Diabetic Retinopathy
Diabetes affects your body from head to toes. This includes your eyes. The most common and most serious eye complication of diabetes is diabetic retinopathy, which may result in poor vision or even blindness.
“Retinopathy” is the medical term for damage to the tiny blood vessels (capillaries) that nourish the retina, the tissue at the back of your eye that captures light and relays information to your brain. These blood vessels are often affected by the high blood sugar levels associated with diabetes.
Nearly half of people with known diabetes have some degree of diabetic retinopathy. The longer you have diabetes, the more likely it is you’ll develop diabetic retinopathy. Initially, most people with diabetic retinopathy experience only mild vision problems. But the condition can worsen and threaten your vision.
The threat of blindness is scary. But with early detection and treatment, the risk of severe vision loss from diabetic retinopathy is small. You can take steps to protect your sight if you have diabetes. These include a yearly eye examination and steps to keep your blood sugar, blood pressure and blood cholesterol under the best possible control.
Diabetic retinopathy is caused by damage of the blood vessels in the retina. Nonproliferative diabetic retinopathy develops first when the vessels in the eye become larger in certain spots. Proliferative diabetic retinopathy is the advanced form of the disease where new blood vessels start to grow in the eye.
Diabetic Retinopathy is caused due to diabetes problems that inadvertently affect the eye at a certain stage. Diabetes eye problem that requires treatment if some or more of the symptoms occur: blurry or double vision, dark or blank spots, pain or pressure in eyes and trouble seeing from the corner of the eyes.
Diabetic Retinopathy – Treatment
If you have mild nonproliferative diabetic retinopathy, you may not require treatment right away. However, your eye doctor will want to closely monitor your retina. Proliferative diabetic retinopathy requires prompt surgical treatment.
Photocoagulation
The goal of photocoagulation, also known as laser treatment, is to stop the leakage of blood and fluid in the retina and thus slow the progression of diabetic retinopathy and vision loss. The decision to use the procedure depends on the type of diabetic retinopathy you have, its severity and how well it may respond to treatment.
Your doctor may recommend photocoagulation if you have:
- Diabetic macular edema, a swelling that involves or threatens the center of the retina.
- Severe nonproliferative diabetic retinopathy, especially if you have type 2 diabetes.
- Proliferative diabetic retinopathy.
- Neovascular glaucoma.
In photocoagulation, a high-energy laser beam creates small burns in areas of the retina with abnormal blood vessels to help seal any leaks. The procedure takes place in your doctor’s office or in an outpatient surgical center. Before surgery your eye doctor dilates your pupil and applies anesthetic drops to numb your eye. In some cases he or she numbs your eye more completely by injecting anesthetic around and behind your eye.
First, your chin and forehead are rested in an examination device called a slit lamp. This is a microscope that uses an intense line of light (slit) to allow your doctor to clearly view portions of your eye. Then, your doctor places a medical contact lens on your cornea — the layer of clear tissue at the front of your eye — to help focus laser light onto the sections of the retina to be treated. Fluorescein angiographic photographs may serve as maps to show where the laser burns should be placed. During the procedure you may see bright flashes from the short bursts of high-energy light.
To treat macular edema, the laser is focused on spots where blood vessels are leaking near the macula. The doctor makes “spot welds” to stop the leakage. If the leaks are small, the laser is applied directly to specific points where the leaks occur (focal laser treatment). If the leakage is widespread or diffuse, laser burns are applied in a grid pattern over a broad area (grid laser treatment).
Shortly after laser treatment, you can usually return home, but you won’t be able to drive, so make sure to arrange for a ride. Your vision will be blurry for about a day. Even when laser surgery is successful in sealing the leaks, new areas of leakage may appear later. For this reason you’ll have follow-up visits and, if necessary, additional laser treatments.
Immediately following laser surgery to treat macular edema, small spots caused by the laser burns may appear in your visual field. The spots generally fade and disappear with time. If you had blurred vision from macular edema before surgery, you may not recover completely normal vision.
Panretinal Photocoagulation
For proliferative diabetic retinopathy, doctors use a form of laser surgery called panretinal or scatter photocoagulation. With this technique the entire retina except the macula is treated with scattered laser burns. The treatment causes the abnormal new blood vessels to shrink and disappear. Thus it reduces the chances of a vitreous hemorrhage and traction retinal detachment. Panretinal photocoagulation is usually done in two or more sessions.
You may notice some loss of peripheral vision afterward. Panretinal photocoagulation is a trade-off. Some of your side vision is sacrificed to save as much of your central vision as possible. You may also notice difficulties with your night vision.
Vitrectomy
A vitreous hemorrhage may clear up on its own. But if the hemorrhage is massive and doesn’t clear, a vitrectomy may help to restore your sight and may allow the application of needed laser treatment.
In this procedure your surgeon uses delicate instruments to remove the blood-filled vitreous. A vitreous cutter cuts the tissue and removes it, piece by piece, from your eye. The tissue that is removed is replaced with a balanced salt solution to maintain the normal shape and pressure of the eye. A light probe illuminates the inside of the eye. The surgeon performs the procedure while looking through a microscope suspended over the eye. In this way the vitreous blood is removed to re-establish clear vision.
A vitrectomy is also used to remove scar tissue when it begins to pull the retina away from the wall of the eye. This allows a detached retina to settle back and flatten out. Your eye doctor may decide not to operate on a retina detached by scar tissue if the detachment is located away from the macula and doesn’t appear to be progressing.
During a vitrectomy the surgeon may also use a laser probe to perform panretinal photocoagulation. This can help prevent renewed growth of abnormal blood vessels, bleeding and scar tissue formation.
Vitrectomy can be performed under local or general anesthesia. Sometimes it is necessary to inject a bubble of expandable gas into the eye cavity. As the gas bubble expands, it pushes on the retina and helps it reattach. You may be required to remain in a face-down position for several days until the gas bubble spontaneously goes away. Your eye will be red, swollen and sensitive to light for some time after surgery. For a short time afterward, you’ll need to wear an eye patch and apply medicated eyedrops to help the healing. Full recovery may take weeks.