DIABETIC RETINOPATHY

Diabetic Retinopathy may occur in patients with diabetes.  Blood sugar levels in diabetics may damage the walls of the blood vessels in the retina.  This damage may affect the integrity of the vessels, causing the vessels to leak fluid or blood.  The vessels may also close altogether, or collapse.  This disruption of normal blood flow in the eye may cause distortion of the central and peripheral vision.

There are two types of diabetic retinopathy:

  • Nonproliferative diabetic retinopathy (NPDR) is the earlier stage of the disorder. Symptoms may be non-existent or mild. The damaged vessels described above may cause small exudates and microaneurysms which lead to macular swelling/edema. The vessels may also close causing areas of the retina to receive less blood supply leading to ischemia. Both of these symptoms will result in central vision loss.
  • Proliferative diabetic retinopathy (PDR) is the more advanced form of diabetic retinopathy. The damage of the vessel walls can progress throughout the peripheral retina causing larger areas of oxygen depletion. When the vessels close, the retina attempts to make new vessels in order to supply oxygen to the ischemic retina. These vessels are weaker and the walls break down easier causing areas of hemorrhage and fibrotic tissue between the retina and vitreous. If left untreated, central and peripheral vision loss can occur due to vitreous hemorrhage, retinal tears, and retinal detachment.

What are the symptoms of diabetic retinopathy?

In the early stages of diabetic retinopathy, a person may not notice any visual changes. A person may not even realize he or she is diabetic. However, areas of ischemia (lack of blood supply) may already be progressing without notice. Microaneurysms causing areas of edema or fluid and hard exudates may be in their beginning stages. These hidden symptoms will not get better on their own and will only worsen, negatively affecting vision over time if left untreated. This is one of the most important reasons, everyone, especially those who are diabetic or with a family history of diabetes should have an annual, comprehensive, dilated eye exam by an ophthalmologist.

PROLIFERATIVE DIABETIC RETINOPATHY (PDR)

 

Noticeable diabetic retinopathy changes may include:

  • Blurred vision
  • Impaired color vision
  • Dark or empty areas in vision
  • Floaters
  • Fluctuating vision
  • Vision loss

If you feel you are experiencing any of these symptoms, please contact our office to schedule an appointment at 215-699-7600

What can I expect during a visit to evaluate diabetic retinopathy?

After a comprehensive, dilated eye examination is performed by your ophthalmologist, a series of diagnostic tests may be ordered to better evaluate the health of your retina.  These tests include, but are not limited to:

Along with a comprehensive eye examination, diagnostic testing directly correlates in the assistance of each patient’s individual plan of care.   Once diagnostic tests are performed, your physician can better map your retinal needs in order to best preserve your vision.

What are the treatment options for diabetic retinopathy?

Each patient’s eye has its own “retina print” somewhat like a fingerprint.  Treatment options will vary from patient to patient due to individual pathology as well as severity of retinopathy.

Treatment options include:

  • Anti-VEGF Therapy.  Vascular endothelial growth factor, or VEGF is a molecule generated by the body that causes new blood vessels to grow. Sometimes this is normal, however, in retinal disorders such as diabetic retinopathy, a higher level of VEGF causes abnormal blood vessels to grow and causes vessels to leak fluid or to bleed causing distortion of vision.  Injections of anti-VEGF drugs into the eye block the activity of VEGF and often result in a decrease in the fluid or bleeding caused by the abnormal vessels.  This procedure only takes moments and is done in the office.
  • Focal Laser Therapy or Photocoagulation Therapy may be used to stop or slow the progress of macular edema from diabetic retinopathy.  The ophthalmologist utilizes a laser light beam targeting selected blood vessels of concern with precision.  Small, superficial, laser burns are applied to these vessels in order to preserve further bleeding, or fluid (edema).  This procedure is done in the office.
  • Pan Retinal Photocoagulation (PRP) is used to treat more advanced diabetic retinopathy disease.  Ocular ischemia and abnormal blood vessel growth may cause a threat to overall retinal health, specifically in the peripheral retina, eventually encroaching on the central macula, which may lead to retinal detachment.  Utilizing a laser light beam, the ophthalmologist can terminate poor and abnormal vascularity in all peripheral quadrants of the retina while preserving central vision.  PRP therapy is performed in the office.  Most PRP patients need multiple laser treatments over two to three visits as this laser therapy covers an extensive preservation of vision.
  • Vitrectomy. A vitrectomy may be recommended in more advanced diabetic retinopathy disease.  When advanced abnormal vessel growth from diabetic retinopathy occurs, the vessels may overwhelm the vitreous space of the eye.  Large amounts of blood or hemorrhage may fill the vitreous, blocking light from entering the retina.  In these cases, laser therapy and/or anti-VEGF therapy may not be enough.  A vitrectomy surgery is an outpatient procedure performed in the hospital or surgical center and is done under general anesthesia.  The surgical physician will remove the hemorrhage in the vitreous and replace it with a salt solution with a balance much like the vitreous itself.  Any scar tissue involving the retina will also be removed.  In some cases, a gas bubble will be injected into the eye to replace the vitreous to help heal the retina and place it back on the posterior wall.  Silicone oil may also be used in cases where multiple surgeries have not secured the retina.  The ophthalmologist will discuss all treatment options with each patient to determine which option will be the most successful.  After surgery, eye drops will be prescribed to help aid the healing process.  A follow up appointment will be scheduled with the surgical physician within a day and/or week to evaluate the outcome of the procedure.

PDR VITRECTOMY

PANRETINAL PHOTOCOAGULATION, OR PRP LASER