People with diabetes are 25 times more likely to lose vision than those who are not diabetic. if you have been diagnosed with diabetes, it is important to have a comprehensive eye exam at least once a year. We perform a thorough retinal exam through dilated pupils to check for any diabetic complications including diabetic retinopathy.
Everyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics do develop it. In the early stages, you may not notice any change in your vision. This is why annual exams are recommended even if you have no symptoms.
Changes in glucose levels increase your risk of diabetic retinopathy, as does long-term diabetes. Diabetes can damage the blood vessels in your eyes causing them to leak which can cause vision loss.
According to guidelines 95 percent of those with significant diabetic retinopathy can avoid substantial vision loss if they are treated in time.
Stages of Diabetic Retinopathy
The stages of diabetic retinopathy are divided into two categories, nonproliferative retinopathy and proliferative retinopathy.
This is the first and earliest stage of diabetic retinopathy. NPDR occurs when the small blood vessels of the retina start to leak fluid or bleed. This activity will lead to the formation of deposits called exudates. Once these blood vessels start to leak swelling within the central part of the retina occurs. When the leakage of these blood vessels causes swelling, macular edema sets in and the blood vessels can become blocked. This stage of diabetic retinopathy is common when a person develops diabetes. Most diabetics have some grade of NPDR.
When new vessels start to grow as a result of the existing vessels becoming blocked, this marks the beginning of the next stage of diabetic retinopathy, proliferative diabetic retinopathy. This level of diabetic retinopathy is the most severe and dangerous for the diabetic patient. These new abnormal blood vessels can grow on the retina, optic nerve, iris or into the vitreous gel inside the eye, and tend to grow poorly and are very fragile. The damage that these blood vessels bring to retina can be catastrophic and include hemorrhages on the retina, scar tissues build up, and possible retinal detachment.
Diabetic Retinopathy Symptoms
If you are diabetic, it is suggested hat you have regular eye exams to look for symptoms. Diabetic retinopathy does not really have any initial warning signs.
*If proliferative diabetic retinopathy is left untreated blindness can occur. The best alternative to fighting PDR is early detection so that you and your eye doctor can begin to control this development.
Detecting Diabetic Retinopathy
TThe diabetic retinopathy is detected through regular comprehensive eye exams in diabetic patients. In the earliest stages of diabetes, eye exams once or twice a year may be acceptable. Your doctor will be specificly looking for the leaking blood vessels that can lead to more advanced levels of this eye disease. A dilated eye exam will be performed by your eye doctor and retinal photographic equipment will be used.
Diabetic Retinopathy Treatments:
Vitrectomy - A vitrectomy may be performed to clear blood and debris from the eye, to remove scar tissue, or to alleviate traction on the retina. The Vitrectomy actually removes vitreous gel from the eye through a small incision using a laser. Vitrectomy allows the retina to flatten. Depending on the severity of the diabetic retinopathy, gas or air might be placed in the eye to replace the vitreous fluid that was removed. This gas or air helps smooth out the retina and prevent retinal detachment.
Cystoid Macular Edema (CME)
Cystoid Macular Edema (CME) is a condition in which the macula develops microscopic swelling which can blur the central vision. CME most commonly develops following intraocular surgery, but may be associated with a variety of vascular conditions such as macular degeneration, diabetic retinopathy or vascular occlusion. Treatments for CME depend on its cause. CME may be treated with medicated eye drops, injected medication, laser treatments and surgery.
Retinal Vein Occlusions:
Retinal vein occlusion occurs when one of the tiny retinal veins becomes blocked by a blood clot. It usually leads to a painless decrease in vision in one eye. Risk factors include high blood pressure, high cholesterol levels, diabetes, smoking and raised pressure in the eye (glaucoma). Treatment includes treating any possible risk factors and also treating any complications.
Whenever retinal vein is occluded the blood cannot drain away from the retina as easily and there is a backlog of blood in the blood vessels of the retina. This can lead to a build-up of pressure in the blood vessels. As a result, fluid and blood start to leak from the blood vessels, which can damage and cause swelling of the retina, affecting your eyesight.
There are two main types of retinal vein occlusion:
Branch retinal vein occlusion is two to three times more common than central retinal vein occlusion.
Epiretinal Membranes (Macular Puckers)
An epiretinal membrane, commonly called a macular pucker, is a thin film-like covering that can develop over the central retina known as the macula. This area of the retina is responsible for your clear central vision. Epiretinal membranes may lead to blurry or distorted vision. Some epiretinal membranes require vitrectomy surgery with removal of the membrane for improvement of vision.
Flashes and Floaters - Posterior Vitreous Detachments
Flashes of light and floaters in the field of vision occur in healthy people, but may also be a sign of serious problems. If flashes occur suddenly, it may be a sign that the retina is torn. In this case, you should contact your doctor immediately. Floaters, usually due to a posterior vitreous detachment, are caused by particles that are floating in the vitreous gel and cast shadows on the retina. Floaters may naturally appear with increasing age. However, if floaters occur suddenly, it may be a sign that the retina is torn. You should contact your doctor immediately if you experience such sudden symptoms.
Macular degeneration is one of the most common eye diseases treated by the doctors at Clay Eye Physicians and Surgeons. Macular degeneration is associated with aging. It can destroy sharp central vision and is the leading cause of legal blindness among people over the age of 50 in the western world. In some individuals, tiny dot-like deposits, known as drusen, slowly accumulate beneath the macula. While these deposits usually do not cause visual loss directly, they indicate that a person is at risk for developing further problems with the macula. Atrophic or thin areas can develop in the macula which can lead to visual loss in the “dry” form of macular degeneration. In some patients, abnormal blood vessels may develop under the macula leading to the “wet” form of macular degeneration. If these vessels can be identified at an early stage, it may be possible to seal them with injection of new medications developed for wet macular degeneration or other treatments. If you notice any new distortion or visual changes, it is critical to contact your eye care provider immediately.
