Diabetic Retinopathy (Eye Damage)

Diabetic Retinopathy (Eye Damage)

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  • 1 Answer
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    Background retinopathy is a type of damage to the retina of the eye, marked by bleeding, fluid accumulation, and abnormal dilation of the blood vessels. Background retinopathy is an early stage of diabetic retinopathy. It is also called simple or nonproliferative retinopathy.
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    Photocoagulation is a treatment for diabetic retinopathy (diabetic eye disease). A strong beam of light (laser) is used to seal off bleeding blood vessels in the eye and to burn away extra blood vessels that should not have grown there.
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    Type 2 diabetes commonly affects organs with small blood vessels, such as the eye. High blood sugars cause the lining of blood vessels to thicken and make it difficult for these small vessels to dilate (open up) and constrict (clamp down) appropriately. Over time, this stress causes blood vessels to become leaky and weak, leading to diabetic eye disease called diabetic retinopathy.
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  • 5 Answers
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    Diabetic retinopathy is a vision-threatening complication of diabetes mellitus that is marked by changes in the blood vessels in the retina, the light-sensitive tissue at the back of the eye.
    These changes occur over time due to high blood sugar levels, causing the walls of the blood vessels that supply blood to the retina to become thicker. Initially, this causes the blood vessels to become more porous or leaky. Leakage of fluid, blood, and lipids (fat) may accumulate in the center of the retina, or macula, leading to blurred vision—also known as diabetic macular edema.
    In later stages of diabetic retinopathy, small blood vessels in the retina close, depriving the tissue of food and oxygen (ischemia). This fosters the release of a vasoproliferative substance inside the eye, which causes new, abnormal blood vessels to form—a condition known as neovascularization.
    Diabetic retinopathy is the leading cause of blindness in Americans ages 20 to 65. However, regular eye exams and timely treatment can prevent or curb visual impairment associated with the condition.
    In the early stages of diabetic retinopathy, termed nonproliferative retinopathy, the tiny blood vessels in the retina develop outpouchings, called micro-aneurysms. These bulges, in conjunction with leaking capillaries, may leak blood or fluid anywhere in the retina. If this fluid builds up in the macula, central fine vision becomes affected. If fluid buildup becomes severe, and if both eyes are affected, reading and driving vision may be lost. 
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    People with diabetic retinopathy often don't show any symptoms until macular edema (swelling in part of the retina) or a vitreous hemorrhage (blood in the eye) occurs. When symptoms do occur, they include:

    • Blurred central vision (due to macular edema)
    • Seeing floating spots or cobwebs (due to a hemorrhage)
    • Loss of central or side vision (due to a retinal detachment)
    • Blindness (a complication of retinal detachment or substantial compromise of blood flow)
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    Your physician will study your eye with an ophthalmoscope during a dilated eye examination. Adults over 30 who have diabetes should have a dilated eye exam once a year after first diagnosis. People who are diagnosed with diabetes before the age of 30, and have had the disease at least five years, should also have a yearly dilated eye exam. Once diabetic retinopathy develops, more frequent exams may be necessary.

    A test called fluorescein angiography, an injection of dye into blood vessels in the arm followed by a series of photographs of the back of the eye, may also be needed to track the disorder as well as help guide treatment.

