Diabetic Retinopathy – Damaged blood vessels in the rear of the eye
Understanding Diabetic Retinopathy:
This condition is caused due to the eye's normal aging process in which a person is unable to focus on the near objects clearly due to the decrease in the elasticity of the normal lens. This loss of elasticity limits the ability of the eye to change its point of focus from distance to near. It starts at the age of about forty years.
What is diabetic retinopathy?
Diabetes damages blood vessels in the rear of the eye. This condition is called diabetic retinopathy. It can lead to vision loss or blindness. You already may have diabetic retinopathy, or be at risk for it. But you can take steps to reduce your risk of vision loss from this condition.
Diabetes and vision loss:
Diabetes may prove harmful for your eyes. You are at the risk of loosing your vision. The feeling of loss of vision can send chills down your spine but you can work with your healthcare team to manage your diabetes and keep diabetic retinopathy under control.
Initially, Diabetic Retinopathy may cause no vision loss or other symptoms. With time it can still harm vision.
Diabetic retinopathy and its symptoms:
- Having blurred, darkened, or cloudy vision.
- Seeing floaters (dark spots) or black lines.
Pregnancy and diabetic retinopathy:
Pregnancy can make diabetic retinopathy worse. If you are planning for a baby, see your eye doctor right away. If possible, one should get their eyes tested before you plan for a baby and also during the initial 3 months of pregnancy.
Learning about diabetic retinopathy :
At Lasik we will help you to learn more about diabetic retinopathy and how to control it. When you meet your doctors, ask questions. Take notes, or have a family member or friend take notes. Ask for written instructions your doctor. We are always ready to help you.
Your ophthalmologist :
Ophthalmologists are medical doctors. They oversee vision care, diagnose and treat eye disorders. Your ophthalmologist can design a treatment plan to protect your vision. Keeping your appointments and following your treatment plan will help you save your vision.
Anatomy of the Eye :
The eye receives and processes light. The retina (the inside lining of the eye) turns light into nerve signals. These become visual images in the brain. Tiny capillaries (blood vessels) bring blood to nourish the retina.
The mechanism of sight:
Light enters the eye through the pupil.
A healthy retina includes :
- The light passes through the clear tissue of the lens and the vitreous (the clear gel that fills the eye).
- The light then strikes the retina, where special cells send signals to the brain
- The brain turns these signals into visual images resulting in what you see.
- The Macula, the area of the retina where sharp central vision takes place.
- The Fovea, the most sensitive part of the retina .
- The Periphery, which surrounds the Macula. This provides peripheral (side) vision what we see outside our sharp central vision.
- Capillaries that nourish the retina with blood.
Diabetes and the eye :
Diabetes can cause capillaries on the retina to leak or collapse. Then fragile new capillaries may grow on the retina, causing more damage. Both types of damage to the retina are forms of diabetic retinopathy.
An Unhealthy Retina:
Damaged capillaries can interfere with vision. They can also reduce the amount of blood nourishing the retina. Reduced blood flow causes fragile new capillaries to grow on the retina (called neo-vascularization). As diabetic retinopathy progresses, vision loss increases.
Damage from existing capillaries:
Existing capillaries may:
Damage from new capillaries:
- Form micro-aneurysms (bulges in the capillary wall). These may leak fluid and fatty substances (hard exudates). This leakage can cause macular edema (swelling).
- Close up, forming cotton wool spots (soft exudates).
- Cause bleeding on the retina (dot-blot hemorrhages).
Fragile new capillaries may:
- Bleed into the vitreous.
- Cause the vitreous to pull on the retina (traction).
- Traction can cause bleeding, create scar tissue, or dislodge the retina from the back of the eye (tractional retinal detachment).
Traction can cause bleeding, create scar tissue, or dislodge the retina from the back of the eye (tractional retinal detachment).
How your vision can change :
Diabetic retinopathy may progress from its early stage (non-proliferative) to its later stage (proliferative). Either stage may cause vision loss. There may be little or no vision loss at first. But even without early vision loss, diabetic retinopathy still damages the retina. Severe vision loss, even blindness may occur later.
