Proliferative Diabetic Retinopathy

If you suddenly see a few specks or spots floating in your vision, this may indicate you are at risk for proliferative diabetic retinopathy, the growth of abnormal new blood vessels on your retina and optic nerve. Diabetic retinopathy is a condition occurring in persons with diabetes, which causes progressive damage to the retina, the light sensitive lining at the back of the eye. It is a serious sight-threatening complication of diabetes.

 

Diabetes is a disease that interferes with the body's ability to use and store sugar, which can cause many health problems. Too much sugar in the blood can cause damage throughout the body, including the eyes. Over time, diabetes affects the circulatory system of the retina. Diabetic retinopathy is the result of damage to the tiny blood vessels that nourish the retina. They leak blood and other fluids that cause swelling of retinal tissue and clouding of vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness.

 

Symptoms of diabetic retinopathy include:

• Seeing spots or floaters in your field of vision
• Blurred vision
• Having a dark or empty spot in the center of your vision
• Difficulty seeing well at night

In patients with diabetes, prolonged periods of high blood sugar can lead to the accumulation of fluid in the lens inside the eye that controls eye focusing. This changes the curvature of the lens and results in the development of symptoms of blurred vision. The blurring of distance vision as a result of lens swelling will subside once the blood sugar levels are brought under control. Better control of blood sugar levels in patients with diabetes also slows the onset and progression of diabetic retinopathy. Often there are no visual symptoms in the early stages of diabetic retinopathy. That is why the American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.

How is the Diagnosis of Proliferative Diabetic Retinopathy Made? The first step is a careful eye exam where both pupils are dilated. If new blood vessel growth is suspected, you may need a special test called a fluorescein angiogram. This is a photographic study of the back of the eye performed after an orange-colored dye is injected in a vein in the hand or arm. The dye circulates through the body into the eye to highlight abnormal vessels, or where treatment is needed. If the eye is too filled with blood to examine, your doctor can perform a quick and painless evaluation of the eye’s internal structure with sound waves. This kind of “sonar” for the eye is called an ocular ultrasound.

Treatment:
Treatment of diabetic retinopathy varies depending on the extent of the disease. It may require laser surgery to seal leaking blood vessels or to discourage new leaky blood vessels from forming. Injections of medications into the eye may be needed to decrease inflammation or stop the formation of new blood vessels. In more advanced cases, a surgical procedure to remove and replace the gel-like fluid in the back of the eye, called the vitreous, may be needed. A retinal detachment, defined as a separation of the light-receiving lining in the back of the eye, resulting from diabetic retinopathy, may also require surgical repair.

If you are a diabetic, you can help prevent or slow the development of diabetic retinopathy by taking your prescribed medication, sticking to your diet, exercising regularly, controlling high blood pressure and avoiding alcohol and smoking. If you have proliferative diabetic retinopathy, you'll need prompt surgical treatment. Sometimes surgery is also recommended for severe nonproliferative diabetic retinopathy. Depending on the specific problems with your retina, options may include:

• Focal laser surgery: Focal Laser treatments can effectively reduce further damage being caused by leaky vessels.  The procedure is both safe and effective, and can usually be done in just a few minutes without need for a hospital visit. Usually this is done in a clinic with only topical anesthesia.
• Scatter laser surgery: Scatter laser treatment is used to treat advanced stages of diabetic retinopathy or proliferative diabetic retinopathy. Scatter laser treatment is applied to the retina to slow or stop tiny blood vessels from leaking. During the procedure, up to 2,000 laser burns are carefully placed away from the central retina, causing abnormal blood vessels to shrink. Scatter laser treatment does not usually restore previous vision loss, but helps to prevent further vision loss or blindness from occurring.
• Vitrectomy: Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye camera. It may be done when there is a retinal detachment, because removing the vitreous gel gives your eye doctor (ophthalmologist) better access to the back of the eye. The vitreous gel may also be removed if blood in the vitreous gel (vitreous hemorrhage) does not clear on its own. At the end of the surgery, silicone oil or a gas is injected into the eye to replace the vitreous gel and restore normal pressure in the eye. Vitrectomy may require an overnight hospital stay.

Be sure to check with your doctor to make sure you understand the risks and benefits of all eye surgery.

I’m Dr. Mike Morton, If you have any questions about Proliferative Diabetic Retinopathy, feel free to call my office and tell them you want to “Ask My Eye Doctor.” SB Eyecare Associates, your premier San Bernardino Optometry office, at (909) 963-1420 or stop by our office: 222 North G. Street, Suite 1 San Bernardino, CA 92410

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