 Central Florida Retina Institute, Specializing
in diseases and surgery of the retina, macula, and vitreous,
 877-245-2020
Retina FAQs | Glossary
of Ophthalmologic Terms | Description
of a Retina | Diabetic
Retinopathy | Epiretinal
Membranes | Flashers &
Floaters | Macular Degeneration
| Macular Holes | Retinal
Detachment | Retinopathy
Of Prematurity | Clinical Trials
Q: What Is Diabetic Retinopathy?
A: Retinopathy literally means
"disease of the retina". Diabetic retinopathy is damage
to the retina caused by diabetes, and particularly by abnormally
high blood sugar levels. Naturally the level of circulating blood
sugar must average 100 mg/dl (80 to 100 fasting and 120 two hours
after meals). Long standing higher concentrations of blood sugar
results in damage to capillaries (tiny, hair-like blood vessels).
Since the retina requires high levels of oxygen to function normally,
capillaries are in abundance in the superficial layers of the
retina.
Early damage results in out-pouching
of capillaries, these are known as microaneurysms. Microaneurysms
initially allow leakage of the blood serum or plasma (the fluid
portion of the blood) into the retinal layers resulting in swelling
or edema of the retina as well as formation of cholesterol type
deposits known as exudates between superficial retinal layers.
When this occurs in the macula (the center portion of the retina)
this is called macular edema. Macular edema is the most common
cause of central vision loss in diabetic retinopathy. There are
also other factors which can worsen macular edema. Recent research
has shown that patients with higher levels of low-density lipids
(LDL), or "bad" cholesterol, have twice the risk of
developing visual loss from macular edema. Also, diabetics taking
Avandia (rosiglitazone maleate) for glycemic control have rarely
been reported to have new onset or worsening macular edema. Microaneurysms
in time may burst causing localized retinal hemorrhages. The
presence of microaneurysms, retinal hemorrhages, retinal leakage
and exudates is termed Nonproliferative (or Background) Diabetic
Retinopathy (NPDR).)
Retinal microaneurysms may also
ultimately seal up resulting in disruption of retinal blood flow
and poor retinal oxygen flow, a state know as ischemia. Retinal
ischemia usually results in formation of new abnormal blood vessels
known as neovascularization. In the presence of retinal neovascularization
the disease is called Proliferative Diabetic Retinopathy (PDR).
Patients with PDR may experience vision loss as the result of
the underlying ischemia or may develop bleeding inside the eye
cavity known as vitreous hemorrhage. Neovascularization could
also form scars on the surface of the retina which may result
in a form of retinal detachment known as Traction Retinal Detachment
(TRD). If retinal neovascularization goes untreated it could
also grow on the iris (colored part of the eye) (Iris Neovascularization)
causing a severe form of glaucoma known as Neovascular Glaucoma.
Many eyes reaching this stage will not have a good visual outcome
although prompt treatment with Avastin injection can save the
eye.
Q: How Do I Know If I Have Retinopathy?
A: Regular dilated eye examinations
are the only certain way to know if you have retinopathy. Timely
diagnosis of retinopathy is also the best way to insure effective
treatment to decrease the possibility of vision loss. Other ancillary
tests such as fluorescein angiography, which is a diagnostic
test using a dye to study retinal vessels, or laser scanning
of the retina may be helpful in assessment of various aspects
of this disease.
Periodic follow-up examinations
are also necessary to track the progression of the disease, as
well as the effectiveness of any treatment. Self-monitoring by
the patient based on his/her vision is not an effective way to
assess changes, as the progression of retinopathy does not always
result in further vision loss. However, if any worsening of the
vision is noted, you should report to your eye doctor immediately.
Q: Are there any treatments for diabetic
retinopathy?
A: The primary management of
diabetic retinopathy (both as a preventive strategy as well as
reducing the possible damage) is improved and optimum control
of the blood sugar. As blood pressure and cholesterol play important
roles in the course of this disease, special effort should be
made for the best control of these conditions.
Both macular edema and neovascularization
must be treated, usually by laser. Laser is an extremely effective
therapy for diabetic retinopathy. Early detection and treatment
insures better long term prognosis. But even if the diagnosis
is made in more advanced stages, effective treatment is often
still possible.
In the presence of vitreous
hemorrhage, traction retinal detachment and neovascular glaucoma,
most patients have to undergo operating room surgery called vitrectomy
and possibly glaucoma surgery.
Although laser has been used
for several years with good success, more recent treatments utilized
to combat diabetic retinopathy include vitreous injections of
various pharmaceutical agents as well as oral medications under
research.
Diabetic visual loss and blindness
is an unfortunate event, however, in the majority of cases this
can be prevented by better management of the disease, proper
eye examinations, and timely treatment.
If you have
any further questions about the service provided by Central Florida
Retina Institute or if you would like to make an appointment,
please call (863) 682-7474 or call toll-free at 877-245-2020.
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