Non-proliferative diabetic retinopathy:
At this stage, capillaries in the retina have been damaged. But there is no growth of fragile new capillaries on the retina. This stage of diabetic retinopathy may cause no symptoms. Or it may result in some vision loss. This stage is also called background diabetic retinopathy
Proliferative diabetic retinopathy:
At this stage, fragile new capillaries begin to grow on the retina. This capillary growth may result in bleeding or traction, causing severe vision loss
. This stage is more common in people who have had diabetic retinopathy for along time.
Indications or what you may see:
As diabetic retinopathy progresses, seeing clearly may become more difficult. Vision may become impaired
. Vision may worsen quickly without warning, or slowly over time.
No vision loss yet:
Problems such as leakage, closed capillaries, or capillary growth may be present. But they may not yet have affected your vision.
Slight to moderate vision loss:
Problems with capillaries such as swelling due to focal leakage (leakage near the fovea), cotton wool spots, or capillary closure may result in the first signs of vision loss.
Moderate to severe vision loss:
Vision may decline further because of swelling due to diffused leakage (leakage throughout the macula) or other worsening problemswithcapillaries.
Cloudy, blurry vision:
This often results when weak new capillaries growing into the vitreous begin to bleed.
Severely reduced vision:
Capillary growth and scar tissue in the vitreous may result in traction. Traction may cause the retina to detach from the back of the eye (tractionalretinal detachment). If this occurs, vision may be severely impaired.
Managing your health :
You can reduce your risk of vision loss from diabetic retinopathy by managing your overall health. Start by closely managing your diabetes. And take care of other health problems that can make diabetic retinopathy worse.
Manage your diabetes:
The best way to protect your vision is to keep your blood sugar level in a healthy range. Check your blood sugar regularly. Follow your diabetes management plan
. And work with your primary care physician or endocrinologist (diabetes doctor) if you are having trouble keeping your blood sugar in a healthy range.
Control your risk factors
Other factors that damage blood vessels can make diabetic retinopathy worse. These include:
- High blood pressure
- High cholesterol
Work with your healthcare team to control these problems and help lower your risk. A diabetes educator these problems and help lower your risk. A diabetes educator can help you control blood pressure and high cholesterol. He or she can also recommend stop-smoking programs.
Using the amsler grid :
An amsler grid helps you track changes in your vision. Use the grid below. Or use one supplied by your eye doctor. Use the grid as often as he or she suggests. Keep the grid where you will remember to use it. If you notice any vision changes even if your vision improves call your ophthalmologist.
How to use the Amsler's grid
- Use it in a well lighted area.
- Wear glasses or contacts if you usually wear them.
- Hold the grid at your normal reading distance (about 16 inches)
- Cover your left eye.
- Look at the dot in the grid’s centre with your right eye.
- While looking at the dot, notice if any of the lines appear wavy or disappear, or if the boxes change shape.
- Jot down any changes from the last time you used the grid.
- Repeat with your other eye.
- If you have noticed any vision changes, call your ophthalmologist right away.
Evaluating your eyes :
You need to visit your ophthalmologist for a complete detailed eye examination at least once in a year (more often if you are pregnant). During the examination, he or she will review your medical history, check your vision and examine your eyes.
Your medical history:
Your ophthalmologist will ask you about:
- Your diabetes type, history, treatments (such as insulin), and how you monitor your blood sugar level.
- Your family’s health, including whether any relative has had diabetes or diabetic retinopathy.
- Any diseases, surgeries, or other medical procedures you have had.
- Any medications, herbs, or supplements you use, including those you buy over the counter.
Your ophthalmologist will use various procedures to examine and evaluate the state of your vision and eyes.
These may include:
- Tonometry.measures fluid pressure inside your eye.
- Slit lamp exam. This lets your doctor view the structures of the eye.
- Ultrasound.This uses sound waves to create an image of your eye. It may be used if there is blood in the vitreous.
Fluorescein Angiography uses special photographs of the retina to reveal changes in the capillaries. Before this procedure, dye is injected into your arm or hand. The dye highlights capillaries in the retina. Photographs are taken before and after the dye is injected.
During the procedure you may briefly feel some nausea. After the procedure, your skin, eyes, and urine may appear yellow for a few hours.
What is the next step?
Your ophthalmologist will work with you to design a treatment plan that is best for you. You may need more than one type of treatment:
- Laser photocoagulation,to control leaking capillaries and prevent growth of new capillaries.
- Vitrectomy,to remove a cloudy vitreous and scar tissue.
- Cryotherapy, to shrink capillaries and repair the retina.
