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Diabetic Retinopathy

Diabetic Retinopathy.jpeg

A fundus photograph showing nonproliferative diabetic retinopathy


A fundus photograph showing proliferative diabetic retinopathy


An OCT photo showing diabetic macular edema

Diabetic retinopathy is damage to the retina that results from Type 1 or Type 2 diabetes mellitus.  There are two major classifications, nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinoapthy (PDR).  Diabetic retinopathy may also be complicated by swelling in the center of the retina (macular edema), relative loss of macular blood flow (macular ischemia), bleeding into the eye (vitreous hemorrhage), high eye pressure (glaucoma), or a retinal detachment.  Early cataract formation is also common in diabetes.  


What are risk factors for diabetic retinopathyRisk factors for retinopathy include long duration of diabetes, poor blood sugar control, high blood pressure, and cigarette smoking.

Nonproliferative Diabetic Retinopathy (NPDR):

NPDR is marked by several microvascular changes in the retina.  The earliest sign is small dilations of the retinal blood vessels called microaneurysms.  These microanuerysms can leak fluid from their weakened vessel walls, and if this occurs in the macular it is called diabetic macular edema.  Bleeding into the retina can also occur.  During this stage, complications such as diabetic macular edema are treated and the eye is monitored frequently for onset of PDR.


Proliferative Diabetic Retinopathy (PDR):

Progressive loss of circulation can stimulate the retina to produce a signal (VEGF) in order to build new blood vessels, a process called neovascularization.  These blood vessels grow in a disorganized fashion, rupture and bleed easily, and can scar and produce retinal detachments.   Nearly all cases of PDR require prompt treatment to prevent future complications, such as vitreous hemorrhage, glaucoma, or retinal detachment.  Treatment is often a combination of injections of medicine into the eye (intravitreal injections) and laser treatment (panretinal photocoagulation).  

Diabetic Macular Edema (DME):

The center of the retina is the macula.  DME can occur at any stage of diabetic retinopathy and causes blurry central vision.  Mild stages of DME might not require treatment, but more severe disease often does.  The mainstay of treatment are intravitreal injections.  Several different medication options exist, and your physician will review these with you.  In certain cases, laser procedure (focal or micropulse laser) is beneficial as well.

Diabetic macular ischemia:

Macular ischemia refers to loss of blood flow in the central retina resulting in loss of oxygen to the tissue.  This causes permanent retinal damage and often significant vision loss.  Unfortunately, there is no way to reverse macular ischemia, but good blood sugar and blood pressure control is essential to limit its progression.

Vitreous hemorrhage:

In some eyes with PDR, the new blood vessels may rupture causing large bleeds into the vitreous cavity of the eye.  This often produces a large amount of new floaters and depending on severity significant vision loss.  Mild cases of vitreous hemorrhage can be managed non-operatively with intravitreal injections or laser treatments, however more severe or persistent cases require surgery to remove the blood (vitrectomy).

Neovascular Glaucoma:

In some eyes with PDR, the new blood vessels can grow in the front chamber of the eye and block the normal method for fluid outflow from the eye.  This is a medical emergency and can cause severely elevated eye pressure and blindness if not treated promptly.  The goal of treatment is to rapidly reduce the eye pressure with medication or surgery and then treat the underlying PDR.  

Retinal Detachment:

End stage PDR often results in a tractional retinal detachment.  The new blood vessels that grow in the eye often eventually die off and scar.  This scar tissue can act like a rope to pull the retina off of the eye wall.  Mild, peripherally located tractional detachments might be safe to manage non-operatively, but more severe or central detachments involving the macula require vitrectomy surgery.  Even with a successful surgery, permanent vision loss is common.

How often should I get my eye examined if I have diabetes?
All patients with diabetes should undergo a thorough examination of the retina at least once a year. Patients with retinopathy often need evaluation more frequently. ​

How can I prevent my diabetic retinopathy from worsening?
Progression of diabetic retinopathy is based primarily on the severity of the underlying diabetes.  Progression is less likely with strict blood sugar and blood pressure control.

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