November 25, 2008 I was diagnosed with diabetic retinopathy, can you describe a little more in detail what this disease is and how is it treated?
Diabetic retinopathy
Diabetic retinopathy is one of the most serious complications of diabetes. The present treatment of diabetes has significantly contributed to the longer lifetime of the diseased, but many complications of the disease, unfortunately, often appear .
Basic feature of diabetes is elevated level of glucose in the blood, which spurres a disorder of circulation in small blood vessels and leads to a reduction of the supply of the oxygen in the tissue (hypoxia), and eye as an organ with highly developed function is particularly sensitive to it. Pathological changes in the eye are numerous and can affect all parts of the eye. Special significance, however, have diabetic changes in the retinal blood vessels, which often cause severe visual impairment, so today diabetic retinopathy is the leading cause of blindness in the world. The possibility of diabetic retinopathy is higher as the disease lasts longer. It usually occurs after 10 years duration of diabetes, and regularly after 15 – 20 years. In patients with diabetes duration longer than 15 years, there is even up to 75%, and in patients where the disease lasted less than 10 years signs of diabetic retinopathy appeared in 10 – 35%.
Because diabetic retinopathy is asymptomatic in almost all stages of which can still be treated,in other words that potentially blinding forms of the disease may develop much earlier than the patient notices any vision problems, it is very important for a diabetic to regularly goes for ophthalmological controls.
Classification of diabetic retinopathy
Classification of diabetic retinopathy has significantly changed through history. Today, most used is modified Airlie House classification by which we distinguish:
– Unproliferative diabetic retinopathy (mild, moderate and severe)
– Proliferative diabetic retinopathy (starting type, type with high-risk criteria or long diabetic eye disease)
– Diabetic makulopathy (macular edema or clinically significant macular edema)
At this stage there may be different stages at the same time e.g.,unproliferative moderate retinopathy and clinically significant macular edema.
In the most early stage of the disease or the stage of unproliferative diabetic retinopathy, the retinal arteries become weakened and begin to leak plasma and blood cells, which causes appearance of small, dotted bleedings. Also occur microanerurisms (capillary protrusions) and exudates (deposits in the retina as a result of increased permeability of blood vessels). The macular edema can occur which leads to a decrease in visual acuity and injury.
Harder degree of the disease is called proliferative diabetic retinopathy. Due to the reduced supply of oxygento the reatina and consequent ischemia, new blood vessels are produced (with which the body wants to increase the supply of blood and oxygen to the affected area). Creation of these new blood vessels is called neovascularization. However, new veins are of lower quality and they can easily break, so it comes to bleeding into vitreum why people see “flying blurrings and stains in front of the the affected eye, and also vision can be significantly reduced.
In the final stage of the disease further growth of abnormal blood vessels and connection of connective scars inside the eye cause serious complications such as unsticking of the retina and glaucoma (optic nerve damage due to elevated intraocular pressure) with consequent total loss of vision.
Diabetic macular edema is the leading cause of blindness in diabetic patients. There are two possible mechanisms of appearace of diabetic macular edema. On of them is thickening of the macula due to leakage of microaneurism that leak serum, lipids and blood in the retina, which impairs the function of the retina and causes damage to visual acuity. The second mechanism is the thickening of the retina caused by cellular necrosis and edema in ischemic condition (macular ischaemia). It is of great clinical importance to differentiate the two mechanisms of development of macular edema in an individual patient, since treatment and prognosis are quite different.
Some of the symptoms of diabetic retinopathy include:
* Blurry and distorted vision (often associated with blood sugar levels)
* “Blurred dots“ and flashes before the eyes
* Sudden loss of vision
Treatment of diabetic retinopathy
There are several ways of treating diabetic retinopathy, depending on the stage of the disease and specific problems that the patient has. Results in which the disease progression is being monitored and on which are brought decisions about treatment including fluorescein angiography (contrast imaging of retinal blood vessels), retinal photography and UTZ eye view .
Treatment of diabetic retinopathy is complex. It is very important to control blood sugar and maintaining normal blood glucose levels. This is done with specific medication with proper diet and exercise. For the purpose of treatment, i.e. slowing the progression of retinopathy, a laser photocoagulation is applied. It is a therapeutic process that will not heal retinopathy, but will reduce symptoms and maintain patient’s visual ability for as long as it can. Laser treatment is more effective in the initial stages of the disease, so regular ophthalmologic controls are very important. Before laser therapy, a control of fluorescein angiography that shows areas of poor blood flow is done because they can’t be seen in ophthalmological control ,and by the review the findings of a FAG, ophthalmologist determines the indication for laser photocoagulation. By using lasers we “destroy” the ischemic tissue of the retina and create blind spots in the field of peripheral vision, prevent the growth of new abnormal blood vessels and end the bleeding from existing ones. Photocoagulation laser results are promising: with the unproliferative retinopathy it is noticed the disappearance of macular edema, microaneurism and partial resorption exudation. In proliferative retinopathy it is seen a gradual reduction of retinal neovasculizations. Another way of treatment is vitrectomy. This is a surgical procedure that treates diabetic retinopathy complications such as bleeding into vitreum. With this procedure the surgeon removes the blood and vitreum from the eye and binding traces that depart from vitreum and catch for the retina and whose strain may cause a retinal ablation, and they should therefore be removed.
Taken from: mamed.medri.hr