Gainesville Eye Associates

What is diabetic retinopathy?
Diabetes is a condition in which the body's ability to process and store sugar has been impaired. Among the characteristics of the disease are gradual changes in blood vessels. Diabetic retinopathy is a complication of diabetes caused by the deterioration of blood vessels nourishing the retina at the back of the eye. These blood vessels become damaged due to persistently elevated blood sugar. The damaged blood vessels can leak blood and fluid resulting in swelling of the retina. This swelling can lead to permanent visual loss.

Who is at risk?
Persons who have had diabetes for a number of years are especially at risk of developing diabetic retinopathy. However, some patients can have evidence of diabetic retinopathy at the time they are diagnosed with diabetes. Six in ten who have had diabetes for over 15 years show symptoms of retinal damage; high blood pressure and pregnancy both worsen the condition. Although diabetic retinopathy is easily detected during routine eye examinations and treatable with laser surgery in early stages, it is the leading cause of new blindness among adults. Diabetics are 25 times more likely to become blind than those without the disease.

Two types of retinopathy
The two types of diabetic retinopathy are background retinopathy and proliferative retinopathy.
In background retinopathy, blood vessels weaken and begin to leak blood and serum. These fluids collect and form deposits in the retinal tissues, causing it to swell. If the leaking blood vessels are in the peripheral area of the eye, no serious visual impairment usually occurs. However, if the fluid collects in the macula - the area of the retina responsible for straight-ahead, detail, and color vision - blind spots and blurred vision can make activities such as reading and driving difficult or impossible.

Proliferative retinopathy
In the second, and more advanced stage of diabetic retinopathy, the abnormal cells rapidly spread (proliferate) across the inner surface of the retina. These weakened vessels can bleed into the vitreous and stop light from reaching the retina. In addition, the connective scar tissue, which forms as a result of the ruptured blood vessels, can shrink, pulling the retina away from its underlying structure, causing it to detach. Severe loss of sight - even blindness - may result.

What to look for
There is no pain associated with either form of retinopathy. Gradual blurring of vision may occur. But changes in the eye can go undetected without a medical eye exam. When bleeding occurs in proliferative retinopathy, the patient may see spots, a clouding of vision, or experience a complete loss of sight in the affected eye.

Detection and diagnosis
There are numerous instruments and techniques that eye doctors use to examine the retina. The important point is that every person with diabetes needs an annual eye exam to screen for diabetic retinopathy. The exam typically takes about 10 minutes and involves dilating both eyes.

Treatment of retinopathy
Drs. Chapman & Farkas have extensive experience in diagnosing and treating diabetic retinopathy. They will take into account your age, medical history, lifestyle, and the degree of damage to the retina before recommending a course of action. In many cases, treatment is not required; in others, laser treatments may be recommended to halt further progress of the disease. These laser treatments can be performed in our state of the art office facilities. The laser procedures typically take 10-20 minutes to perform.

In cases of background retinopathy, the laser is focused with pinpoint accuracy on the damaged blood vessels. Heat from the laser seals the vessels and helps bond the retina to the back of the eye by forming small scars.

One common treatment for proliferative retinopathy is called panretinal photocoagulation. In this procedure, the peripheral retina is scattered with laser light beams, like the pattern made by a shotgun. Although a certain amount of healthy tissue is destroyed, this technique usually stops further growth of abnormal cells and preserves the macula, saving valuable straight-ahead and color vision.

Removal of the vitreous
If the vitreous has become too clouded with blood to clear on its own, a surgical procedure called a vitrectomy may be recommended. In this technique, the vitreous is drained and replaced with a clear, artificial solution. An immediate improvement in sight is noted in about 70% of cases.

Retinal detachment
Retinal detachment occurs when the transparent layer of the retina separates from the wall of the eye. As the retina separates away, vision becomes darkened and distorted. Complete detachment leads to complete loss of vision. Retinal detachment typically requires a vitrectomy or scleral buckle surgery to re-attach the retina.

Conclusion
If you have diabetes, your eyes are at risk for diabetic retinopathy. Early detection and diagnosis of diabetic retinopathy is important if good vision is to be maintained. As there are no symptoms in early stages, regular eye exams are vital. A consultation by Drs. Chapman & Farkas can ensure quality care for your eyes.

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