Macular holes are just that, holes in the macula. The macula is the central portion of the retina that is responsible for seeing fine details clearly. Macular holes involve cellophane-like wrinkling of the macula. If the wrinkling is especially severe, it can stretch the macula and cause a hole to form. Many macular holes are treatable with vitrectomy surgery.
Retinal Tears and Detachment
Retinal tears and detachment occur when the vitreous, a clear jelly-like substance that fills the eye, pulls from the retina and causes the retina to tear. Liquid that passes through the tear and settles under the retina results in separation of the retina from the back wall of the eye. The condition is termed a retinal detachment. An untreated detached retina usually causes blindness.
You should contact your doctor as soon as you develop the symptoms of retinal detachment. Symptoms include seeing flashing lights, new floaters, or a gray curtain move across your field of vision.
Retinal vascular diseases are common in people with high blood pressure, diabetes, and other factors that cause vascular disease throughout the body such as increasing age, high cholesterol, smoking, and hypertension. Retinal vascular diseases include retinal arterial macro aneurysm, retinal branch and central artery and vein occlusion, diabetic retinopathy, and ocular ischemic syndrome. In simple terms, these are conditions that can restrict the blood flow throughout your eye structures and lead to vision loss or blindness.
Various retinal treatments are peformed through lasers and we at Javed Eye Centre are equipped with 532 Green Laser, Diode Laser and Yag Laser which enable us to perform various treatments.
These laser treatments are also known as photocoagulation. The laser uses controlled bursts to seal leaking blood vessels, destroy abnormal blood vessels, seal retinal tears and remove abnormal tissue that has formed on the back of the eye.
Depending on the type of retinopathy you have, your doctor may recommend laser treatment. Laser treatment can be used to help reduce the swelling in your retina caused by leaky blood vessels. It can also be used to treat a more aggressive form of retinopathy, called "proliferative," which can lead to bleeding into your eye, retinal detachments, and loss of vision.
Avastin, Lucentis, Eylea and Ocriplasmin Injections are all treatment options for various retinal diseases including age-related macular degeneration and retinal vascular diseases (blood vessel blockages including diabetic retinopathy). These agents work to block the growth of new blood vessels that may leak and contribute to vision problems. They are injectable medications that block the effects of Vascular Endothelial Growth Factor (VEGF) which is responsible for the growth of new blood vessels in the eye. VEGF is implicated in the development and progression of wet macular degeneration, diabetic retinopathy, and macular edema. VEGF promotes the growth of new abnormal blood vessels and increases the permeability of existing vessels leading to leakage. By blocking VEGF, Avastin and Lucentis can, in some cases, improve outcomes in patients with a broad variety of retinal and macular diseases.
There are several methods of treating a detached retina which all depend on finding and closing the breaks which have formed in the retina.
Cryopexy and Laser Photocoagulation
Cryotherapy (freezing) or laser photocoagulation are occasionally used alone to wall off a small area of retinal detachment so that the detachment does not spread.
Scleral buckle surgery
Scleral buckle surgery is an established treatment in which the eye surgeon sews one or more silicone bands to the sclera (the white outer coat of the eyeball). The bands push the wall of the eye inward against the retinal hole, closing the break or reducing fluid flow through it and reducing the effect of vitreous traction thereby allowing the retina to re-attach. Cryotherapy (freezing) is applied around retinal breaks prior to placing the buckle. Often subretinal fluid is drained as part of the buckling procedure. The buckle remains in place. The most common side effect of a scleral operation is myopic shift. That is, the operated eye will be more short sighted after the operation. Radial scleral buckle is indicated for U-shaped tears or Fishmouth tears and posterior breaks. Circumferential scleral buckle indicated for multiple breaks, anterior breaks and wide breaks. Encircling buckles indicated for breaks more than 2 quadrant of retinal area, lattice degeration located on more than 2 quadrant of retinal area, undetectable breaks, and proliferative vitreous retinopathy.
This operation is generally performed in the doctor's office under local anesthesia. It is another method of repairing a retinal detachment in which a gas bubble is injected into the eye after which laser or freezing treatment is applied to the retinal hole. The patient's head is then positioned so that the bubble rests against the retinal hole. Patients may have to keep their heads tilted for several days to keep the gas bubble in contact with the retinal hole. The surface tension of the air/water interface seals the hole in the retina, and allows the retinal pigment epithelium to pump the subretinal space dry and suck the retina back into place. This strict positioning requirement makes the treatment of the retinal holes and detachments that occurs in the lower part of the eyeball impractical. This procedure is usually combined with cryopexy or laser photocoagulation.
Vitrectomy is an increasingly used treatment for retinal detachment. It involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble or silicon oil. Advantages of using gas in this operation is that there is no myopic shift after the operation and gas is absorbed within a few weeks. Silicon oil, if filled needs to removed after a period of 2–8 months. Silicon oil is more commonly used in cases associated with proliferative vitreo-retinopathy (PVR). A disadvantage is that a vitrectomy always leads to more rapid progression of a cataract in the operated eye. In many places vitrectomy is the most commonly performed operation for the treatment of retinal detachment.