Diabetic Retinopathy

Diabetic retinopathy is retinopathy (damage to the retina ) caused by complications of diabetes mellitus , which could eventually lead to blindness "Retinopathy" is the medical term for damage to the tiny blood vessels (capillaries) that nourish the retina, the tissue at the back of your eye that captures light and relays information to your brain. Unfortunately, patients who are not properly referred for evaluation and management or those who, for any reason, fail to get proper care from an ophthalmologist, are at the greatest risk of vision loss. Findings in the retina include dot and blot hemorrhages (tiny hemorrhages in the retina itself), microaneurysms (out-pouchings of capillaries), and exudates (retinal deposits occurring as a result of leaky vessels). This is known as retinal detachment , and it can lead to blindness if untreated. In addition, abnormal blood vessels can grow on the iris , which can lead to glaucoma . In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. Blood may leak into the retina and vitreous , causing spots or floaters , along with decreased vision.You can take steps to protect your sight if you have diabetes. These include a yearly eye examination and steps to keep your blood sugar, blood pressure and blood cholesterol under the best possible control. This scar tissue shrinks and may pull on the retina, creating a form of retinal detachment called "traction retinal detachment". This bleeding can also cause scar tissue to form, which can pull on the retina and cause the retina to detach from the wall of the eye ( retinal detachment ). Ophthalmologists may recommend treatment at this stage, especially if the opposite eye has had diabetic related complications.

Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Nearly half of people with known diabetes have some degree of diabetic retinopathy. An extraordinary amount of research has already been completed, and is relied upon heavily by practicing ophthalmologists, in the treatment of patients with diabetes. The development of this condition in type I (juvenile-onset) diabetics is rarely present prior to three or four years following the onset of diabetes. The blocked vessels may also deprive parts of the retina of adequate oxygen, and this too contributes to a disturbance in the retina's ability to process images. The new blood vessels can cause scar tissue to develop, which can pull the retina away from the back of the eye. This may be coupled with a fundus fluorescein angiography , a test done to assess the extent and type of changes in the retina and its blood vessels. One of the important reasons for routine eye examinations is that if new vessel formation is detected early, it may be treated effectively and the dangerous vessels dispersed by applying multiple laser burns to the periphery (outside edges) of the retina .

Causes of Diabetic Retinopathy

The common Causes of Diabetic Retinopathy :

Diabetic retinopathy arises from the fact that diabetes, especially if not kept under control, tends to cause tissue damage featuring small and large blood vessels in many parts of the body.
Changes in blood-sugar levels increase your risk of diabetic retinopathy, as does long-term diabetes.
New blood vessels start to grown within the eye.
These new vessels are fragile and can bleed (hemorrhage), which may cause vision loss and retinal scarring.
Diabetes damages small blood vessels throughout the body, leading to reduced blood flow.
Retinopathy becomes proliferative when abnormal new blood vessels grow (proliferate) in the retina or the optic disc.
A similar process is common in the kidneys .
The Diabetic Complications Control Trial (DCCT) has demonstrated that intensive glucose control reduced the incidence and the progression of diabetic retinopathy in patients with insulin-dependent diabetes mellitus (IDDM).

Symptoms of Diabetic Retinopathy

Some common Symptoms of Diabetic Retinopathy :

Blurred vision (this is often linked to blood sugar levels
Floaters and flashes
Sudden loss of vision
In nearly all cases, diabetic retinopathy can be diagnosed with an eye exam.
A dark or empty spot in the center of your vision
"Spiders," "cobwebs" or tiny specks floating in your vision
Poor night vision
Blindness
Blurred vision
Characteristic signs of retinal changes may be seen during examination of the retina.
Partial or total loss of vision or a shadow or veil across your field of vision.

Treatment of Diabetic Retinopathy

Diabetic macular edema, a swelling that involves or threatens the center of the retina
Severe nonproliferative diabetic retinopathy, especially if you have type 2 diabetes
The goal of treatment is to control your blood sugar, blood pressure, and cholesterol.
Treatment, however, usually does not reverse existing damage, but will keep the disease from getting worse.
Drugs that keep abnormal blood vessels from growing in patients with proliferative diabetic retinopathy are under development.
The Early Treatment for Diabetic Retinopathy Study (ETDRS) found that 650 mg of aspirin daily did not offer any benefit in preventing the progression of DM retinopathy.
Ideally, laser treatment should be done early in the course of the disease to prevent serious vision loss rather than to try to treat serious vision loss after it has already developed.
If the edema is due to leakage of specific microaneurysms, the leaking vessels are treated directly with focal laser photocoagulation.
Some patients may find that walking regularly, taking warm baths, or using elastic stockings may help relieve leg pain.

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