Diabetic Retinopathy

Diabetic retinopathy is a series of pathological changes in the retina caused by long term elevation of blood sugar from diabetes.  The clinical findings first consist of abnormal blood vessels, tiny hemorrhages (bleeds), and exudates in the retina and later progress into areas of non-perfusion (no blood flow), macular edema (swelling in the center of the retina), and new blood vessel growth.  Diabetic retinopathy is usually asymptomatic in the early phases and you may not be aware that there is a problem.  Later in the disease, patients can lose vision in several ways:

  • Diabetic Macular Edema: Diabetic patients often develop swelling in the center of the retina, or macula.  This causes blurred vision and distortion.  With treatment, these changes can be reversed early in the disease, but later the vision loss is often permanent.
  • Vitreous Hemorrhage: Abnormal blood vessels can grow on top of the retina.  These blood vessels can easily bleed filling the eye with blood.  The blood will sometimes clear on its' own, but sometimes it requires surgery.  Injections of medicine or laser may be used to prevent further bleeding.
  • Tractional Retinal Detachment: As the abnormal blood vessels progress in the eye, they often contract, pulling the retina up towards the center of the eye.  This can lead to a retinal detachment with loss of vision or distortion.  When the center of the retina or fovea is involved, surgery is done to prevent further vision loss and try to restore some vision.
  • Macular Non-Perfusion: In some patients the blood flow in the center of the retina or fovea is so poor that the vision drops.  This is called macular non-perfusion, and unfortunately there is no treatment for this condition at this time.

It is critical that diabetic retinopathy be detected early and treated aggressively to preserve vision.  If you have been diagnosed with diabetes, you should see an eye doctor at least once a year.  If you have diabetic retinopathy, you should be seen by a surgical retina specialist to discuss all of your treatment options.

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