Diabetic Retinopathy

Diabetes can produce two types of changes that are among the leading causes of blindness-non-proliferative and proliferative retinopathy. These changes can occur in diabetics who take insulin and those who don't.

Diabetes affects the retina because high blood sugar (glucose) levels make the walls of small blood vessels thicker but weaker and therefore more prone to deformity and leakage. The extent of retinopathy and vision loss is related to how well blood sugar levels are controlled and, more important, how long the person has had diabetes. In general, retinopathy doesn't develop until at least 10 years after a person becomes diabetic.

In nonproliferative (background) retinopathy, small capillaries in the retina break and leak. The area around each break in the capillaries swells, forming small pouches in which blood proteins are deposited. A doctor diagnoses this condition by examining the retina. Fluorescent angiography a procedure in which a doctor injects dye into a vein, waits for it to reach the retina, and then photographs the retina helps determine the extent of the condition. In its early stages, nonproliferative retinopathy doesn't cause blindness. Small retinal hemorrhages may distort parts of the field of vision, or if they're near the macula, may blur vision.

In proliferative retinopathy, damage to the retina stimulates the growth of new blood vessels. Such growth may seem beneficial, but it isn't. The new blood vessels grow abnormally, leading to scarring and sometimes to retinal detachment. They may grow or bleed into the vitreous cavity. Prolif erative retinopathyis much more damaging to the vision than nonproliferative retinopathy and can lead to total or nearly total blindness.

Prevention and Treatment

The best way to prevent diabetic retinopathy is to control diabetes and keep blood pressure at normal levels. People with diabetes should have annual eye examinations starting 5 years after diabetes is diagnosed, so that any necessary treatment can be started early and vision may be saved.

Treatment consists of laser photocoagulation, in which a laser beam is aimed through the eye to destroy the new blood vessels and seal off leaking ones. This treatment is painless because the retina doesn't sense pain. If bleeding from damaged vessels has been extensive, surgery to remove the blood that leaked into the vitreous humour (a procedure called a vitrectomy) may be needed. Vision improves after the vitrectomy, and the vitreous humor is gradually replaced.

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