THE RETINA is a thin layer of light-sensitive nerve tissue that lines the back of the eye (or vitreous) cavity. When light enters the eye, it passes through the iris to the retina where images are focused and converted to electrical impulses that are carried by the optic nerve to the brain resulting in sight.
Risk Factors: Anyone who has diabetes is at risk of developing diabetic retinopathy. Additional factors can increase the risk:
It is possible to have diabetic retinopathy for a long time without noticing symptoms until substantial damage has occurred. Symptoms of diabetic retinopathy may occur in one or both eyes.
Symptoms may include:
OCT of a patient with bilateral proliferative diabetic retinopathy with diabetic macular edema in the left eye. ©ASRS Retina Image Bank, May 2016. Image 26525. Olivia Rainey, Retina Specialists of Michigan.
An optical coherence tomography (OCT) test provides highly detailed cross-sectional images of the retina that show its thickness, helping determine whether fluid has leaked into retinal tissue.
The physician may take fundus photographs of the back of the eye to help detect and document diabetic retinopathy. These photos make it easier for the physician to monitor the disease on follow-up visits to determine if it is worsening.
To evaluate retina blood vessel circulation, the physician may conduct a retinal photography test called fluorescein angiography (FA). After dilating the pupils, the physician will inject a dye into the patient’s arm. The dye then circulates through the eyes and works like a food coloring; however, it does not affect the kidneys and is unlike the dye that is used with MRIs and CAT scans.
As the dye circulates, the physician takes pictures of the retina to accurately detect blood vessels that are closed, damaged, or leaking fluid. The pictures are black and white to help the doctor detect these changes more easily, but the process does not expose you to any radiation. Prior to examination, ask your physician to discuss the risks and benefits of obtaining these images.
With proper examinations, diabetic retinopathy can be detected before vision loss begins. If the physician detects signs of diabetic retinopathy, she/he will determine how frequently follow-up examinations will be required to detect changes that would require treatment.
Retinal fundus photo of a patient with proliferative diabetic retinopathy. ©ASRS Retina Image Bank, 2012. Image 774. Michael P. Kelly, FOPS, Duke University Hospital.
FA of a patient with proliferative diabetic retinopathy, retinal capillary nonperfusion, and neovascularization. ©ASRS Retina Image Bank, 2012. Image 2305. Sharon Fekrat, MD, FACS. Duke University Eye Center.
Treatment and Prognosis: As a result of major government- and industry-sponsored studies, there are many approved treatments for diabetic retinopathy, including intravitreal injections (small injections of medications into the middle cavity of the eye), laser treatments, and vitreous and retina surgery. These procedures can be done in an office or hospital setting to prevent, treat, or reverse damage from diabetes in the retina.
Research has shown that eye injections often result in better vision than laser treatment alone for patients with diabetic macular edema. The key to these treatments is their ability to block vascular endothelial growth factor (VEGF), a chemical signal that stimulates leakage and abnormal blood vessel growth. Repeated doses of anti-VEGF medications may be needed to prevent blood vessels from leaking fluid and causing vision loss. Some eyes with diabetic macular edema respond better to intravitreal steroid injections than anti-VEGF injections. When proliferative diabetic retinopathy develops, this is treated with a laser treatment called panretinal photocoagulation (PRP) and possibly anti-VEGF injections. Vitrectomy surgery (removal of the vitreous) may be used in eyes with vitreous hemorrhage or severe scar tissue on the retina (epiretinal membrane or traction retinal detachment).
If you have been diagnosed with diabetic retinopathy or diabetes and have vision loss that cannot be reversed, a retina specialist can help you find access to rehabilitation with a variety of tools to make everyday living with this disease a little bit easier.
Prevention: Patients with diabetes frequently ask, “Is there anything I can do to keep from getting diabetic retinopathy or to prevent or treat vision loss once it occurs?”
If you have diabetes, the National Eye Institute suggests that you keep your health on TRACK:
Regular dilated eye exams reduce the risk of developing more severe complications from the disease.
It is extremely important for diabetic patients to maintain the eye examination schedule put in place by the retina specialist. How often an examination is needed depends on the severity of your disease. Through early detection, the retina specialist can begin a treatment regimen to preserve your vision.
Diabetic macular edema (DME): The term used for swelling in the macula in eyes, or the center part of the retina which is responsible for providing the sharp, straight-ahead vision used for reading and recognizing faces as well as color vision.
Fluorescein angiography (FA): An imaging technique where a yellow dye called sodium fluorescein is injected into a vein in the arm. The dye allows a special camera to record circulation in the retina and choroid in the back of the eye. This test can be very useful in diagnosing a number of retinal disorders.
Fundus photography: Involves the use of specialized cameras equipped with lenses that capture images of the back of the eye where the retina, macula, vitreous, choroid and optic nerve are located.
Intravitreal injection: Treatment where a medication is injected into the vitreous cavity in the middle of the eye.
Macula: A small area at the center of the retina where light is sharply focused to produce the detailed color vision needed for tasks such as reading and driving.
Neovascularization: Excessive growth of new blood vessels on abnormal tissue as a result of oxygen deprivation that can cause vision loss.
Optical coherence tomography (OCT): A non-invasive imaging technique that uses light to create a 3-dimensional image of your eye for physician evaluation.
Proliferative diabetic retinopathy (PDR): An advanced stage of diabetic retinopathy in which new abnormal blood vessels and scar tissue form on the surface of the retina. The scar tissue can pull on the retina and cause retinal detachment and loss of vision. If blood vessels grow on the iris it can clog the drainage system of the eye causing glaucoma (high pressure in the eye), pain and vision loss.
Retinal detachment: A condition where the retina separates from the back of the eye cavity. This may be caused by vitreous gel or fluid leaking through a retinal tear or hole and collecting under the retina, causing it to separate from the tissue around it.
THANK YOU TO THE AUTHORS
Sophie J. Bakri, MD Audina Berrocal, MD
Thomas Ciulla, MD, MBA Geoffrey G. Emerson, MD, PhD Roger A. Goldberg, MD, MBA Dilraj Grewal, MD
Larry Halperin, MD Vi S. Hau, MD, PhD
G. Baker Hubbard, MD Talia R. Kaden, MD
M. Ali Khan, MD
Mathew J. MacCumber, MD, PhD Timothy G. Murray, MD, MBA Oded Ohana, MD, MBA Jonathan L. Prenner, MD
Carl D. Regillo, MD, FACS Naryan Sabherwal, MD Sherveen Salek, MD Andrew P. Schachat, MD Michael Seider, MD
Janet S. Sunness, MD Edward Uchiyama, MD Allen Z. Verne, MD Christina Y. Weng, MD, MBA Yoshihiro Yonekawa, MD
John T. Thompson, MD
MEDICAL ILL US TRAT OR
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