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Diabetic Retinopathy

Diabetic Retinopathy

Diabetes occurs when your body cannot use or store sugar properly. When your blood sugar gets too high, it can damage the blood vessels in the retina. This damage may lead to diabetic retinopathy. The longer someone has diabetes, the more likely he or she will have retinopathy.

Diabetic Retinopathy Symptoms and Signs 
Everyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics do develop it. In its early stages, you may not notice any change in your vision, but later it can become sight-threatening.

Difficulty reading or doing close work can indicate that fluid is collecting in the macula. This is called macular oedema. Macular oedema can be diagnosed using an instrument called Optical Coherence Tomography (OCT). It can also be diagnosed by a method called fluorescein angiography where a dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your ophthalmologist to identify any leaking blood vessels and recommend treatment.

 

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Floaters can be a sign of diabetic retinopathy. Another sign is double vision, which occurs when the nerves controlling the eye muscles are affected.

In addition, abnormal blood vessels can grow on the iris, which can lead to glaucoma.

As soon as you've been diagnosed with diabetes, you need see your ophthalmologist to have a dilated eye examination and to have photographs of the back of your eye taken with a fundus camera. Thereafter diabetics should be monitored (often just with photography) at least once every two years.

What Causes Diabetic Retinopathy? 
Changes in blood-sugar levels increase your risk of diabetic retinopathy, as does long-term diabetes. Other risk factors for diabetic retinopathy are concurrent hypertension, smoking and pregnancy.

High blood sugar can damage blood vessels in the retina, and when they are damaged, they can leak fluid or bleed. This causes the retina to swell and form deposits.

What are the Stages of Diabetic Retinopathy? 
Mild Nonproliferative Retinopathy 
At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels.

Moderate Nonproliferative Retinopathy 
As the disease progresses, some blood vessels that nourish the retina are blocked.

Severe Nonproliferative Retinopathy 
Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

Proliferative Retinopathy 
At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye.

Macular Oedema
Fluid can leak into the centre of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses

What can I do to Reduce the Risk of Developing Diabetic Retinopathy? 
Keep your blood sugar and blood pressure under good control. This can be assisted by maintaining a healthy diet. It is also important to exercise regularly and follow your doctor’s instructions.

Diabetic Retinopathy Treatment 
According to the American Academy of Ophthalmology, 95% of those with significant diabetic retinopathy can avoid substantial vision loss if they are treated in time. The possibility of early detection is why it is so important for diabetics to have a dilated eye exam at least once every two years.

Diabetic retinopathy can be treated with laser photocoagulation to seal off leaking blood vessels and destroy new growth.

In some patients, blood leaks into the vitreous humour and clouds vision. This is called a vitreous haemorrhage. A procedure called a vitrectomy removes blood that has leaked into the vitreous humour. The body gradually replaces lost vitreous humour, and vision usually improves. Vitrectomy can also be used to remove the membranes and repair the retinal detachments caused by proliferative retinopathy and may help macular oedema.

If diabetic retinopathy has caused your eye to form a cataract, it can be corrected surgically. Patients who have developed glaucoma should see a glaucoma specialist.

Small studies using investigational treatments for diabetic retinopathy have demonstrated significant vision improvement for individuals who are in early stages of the disease. Two treatments that are closely related, Lucentis and Avastin, may be able to stop or reverse vision loss, similar to very promising results that have been reported when the two drugs have been used as treatments for macular degeneration.