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NATURAL HISTORY OF DIABETIC RETINOPATHY:Diabetes Care:"Screening strategies depend on the rates of appearance and progression of diabetic retinopathy and on risk factors that alter these rates. Vision-threatening retinopathy virtually never appears in type 1 patients in the first 3-5 years of diabetes or before puberty. Over the subsequent 2 decades, nearly all type 1 patients develop retinopathy. Up to 21% of patients with type 2 diabetes have recently been found to have retinopathy at the time of first diagnosis of diabetes, and most develop some degree of retinopathy over subsequent decades. In general, the progression of retinopathy is orderly, advancing from mild nonproliferative abnormalities, characterized by increased vascular permeability, to moderate and severe nonproliferative diabetic retinopathy (NPDR), characterized by vascular closure, to proliferative diabetic retinopathy (PDR), characterized by the growth of new blood vessels on the retina and posterior surface of the vitreous. Pregnancy, puberty, and cataract surgery can accelerate these changes." http://www.findarticles.com/cf_dls/m0CUH/1_23/59175334/p1/article.jhtml Diabetic Retinopathy what is it, how is it treated:buisnesswire.com:"More than 2.5 million people worldwide are blind due to diabetic retinopathy, a common microvascular complication and the leading cause of blindness among adults of working age. Medical specialists today at the 37th Annual Meeting of the European Association for the Study of Diabetes (EASD) met with international media to review the growing prevalence of diabetic eye complications and the critical need for appropriate diagnosis and treatment. Diabetic retinopathy and a manifestation of diabetic retinopathy called diabetic macular oedema have devastating effects on the lifestyles of people with diabetes. Importantly, these disorders are growing in prevalence. The World Health Organization estimates that 151 million people around the world have diabetes and that number is expected to double during the next 25 years. Nearly half of all people with diabetes will develop some form of diabetic retinopathy and 74 percent of people who have diabetes for 10 years or more will show clinical evidence of diabetic retinopathy. Microvascular eye disorders could be detected early if people with diabetes received annual eye exams. There is a trend in some countries" http://www.businesswire.com/webbox/bw.091101/212542016.htm Diabetic Retinopathy comprehensive guide:1UpHealth:"Diabetic retinopathy often has no early warning signs. At some point, though, you may have macular edema. It blurs vision, making it hard to do things like read and drive. In some cases, your vision will get better or worse during the day. As new blood vessels form at the back of the eye, they can bleed (hemorrhage) and blur vision. The first time this happens it may not be very severe. In most cases, it will leave just a few specks of blood, or spots, floating in your vision. They often go away after a few hours. These spots are often followed within a few days or weeks by a much greater leakage of blood. The blood will blur your vision. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from the inside of your eye. In some cases, the blood will not clear. You should be aware that large hemorrhages tend to happen more than once, often during sleep." Contact 1up Health http://www.1uphealth.com/medical/disease/eye-vision-disease/diabetic-retinopathy-1.html ******************************************************
Diabetic eye disease and retinopathy:Gourmet Connection:"Diabetes is a very serious disease that can cause problems like blindness, heart disease, kidney
failure, and amputations. But by taking good care of yourself through diet, exercise, and special
medications, you can control diabetes. And there is more good news. Diabetic eye disease, a
complication of diabetes, can be treated before vision loss occurs. Diabetic retinopathy. This
disease is a leading cause of blindness in American adults. It is caused by changes in the blood
vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell
and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina.
These changes may result in vision loss or blindness."
Diabetic retinopathy, advanced disease and prevention:Diabetic retinopathy Foundation:"Diabetic retinopathy damages the tiny blood vessels that supply the retina (the light-sensitive
nerve tissue at the back of the eye that transmits visual images to the brain). In the early
stages of this disease-called non-proliferative or "background" retinopathy, the retinal vessels
weaken and develop bulges (microaneurysms) that may leak blood (hemorrhages) or fluid (exudates)
into the surrounding tissue. Vision is rarely affected during this stage of retinopathy"
How does diabetes affect the retina?:St. Luke's Cataract & Laser Institute:"Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but
the disease's affect on the retina is the main threat to vision. Most patients develop diabetic
changes in the retina after approximately 20 years. The effect of diabetes on the eye is called
diabetic retinopathy. Over time, diabetes affects the circulatory system of the retina. The
earliest phase of the disease is known as background diabetic retinopathy. In this phase, the
arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These
leaking vessels often lead to swelling or edema in the retina and decreased vision."
RETINAL COMPLICATIONS OF DIABETES:Richmond Eye Associates:"A more severe retinal complication of diabetic eye disease is "proliferative diabetic
retinopathy". Fortunately, only a small number of diabetics will develop this complication, but it
is still treatable. Here, the vascular damage to the retina worsens, with more extensive
hemorrhages, abnormal blood vessels, areas of blocked off blood vessels, and fluid leakage into
the retina. The closure of small retinal blood vessels can become so severe that parts of the
retina begin to produce a chemical (recently identified) that stimulates the growth of NEW blood
vessels. This chemical spreads into the jelly-like material that fills the eye, and can affect
many different parts of the eye.
The new blood vessels which form in response to this chemical are abnormal, frail, and tend to
grow out off of the retinal surface into the jelly material filling the eye. They tend to break
and bleed, causing large hemorrhages inside of the eye, and can become scarred, leading to retinal
detachments. In a detachment, the retinal is tented off of the wall of the eye, being pulled up by
these abnormal blood vessels.
This complication of diabetes requires more extensive treatment, and sometimes intra-ocular
surgery done in the operating room. Sometimes blood vessels can block off supplying the central
vision itself. If this occurs, the central vision is lost and cannot be regained."
Treatments effective in reducing vision loss:National Eye Institute:"There are two treatments for diabetic retinopathy. They are very effective in reducing vision loss
from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of
keeping their vision when they get treatment before the retina is severely damaged.
These two treatments are laser surgery and vitrectomy. It is important to note that although these
treatments are very successful, they do not cure diabetic retinopathy.Laser surgery is performed
in a doctor's office or eye clinic. Before the surgery, your ophthalmologist will: (1) dilate your
pupil and (2) apply drops to numb the eye. In some cases, the doctor also may numb the area behind
the eye to prevent any discomfort.Instead of laser surgery, you may need an eye operation called a
vitrectomy to restore your sight. A vitrectomy is performed if you have a lot of blood in the
vitreous. It involves removing the cloudy vitreous and replacing it with a salt solution. Because
the vitreous is mostly water, you will notice no change between the salt solution and the normal
vitreous.
Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to
protect their vision than someone who waits to have the operation.Early vitrectomy is especially
effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from
a hemorrhage into the eye.Vitrectomy is often done under local anesthesia. This means that you
will be awake during the operation. The doctor makes a tiny incision in the sclera, or white of
the eye. Next, a small instrument is placed into the eye. It removes the vitreous and inserts the
salt solution into the eye."
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