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Diabetic Retinopathy

HOW DOES DIABETES AFFECT MY VISION?

If you have diabetes, you are aware that high blood-sugar levels can damage your blood vessels. The small vessels in the retina can become affected, just as the vessels in the kidneys can. The retina is the nerve fiber layer in the eye that acts like photography paper, sensing light. Damage to blood vessels in the retina is called retinopathy. There are two types, non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

WHAT IS NPDR?

NPDR is an early form of retinopathy in which small blood vessels in the retina become leaky because of chronic uncontrolled blood-sugar levels. Fluid leaks out of the blood vessels and leads to swelling in the retina. This usually does not affect vision unless the swelling involves the macula, the area of the retina responsible for central vision. This is termed macular edema, and is the most common cause of visual loss in diabetics. Macular ischemia can also lead to poor vision, when closure of small blood vessels (capillaries) causes poor oxygenation to the macula, and thus loss of function.

WHAT IS PDR?

PDR is a more advanced stage of diabetic retinopathy in which widespread closure of capillaries causes poor oxygenation to the entire retina. The retina responds to the situation by growing new blood vessels (neovascularization) on the surface of the retina or optic nerve in an attempt to supply blood and oxygen to the areas in need. Although this seems like a good response by the retina, these new blood vessels are not normal and often cause scar tissue to form which can cause a retinal detachment. New blood vessels can also bleed causing a sudden loss in vision from a vitreous hemorrhage. 

CAN DIABETIC RETINOPATHY CAUSE GLAUCOMA?

New blood vessels can grow in other areas of the eye as well, such as on the iris (the colored part of the eye). These blood vessels can physically block the normal outflow of fluid from the eye, and cause pressure inside the eye to rise. This is termed glaucoma and can damage the optic nerve and vision. 

HOW DO I KNOW IF I HAVE RETINOPATHY?

The only way to know if you have any retinopathy is to have a complete dilated eye exam. Dr. Cunningham will discuss with you any retinopathy found, and can even treat some forms of retinopathy before you notice decreased vision. 

HOW IS RETINOPATHY TREATED? 

Treatment will depend on what type of retinopathy you have. Macular edema, PDR, and glaucoma are often treated with laser surgery. A vitreous hemorrhage often clears on its own, but can be treated with a vitrectomy in which the blood is surgically removed from the eye. In the setting of a retinal detachment, repair is accomplished through various surgical techniques.

CAN I PREVENT VISION LOSS FROM DIABETES? 

Yes. You can reduce your risk of vision loss by working with your doctor on tight blood sugar control, and by scheduling regular dilated eye exams. Early detection of retinopathy found on your exam can mean early treatment, prior to experiencing worrisome and sometimes permanent vision loss.