Diabetic Retinopathy
The most common cause of blindness in adults under age 65
Diabetic Retinopathy is the most common serious eye condition caused by diabetes, and is also the most common cause of blindness in adults in the United States. Diabetic retinopathy occurs when blood vessels inside the retina of the eye become abnormal. These abnormal blood vessels can leak or bleed causing damage to the delicate structures inside the eye. Diabetic retinopathy can affect anyone with diabetes, and often has no warning signals. This condition comes in two major forms. The first is called non-proliferative diabetic retinopathy and the second, proliferative diabetic retinopathy.
Non-proliferative diabetic retinopathy is the earlier stage and more mild form of this disease. Patients with this condition generally have changes in the back of the eye which can be discovered through a complete eye examination, usually by an ophthalmologist or Eye MD. For most people, this form of the condition only bears watching, but in some cases, it can cause a condition known as Diabetic Macular Edema in which the delicate light-sensitive cells in the central part of the retina can be damaged without proper treatment. Damage to the macula can result in permanently reduced central vision and difficulty with daily activities.
Proliferative Diabetic Retinopathy occurs when abnormal new blood vessels proliferate, or grow inside the eye. This is a more advanced and potentially more serious condition in the eye caused by diabetes. Abnormal blood vessels are fragile, and may break and bleed. If bleeding occurs, the patient may see new floating spots, strings or cobwebs, or suffer severe loss of vision due to blood filling the inside of the eye. Once there is bleeding inside the eye, the patient is at higher risk to develop permanent damage to the eye and permanent loss of vision.
The longer a patient is diabetic, the more likely it is that retinopathy may occur. Retinopathy may be present even if the vision is a perfect 20/20. With early diagnosis and treatment, however, most problems from diabetic retinopathy can be avoided. That's why the American Academy of Ophthalmology recommends yearly eye examinations for everyone with diabetes.
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Treatment of Diabetic Retinopathy
Control of the blood sugar is most important to prevent the more severe types of diabetic retinopathy.
Regular exercise and healthy diet are the most effective ways to control blood sugar. Good control of blood pressure is also essential.
Regular eye examinations are extremely important for patients with diabetes. These examinations require dilation of the pupil in order for the doctor to examine the retina. The retina is a thin light-sensitive film-like structure in the back of the eye. Early detection is important to allow treatment of retinopathy as soon as it becomes significant. Of course, any symptoms such as blurred vision or new spots floating around are important symptoms to report to the doctor. Sometimes cataract or glaucoma may also complicate diabetic eye care. It is important to control the retinopathy before cataract surgery can be performed.
Laser surgery
In some cases, laser surgery can be beneficial in the treatment of diabetic retinopathy. For macular edema, the laser treatment is painless and quick, and usually has no adverse effect on the vision. In fact, the vision may improve in select cases. Multiple treatments are sometimes necessary. If bleeding occurs in the eye, such as in proliferative diabetic retinopathy, a stronger laser may be necessary. This type of treatment is called panretinal photocoagulation, PRP, or scatter photocoagulation, which causes the fragile new blood vessels to regress or go away. Some loss of night vision or peripheral vision naturally occurs with the stronger laser treatments. However, the goal is to preserve vision, especially the central reading and driving vision. With regular eye examinations and laser surgery as necessary, the risk of blindness is much less than before these treatments were available.
Injections
Recently, injections of medication to reduce swelling in the eye and cause abnormal blood vessels to shrink away have been found to be successful. These injections are generally painless, but often need to be repeated on a regular basis for maximum effect. Some patients see significant visual improvement with these treatments.
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