Diabetic Retinopathy
Diabetic retinopathy is a serious complication of both Type 1 and Type 2 Diabetes. It is usually only seen after years of elevated blood glucose. The glucose slowly leads to the breakdown of the small blood vessels in the body, called capillaries. Patients who have diabetic retinopathy often also have kidney disease and peripheral neuropathy.
In fact, sometimes being told that you have diabetic retinopathy can be the tip of the iceberg, since it is only one manifestation of this devastating disease. This is why the doctors at Bucks-Mont Eye communicate their findings to your primary care doctors.
The damage to the capillaries in the retina, which is nerve tissue that acts like the film of a camera, leads to differing degrees of retinopathy:
Non-Proliferative
Diabetic Retinopathy (NPDR)
This is the early stage of diabetic eye disease. At first, the retina develops tiny hemorrhages that do not cause any visual symptoms. As the condition progresses, the capillaries become blocked (i.e. non-perfused) but there still may not be any symptoms. Over time, blood vessels start to leak, causing swelling of the retina (i.e. edema). When the edema affects the center of the retina, the patient will start to lose vision. In fact, this is the most common reason diabetic patients lose vision.
Proliferative
Diabetic Retinopathy (PDR)
This is the more advanced stage of diabetic eye disease. As a result of the non-perfused capillaries, the retina overcompensates and grows new (neovascular) blood vessels. The neovascular vessels can be very aggressive and bleed into the vitreous gel of the eye; this will cause you to see dark floaters, or it may block your vision altogether. Ultimately, if untreated, these neovascular vessels can lead to severe scar tissue formation which pulls and detaches the retina. A diabetic retinal detachment (different from a detachment caused by a retinal tear) can lead to severe visual loss and even blindness.
Fortunately, there are many different treatment regimens that have been developed over the years. In general, treatments are done to maintain, but not improve sight. Sometimes treatment does lead to improved vision, though. The earlier treatment is started, the better the long term visual prognosis.
Laser treatment for macular edema can be done to the more peripheral areas of the macula. More extensive laser (Panretinal Laser Photocoagulation, i.e. PRP) is done to the entire peripheral retina for proliferative retinopathy. Laser treatment is done less frequently now that intravitreal medications can be injected. Anti – Vascular Endothelial Growth Factor (anti-VEGF) medications, which include Lucentis, Avastin and Eylea, can be administered on a monthly or less frequent basis. Steroids such as Ozurdex, Iluvien and Triesence can also be injected on a periodic basis. For more severe disease, vitrectomy surgery done in a hospital or surgery center may be required.
Your doctor will decide which treatment (or treatments) is best for you, depending upon the severity of retinopathy and any other ocular conditions that are present, such as cataracts and glaucoma.