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Diabetic Retinopathy

The effect of diabetes on the retina is called diabetic retinopathy. Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar in the blood. Diabetes’ effect on the retina is the main threat to vision, even though it may cause problems such as cataracts and glaucoma to develop. Diabetic changes in the retina begin to occur after approximately 10 years but can occur much earlier. These changes are called diabetic retinopathy.

Diabetes damages the circulatory system of the retina at the back of the eye. Tiny blood vessels called capillaries become weak and may leak fluid into the retina resulting in two major medical problems: swelling (diabetic macular edema) and abnormal blood vessel growth (retinal neovascularization). If the edema extends to be close to the center of the macula, significant loss of vision may result. New, abnormal retinal blood vessels are delicate and hemorrhage easily, allowing blood to leak into the vitreous, causing spots or floaters and decreased vision.

Diabetic patients need to have periodic eye examinations on a regular basis to detect eye problems and treat them as early as possible. The patient’s internist and endocrinologist will work closely with the retinal specialist. Diabetes is a chronic disorder and therefore requires regular follow-up for the entire life of persons afflicted. A component of this follow-up is regular retinal exams and treatment when necessary to prevent vision loss before it occurs.



What is the treatment for Diabetic Retinopathy?

Treatment is determined by the stage of the disease and specific problem involved. The retina specialist may use several tests to monitor the problem and make decisions for appropriate treatment such as fluorescein angiogram, which involves injection of a special dye into the patient’s arm. The dye passes through the blood vessels into the retina. The retina physician can then see the leaking blood vessels and take steps to perform laser to seal the vessels and stop the leakage.

Optical Coherence Tomography (OCT) is an exciting new technology allowing physicians to map the specific areas of retinal swelling to help determine which leaking retinal vessels are causing the most damage to the retina.

Laser therapy is used for the treatment of two distinct processes in diabetic retinopathy:

Diabetic macular edema

• Swelling in the macula, the portion of the retina responsible for your detailed vision as a result of leakage from small dilations (called microaneurysms) the fine blood vessels that course through it

• Focal laser is applied to microaneurysms that are near the central part of the macula to cause the leakage to regress

• Grid laser is similar to focal laser except that the leaser to applied over a broader area in cases where there is widespread leakage from microaneurysms

Proliferative diabetic retinopathy

• In response to poor retinal circulation, new and abnormal blood vessels in the retina grow in response to poor retinal circulation. Unfortunately, the appearance of these blood vessels (known as neovascularization) frequently creates complications such as bleeding within the eye (vitreous hemorrhage) and even retinal detachment due to scar tissue formation.

• Panretinal photocoagulation is applied to the periphery of the retina. The peripheral retina is not essential to your field of vision, but still requires a vast network of blood vessels to provide circulation. The application of laser throughout the periphery causes the neovascularization to regress.

•Additionally focal laser may sometimes be applied before panretinal photocoagulation to minimize the amount of macular edema.

Vitrectomy, the removal of the gel inside the eye, may be used to eliminate the blood accumulation and scar tissue that can develop in order to restore sight. Special medicines and steroids can be injected into the vitreous to reduce retinal swelling and improve vision. Physicians at Retina Associates of St. Louis, Inc. are continually developing additional new therapies for diabetic retinopathy.

To protect vision, the diabetic patient is urged to have routine, dilated eye exams at least once a year and often more frequently as well as to maintain good control of blood sugar levels. The onset and progression of retinopathy is lessened by good control of blood sugars.

Physicians at Retina Associates of St. Louis, Inc. are experts in the diagnosis and treatment of diabetic retinopathy, and will devise a plan of treatment especially formulated for each patient to try to prevent, arrest or reverse this sight threatening disorder.