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If you, or someone you love, has had to discuss Diabetic Retinopathy, then you need to read further and find out from us what to do next. Here in this article, you will find a general outline of a clinical condition called Diabetic Retinopathy. A condition that results in damage to the eye's retina. A condition which usually occurs with long-term diabetes. And while it results in some pretty serious effects, education, early diagnosis, and effective treatment options are critical for proper treatment and will be able help you deal with this diagnosis.

In the course of a doctors practice it is sometimes necessary to identify and explain conditions and treatments that are required to enable our precious site to continue.

Your eyesight is very Precious to us. Anything that might get in the way of a patient seeing, is something we care about. It is necessary to examine, to educate, to discuss so that a plan of treatment options can be found, and in general, provide quality care so eyesight is not lost.

What Are Causes Incidence And Risk Factors of Diabetic Retinopathy

- Diabetic retinopathy is caused by damage to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. The purpose of the retina is to make changes to light and images that enter the eye into nerve signals that are sent to the brain. When damage begins, it usually goes in stages and must be identified accordingly.

These two types, or stages of retinopathy: Nonproliferative or proliferative:

Nonproliferative diabetic retinopathy develops first. This happens when the blood vessels in the eye become larger in certain spots (called microaneurysms). As this happens, these blood vessels may also become blocked. There may be small amounts of bleeding (retinal hemorrhages), and fluid may leak into the retina. This leakage into the eye can lead to noticeable problems with your eyesight.

Proliferative retinopathy is the more advanced stage and is the most severe form of the disease. As the body begins to generate new blood vessels in the eye, these new vessels are fragile and can begin to bleed(hemorrhage). This results in causing small scars to develop, both on the retina and in other parts of the eye (the vitreous). Of course the end result is vision loss, and can cause other complications as well. In simple terms, you begin not to see well at all. A sense of urgency is a natural reaction to discussions about Proliferative retinopathy, we believe it is important to be aware of some other conditions that may develop at this stage.

At this stage, other conditions that may develop are:

Macular edema - The macula is the area of the retina that provides sharp vision straight in front of you. If fluid leaks into this area, your vision becomes more blurry.

Retinal detachment - scarring may cause part of the retina to pull away from the back of your eyeball.

Glaucoma - Increased pressure in the eye is called glaucoma. If not treated, it can lead to blindness.

Cataracts - A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away.

As you can tell just from reading about possible complications due to proliferative retinopathy, it is something that Dr. Long encourages you to consider and discuss at length with him, As soon as you can. Diabetic retinopathy is the leading cause of blindness in working-age Americans today. If you have diabetes, then you need to be aware that people with type 1 diabetes and type 2 diabetes are at risk for this condition, and we encourage education, proper treatment, as well as ongoing exams to prevent late stages of these types of disorders. Most often, diabetic retinopathy has no symptoms until the damage to your eyes is so severe that damage is not reversible

Having more severe diabetes for a longer period of time increases the chance of getting retinopathy. Retinopathy is also more likely to occur earlier and be more severe if your diabetes has been poorly controlled. Almost everyone who has had diabetes for more than 30 years will show signs of diabetic retinopathy.

Here are some possible symptoms you may need to ask yourself about:

  • Blurred vision and gradual vision loss
  • Floaters
  • Shadows or missing areas of vision
  • Difficulty seeing at nighttime

Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why Dr. Long encourages everyone with diabetes to have regular eye exams.

In nearly all cases, it is true that Dr. Long can diagnose diabetic retinopathy by dilating the pupils with eye drops and then carefully examining the retina. A retinal photography or fluorescein angiography test may also be used. Proper treatment of the results of the exam is extremely important.

It is also important to note that there are things you can do for preventing diabetic retinopathy. Namely a tight control of blood sugar (glucose), blood pressure, and cholesterol; as well as stopping smoking as quickly as possible.

People with nonproliferative diabetic retinopathy may not need treatment. However, they should be closely followed-up by an eye doctor trained to treat diabetic retinopathy. While treatment usually does not reverse damage which has already occurred, it can help keep the disease from getting worse. Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.