- Other surgery or medicationsas recommended by your ophthalmologist.
Undergoing laser treatment :
Laser photocoagulation uses a laser (a high-energy light source) to treat diabetic retinopathy. But it may slow or halt the progress of the disease.
How is the laser used?
During the procedure, a laser beam is focused on the retina. The laser seals weak capillaries. It also slows or stops new capillary growth.
Types of laser treatment:
The type of treatment you receive depends on the extent and location of damaged capillaries. Treatment may take from a few minutes to a half hour or so. You may need more than one treatment session or type of treatment:-
Risks and complications of laser treatment
- Focal treatmentuses the laser to seal up tiny bulges in capillaries near the fovea.
- Grid treatmentuses the laser to treat swelling in different areas of the macula.
- Pan-retinal treatmentreduces growth of new capillaries throughout the retina.
Preparing for laser treatment
- Pain in or around the eye
- Retinal bleeding
- Watery eyes
- Dilated pupils
- Mild headache
- Double or blurry vision
- Seeing spots
- Problems with glare
- Loss of night or side vision
Tell your ophthalmologist about all medications, herbal remedies, or supplements you use, such as aspirin, ibuprofen, blood thinners, or gingko. Bring dark sunglasses to wear on the way home. Arrange for someone to drive you home after surgery.
During laser treatment
Laser treatment may be done at the doctor’s office, hospital, or eye center. You’ll be awake during treatment. The doctor uses eyedrops to dilate your pupil. The doctor will then hold a special contact lens against your eye.
Laser treatment may cause some discomfort. If so you’ll be given medication to control it. If the discomfort continues, tell your doctor.
After laser treatment
You may be given a patch to protect your eye for a few days. Ask your doctor how long you need to avoid lifting exercising, or swimming. Also ask when you can return to work.
When to call your doctor?
If you have sudden pain or notice decreasing vision after surgery, call your ophthalmologist.
If blood or debris in the vitreous is clouding your vision, your doctor may recommend vitrectomy. This surgery removes the cloudy vitreous
. The vitreous is replaced with fluid or gas. If vision problems continue after vitrectomy, you need additional surgery.
Risks and complications of vitrectomy
- Swollen or droopy eyelid
- Double or blurry vision
- Bloody sclera
- Watery or red discharge
- Cloudiness in lens (cataract)
- Residual vision loss
Working with your healthcare team:
You are the most important member of your healthcare team. Work with your doctors and other healthcare providers to manage your diabetes. Keep visiting your ophthalmologist for regular eye examination and vision-care.
Keep your medical appointments :
Diabetes can harm blood vessels throughout your body as well as inside your eyes. Protect your health and vision with regular medical examination :
Follow your treatment plan :
- Keep scheduled appointments with your healthcare providers.
- Have lab work such as blood or urine tests done as directed.
- Visit your ophthalmologist for an eye exam at least yearly.
Your treatment plan will help you reduce your risk of vision loss. To control diabetic retinopathy:
- Check your blood sugar as directed.
- Take care of your overall health. Do not smoke. Follow your doctor’s advice about exercise and diet.
- Use the amsler grid regularly.
- Report vision changes or other symptoms to your ophthalmologist right away.
The suitability for any of the above treatments is normally determined by your eye doctor after a series of examinations. These might include:
Tips for vision care:
- Visual acuity test.This test measures how your ability to see with clarity at various distances.
- Dilated eye exam.In this test, the doctor administers eye drops to dilate, the pupils. Dilated pupils allows the eye care professional to see more of the inside of your eyes to identify signs or symptoms of diabetic retinopathy.
- A special magnifying lens is used to examine your retina and optic nerve for damage and other eye problems. Subsequent to the examination, your close-up vision may remain blurred for several hours.
- Tonometry.In this examination a numbing eye drop is administered and the doctor uses instruments to measure the pressure in the eye.
Diabetic patients who maintain appropriate blood sugar levels are found to have fewer eye problems than those with little or no control. Healthy eating and regular workouts contribute to the overall health of those with diabetes.
Routine eye examinations can also indicate early onset of symptoms and help manage the condition. Many problems can be treated with much greater success when caught early.
Your healthcare team will help you protect your vision. If you have questions, ask your doctors or other healthcare providers. Share your concerns with your family, friends, or clergy. For help with diabetes and vision care, call or write your state or local commission on the blind.