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    A answered
    Diabetes can result in retinopathy or changes in the blood vessels of the retina, the light-sensitive tissue at the back of the eye. The blood vessels may swell and leak fluid and/or new blood vessels grow on the retina surface, disrupting vision. Often there are no initial symptoms.
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    The eye examination consists of multiple parts, many of which are quantifiable. When vision is tested, it is useful for documenting eye health status and any changes. Vision is usually tested,one eye at a time, for distance and for near. Often it is done without glasses (prescription) and then repeated with glasses. If a patient doesn't have glasses or has reduced vision, a pin?hole device can be used as an estimate of the best potential visual acuity. The next step in an eye exam is utilizing lenses in order to establish best?corrected visual acuity. For instance, you cannot really decide how bad a cataract is without knowing the individual best correction.
    The external eye exam consists of the evaluating pupil reactions, eye muscle movements, lids, and color of the iris. The next part of the exam employs a microscopic instrument called slit lamp. By varying the size beam and the magnification, the eye doctor can stereoscopically view the insides of the eye and diagnose almost all ocular conditions. This is why individuals need to see an ophthalmologist or optometrist in order to diagnose any serious eye problem. The intraocular pressure is measured at this time; this is an important test as part of the evaluation of glaucoma. Primary care doctors and emergency room physicians are usually able to recognize and treat pink eye and other common eye conditions but are unable to get a good look inside the eye without more testing.
    Usually the final part of the eye exam is an evaluation of the retina with either a hand held or head mounted light and lenses. Many systemic conditions, such as diabetes or hypertension, which can affect the eye can be identified through a slit lamp and retina exam. There are other tests that are useful to measure and manage eye disease such as the following: visual fields,color vision, prism measurements of eye deviations, tear tests for dry eyes, and checker board grids for macular degeneration.
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    A answered
    Patients with type 2 diabetes can run into a variety of eye problems such as dry eye, cataract,glaucoma, and most importantly changes in the blood vessels in the back of the eye (diabetic retinopathy). Patients with type 2 diabetes may develop this retinopathy much more quickly than those who are insulin dependent (also known as type 1) diabetes. It is said that there is a greater chance of developing changes in the blood vessels or swelling in the center of the retina,the macula, within 5 years of being diagnosed as type 2 diabetic than in 15 years from the diagnosis of becoming an insulin dependent diabetic.
    The diabetic changes in the retina are of 3 possible types, one of which is background diabetic retinopathy. This is manifested by leakage of small amounts of blood and exudates into the retina. These background little dots do not disturb vision significantly and would usually not be noticed except through a dilated eye exam. 
    The background changes occur because of leakage in blood vessels, which have been disturbed by the frequent rise and fall of blood sugar levels. At the same time, the amount of oxygen arriving at the retina may be compromised causing retinal blood vessels to grow or proliferate at a very rapid rate. This can result in the development of a host of new blood vessels growing into the retina and rapidly compensating vision. There can be bleeding, scarring and detachment of the retina because of this uninvited consequence.
    Because of lack of blood flow in the microcirculation around and beneath the macula, the macula can swell giving a significant ring of blurred vision right in the center of someone's vision. This is called diabetic macular edema.
    All three types of diabetic retinal problems can be managed through the immediate use of laser (photocoagulation) or injection of one of the new medication, which suppress swelling (steroids) or reverse blood vessel growth. These will be explained in detail in later areas.
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    A answered
    Diabetic retinopathy can appear in three forms, macular edema, background retinopathy (BDR), and proliferative diabetic retinopathy (PDR). Macular edema is swelling in the center of the retina without involvement of the periphery. BDR is leakage of blood vessels around the macula and the optic nerve in an irregular scattered fashion. It tends to be slow but may be a forerunner of either macular edema or proliferative changes.
    PDR is characterized by sprout of new blood vessels growing from the surface of the retina or optic nerve directly into the fluid vitreous cavity. This new blood vessel formation is called neovascularization and can also grow from areas in the peripheral retina. The consequences are the same; the blood vessels grow along with scar tissue, which may contract and pull off the retina (retinal detachment). Therefore PDR is the most serious diabetic complication in the eye.
    PDR is associated with:
    • Increased severity of disease
    • Increased duration of disease
    • Elevated HbA1c
    • Protein in the urine
    • Men
    • Increased diastolic blood pressure (the lower number)
    • Family history
    Blurred vision may not be recognized immediately but if the fragile new blood vessels bleed, blurred vision is sudden. And if the retina becomes torn and pulled off, a curtain comes down across the vision. Therefore, annual dilated eye exams are imperative for diabetics so that complications such as BDR and PDR can be detected early. The standard treatment for PDR without bleeding is pan retinal photocoagulation (PRP) laser. The basis for making a concentric series of small laser burns all around the periphery of the retina is to kill off enough cells to extinguish the low oxygen supply to them. By removing the low oxygen stimulus surprisingly these new blood vessels disappear and even background changes may fade. The laser light is absorbed by either the pigment under the retina or the blood cells in the blood vessels enabling the focal scar to occur. The peripheral location of the scars does not affect central vision but does reduce the peripheral visual field and night vision (adaptation to the dark). Given the choice of progressive deterioration in vision and destruction of the retina, PRP has much more benefit than risk. The treatments may be done in one or several sessions and are approximately 55% immediately successful. In many instances, the success rate is much higher when performed by