Here is a list of a few of the procedures or surgeries which are widely accepted in the treatment for diabetic retinopathy:

Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels.

Focal laser photocoagulation is used to treat macular edema.

Scatter laser treatment or panretinal photocoagulation treats a large area of your retina. Often two or more sessions are needed.

A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may also be used to repair retinal detachment.

Drugs that prevent abnormal blood vessels from growing, and corticosteroids injected into the eyeball are being investigated as new treatments for diabetic retinopathy.

If you or a family member cannot see well, here are some general recommendations that you may find helpful around the home:

  • Make sure the home is safe so a fall might be prevented
  • Organize the home in such a way that day to day necessities are found easily

  • Get additional help to make sure you are taking your medicines correctly

  • If you or a loved one has been diagnosed with Diabetic retinopathy, you may be looking for even more information and support

Here are some support groups that you may find very helpful in locating someone in your area if you are not here in the Sherman Denison Texas area. Dr. Long and his staff are here to assist you with any questions you may have about a support group here in the Texoma area.

Support Groups:

American Diabetes Association

National Diabetes Information Clearinghouse

Prevent Blindness America

What Are Some Realistic Expectations (prognosis) About Diabetic Retinopathy?

  1. You can improve the outcome by keeping good control of your blood sugar and blood pressure
  2. Both treatments are effective at reducing vision loss. They do not cure diabetic retinopathy or reverse the changes that have already occurred
  3. Once proliferative retinopathy occurs, there is always a risk for bleeding
  4. You will need ongoing monitoring, and you may need more treatment

Education about the complications that may result is critical in properly understanding this condition. Blindness, Glaucoma, and Retinal detachment are all things you need to call us about for yourself or for a friend or beloved family member.

Call today for an appointment with Dr. Long, as a licensed (ophthalmologist) if you have diabetes and you have not seen an ophthalmologist in the past year.

In addition, Dr. Long recommends that you call us if any of the following symptoms are new or are becoming worse:

  1. You cannot see well in dim light
  2. You have blind spots
  3. You have double vision (you see two things when there is only one)
  4. Your vision is hazy or blurry and you cannot focus
  5. You have pain in one of your eyes
  6. You are having headaches
  7. You see spots floating in your eyes
  8. You cannot see things on the side of your field of vision
  9. You see shadows

Prevention is simple. Call Dr. Long now, and ask for an exam if you or a loved one is experiencing any of the issues above. You can begin tight control of blood sugar, blood pressure, and cholesterol which is very important for preventing diabetic retinopathy. For sure do not smoke, and if you just can't quit, get help making it happen sooner rather than later. You may not know there is any damage to your eyes until the problem is gets really bad. Dr. Long can catch problems early if you get into the office for regular exams.

In the discussion of what to be done with regard to children , Dr. Long agrees with most leading doctors that children older than 10 years who have had diabetes for 3 - 5 years or more need to have an exam now. Adults and adolescents with type 2 diabetes soon after diagnosis is made. Adolescents and adults with type 1 diabetes within 5 years of diagnosis. After the first exam, most patients should have a yearly eye exam. If you are beginning a new exercise program or are planning to get pregnant, have your eyes examined. Avoid resistance or high-impact exercises, which can strain already weakened blood vessels in the eyes.

If you are at low risk, you may need follow-up exams only every 2 - 3 years. The eye exam should include dilation to check for signs of retinal disease (retinopathy).

The information contained in this article has used information contained in the following sources.

1. American Diabetes Association. Standards of medical care in diabetes--2010. Diabetes Care. 2010 Jan;33 Suppl 1:S11-61. [PubMed: 14693923]

2. O'Doherty M, Dooley I, Hickey-Dwyer M. Interventions for diabetic macular oedema: a systematic review of the literature. Br J Opthalmol. 2008;92:1581-1590. [PubMed: 18952646]

3. Diabetic Retinopathy Clinical Research Network (DRCR.net), Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009;127:245-251. [PubMed: 19273785]

Review Date: 4/27/2010. Reviewed by: Daniel E. Bustos, MD, MS, Private Practice specializing in Comprehensive Ophthalmology in Eugene, OR. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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