of the eyes.   The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy.   Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness for people aged 20 to 64 years.

There are 2 stages of Diabetic Retinopathy.

In the first stage, non-proliferative diabetic retinopathy (NPDR),  there are no symptoms, it is not visible to the naked eye and patients often have normal vision. The only way to detect NPDR is by dilated exam and/or fundus photography, in which microaneurysms (microscopic blood-filled bulges in the artery walls) can be seen. If there is reduced vision, fluorescein angiography can be done to delineate the vasculature of the retina. Narrowing or blocked retinal blood vessels can be seen clearly and this is called retinal ischemia (lack of blood flow); which can ultimately lead the 2^nd stage.

Macular edema may occur in which blood vessels leak causing swelling (edema) in the macular region. The symptoms of the above are blurring of distortion of images if edema occupies the central macular region (fovea). 10% of diabetic patients will have vision loss related to macular edema. The above can be visual seen by a professional and can use Optical Coherence Tomography to further show the extent of the edema.

In the second stage, abnormal new blood vessels (neovascularization) form in the retina and this is called proliferative diabetic retinopathy (PDR). Neovascularization can and often times bleed which leads to (vitreous hemmorhage) and substantial loss of vision!!!

Treatment/Management

1. Observation. Most often may require re-examination depending on the state of change of retinopathy.
2. Focal Laser Photocoagulation. Using an argon laser, treatment is applied to the “leaky microaneurythms.
3. Modified Grid Laser Photocoagulation. At times the edema may be quite extensive that an area of this edema needs to be treated rather than pinpoint “lasering pock marks”.
4. Intravitreal injection. Steroid or Avastin injections can be done especially when edema strikes the fovea and photocoagulation is contra
5. Panretinal Photocoagulation. This type of treatment is indicated in cases of Proliferative Diabetic Retinopathy and concurrent bleeding.  Large peripheral sections of the retina are destroyed using argon laser which cause the neovascularization to disappear!!!  Patients may experience loss of peripheral vision.
6. Vitrectomy. When a hemorrhage occurs in the vitreous body and as a result causes an inability to perform Panretinal Photocoagulation or if a hemorrhage is long standing and nonclearing,  Removal of the vitreous body is indicated i.e. Vitrectomy