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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

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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 Gourmet Magazine
c/o CAPCO Marketing
PO Box 842
Baldwinsville, NY 13027
http://diabeticgourmet.com/articles/65.shtml

diabetic retinopathy..what is it?:nei.nih.gov:"Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. At this point, most people do not notice any changes in their vision. Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, blurring vision. As the disease progresses, it enters its advanced, or proliferative, stage. Fragile, new blood vessels grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina."
http://www.nei.nih.gov/health/diabetic/retinopathy.htm

Proliferative diabetic retinopathy:RNIB:"Sometimes diabetes can cause the blood vessels in the retina to become blocked. If this happens then new blood vessels form in the eye. This is nature's way of trying to repair the damage so that the retina has a new blood supply. Unfortunately these new blood vessels are weak. They are also in the wrong place - growing on the surface of the retina and into the vitreous jelly. As a result these blood vessels can bleed very easily and cause scar tissue to form in the eye. The scarring pulls and distorts the retina. When the retina is pulled out of position this is called retinal detachment. This condition is rarer than background retinopathy and is more often found in people who have been insulin dependent for many years. The new blood vessels will rarely affect your vision, but their consequences, such as bleeding or retinal detachment can cause your vision to get worse suddenly. Your eyesight may become blurred and patchy as the bleeding obscures part of your vision. Without treatment, total loss of vision can happen in proliferative retinopathy. With treatment most sight-threatening diabetic problems can be prevented if caught early enough."
eyehealth@rnib.org.uk
http://www.rnib.org.uk/info/diabetic.htm

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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"
Diabetic retinopathy Foundation
350 North LaSalle, Suite 800
Chicago, IL 60610
http://www.retinopathy.org/info02.htm

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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."
Main Office - Tarpon Springs
43309 U.S. Highway 19 N.
P.O. Box 5000
Tarpon Springs, FL 34688-5000
727.938.2020
Toll free: 1.800.282.9905
http://www.stlukeseye.com/Conditions/DiabeticRetinopathy.asp

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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."
West End Office:
4600 Cox Rd., Mercer Plaza, Suite 120
Glen Allen, VA 23060
804-270-0330
(fax) 270-1003
contact Richmond eye associates
http://www.richmondeye.com/diab1.htm#retina

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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."
National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
Contact the National Eye Institute
http://www.nei.nih.gov/health/diabetic/retinopathy.htm

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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010


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