Patients suffering from diabetes mellitus fail to use and store blood sugar (glucose) suitably for proper health. The improper glucose control is detrimental to the vessels of the retina, an important structure in the back of the eye that processes visual images. Diabetic retinopathy is damage to these retinal vessels.
Nonproliferative diabetic retinopathy (NPDR), (also named background diabetic retinopathy) is a stage where miniscule retinal capillary vessels dysfunction and release a substance called vascular endothelial growth factor (VEGF). VEGF causes retinal vessels to leak. The leaks result in bleeding or swelling and can create deposits named exudates. This swelling stage is named macular edema (ME) and prevents clear image formation.
A more severe form of diabetic retinopathy is proliferative diabetic retinopathy (PDR).
In PDR, the retina is so damaged it bleeds, resulting in a vitreous hemorrhage blocking vision. Untreated scar tissue can develop which pulls and wrinkles the retina. Untreated PDR can result in glaucoma, retinal detachment, loss of vision and loss of the eye.
Apart from a dilated examination of the retina, diagnostic clinical tests are optical coherence tomography (OCT) and fluorescein angiography (FANG). While an OCT is a noninvasive multidimensional scanning image of the retina, a FANG involves injection of fluorescein dye in an arm vein and photographing it as it circulates in the retina. Both examinations can be performed multiple times, typically with no harm to the eye or body.
Diabetic macular edema seen with OCT
Diabetics who control their hemoglobin A1C (HA1C) with their internist should target levels under 6.5%.
Management of diabetic retinopathy goes beyond mere blood sugar control. Regional (focal) laser surgery is applied to shrink abnormal blood vessels and help the absorption of retinal fluids.
In-office laser with digital angiogram for treatment of diabetic retinopathy
If the regional laser treatments are insufficient to control leaks, injections of anti –VEGF have proven very effective in slowing the spilling of capillary blood or fluid into the retina.
In-office injection therapy for diabetic retinopathy
In severe PDR extensive laser, or Pan Retinal Photocoagulation (PRP), is necessary to control the damaged blood flow in the retina.
After in office PRP laser
While the above diagnostic and therapeutic advances have been successful for in-office evaluation for diabetic retinopathy, on occasions the most stubborn forms of the disease require performing surgical management of the blood, scars and vessel abnormalities in an operating room.
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