Diabetic Retinopathy treatment in St.Louis STL

DIABETIC RETINOPATHY

Diabetic

etinopathy

as it is called, is deterioration of blood

vessels in

the retina

which

may

lead to bleeding inside the eye and

eventually loss of

vision. It usually

develops a few years

after a

person has had diabetes,

although sometimes it can

show much

earlier especially if

someone has

poorly controlled blood sugar

levels,

obesity, and poor circulation.

In a diabetic patient, blood vessels in the retina become weak and

start

to leak fluid

and blood.

This can be seen by an experienced

doctor as a

small retinal hemorrhage

or thickened retina.

This

weakening and

narrowing of blood vessels leads to oxygen

deprivation in the retina. This

non proliferative

stage and can mild, moderate or

severe

. In later

proliferative stages of

the disease, tiny fragile

blood

vessels develop

on the surface of

the retina

which lead to major

bleeding episodes and

severe

scarring and possible

retinal

detachment. Sometimes these fragile vessels may just

burst open

and bleed

inside the eye, causing what is called a vitreous

hemorrhage.

Some

patients may

have leakage from blood vessels

causing swelling in

the central

part of the retina,

called Diabetic

Macular Edema, which

effects the central vision.

TREATMENT

Treatment of diabetic retinopathy depends on the stage of the disease and its

location

within the

retina

. In very

early stages, if

it is not threatening to the

central vision, it may

only need observation. If

central vision is

threatened or the

disease is

moderately

advanced, laser photocoagulation may be

required to

arrest the

progression of the

disease. This procedure is

done in the office and

causes

minimal discomfort and

takes only

few minutes.

More r

ecently some

newer

medications,

when injected

directly

into the

eye, have shown to help

arrest the

disease.

This

may need to be combined with laser

treatment. If the disease

is in

advanced

stages or if

there is a

retinal detachment

along with

extensive

scarring,

surgery may be the only way to slow

down the

disease process

and

possibly

restore

some of the

vision.

Cataracts are also very common in people with advanced diabetes and may

have to

be removed so

that the

retina can be

visualized and treated if needed.

Diabetic retinopathy in advanced stages may lead to a glaucoma called

neovascular

glaucoma

which is extremely

difficult to

treat.

This type of

glaucoma

is very painful and

may require

multiple modalities of

treatment to control

the pain and

the

increased

pressure which is

associated with it.

Unfortunately,

some of the

atients

with this type

of glaucoma end

up losing their sight despite all

the efforts.

Treatment

depend

on severity of the disease, it may be simply observation

or laser photocoagulation.

Some

cases may

require intravitreal

injections

or vitrectomy.

Fluoroscein Angiogram

showing

the dye in the

blood

vessels in

the

retina and the

bleeding

over

the surface of

the

retina

A NORMAL OCT ON THE LEFT, SHOWING DIFFERENT LAYERS OF THE RETINA. ON THE RIGHT, ABNORMAL SWELLING FROM DIABETIC MACULAR EDEMA.

FLUORESCEIN

ANGIOGRAPHY

Fluorescein Angiography - our practice provides medical treatment of retina and vitreous disorders. We . We are also committed to

patient

education and encourage patients to participate in their treatment. For evaluation of retinal problems, we use diagnostic tests

such as

optical coherent tomography (OCT) and fluorescein angiogram (FA). Fluorescein angiography is a diagnostic test which uses

a special

photosensitive dye to examine the circulation of the retina. This test is very useful for finding leakage or damage to the blood

vessels which

nourish the retina. Fluorescein is a yellow dye which glows in visible light. Some patients may have an allergic reaction

to the dye. Nausea

and hives are the most common, however anaphylactic shock has been recorded. In this test the colored dye is

injected into a vein in the

arm of the patient. The dye travels through the circulatory system and reaches the vessels in the retina and

choroid. The FA test begins with

some color photos of the fundus. Following this, the fluorescein dye is injected and then a series of

photographs are

taken

as the dye travels

through the retina. Findings of

hyper fluorescence

hypo fluorescence

and the pattern on

the

FA may reflect pathologic changes in the

retina. Causes of

hyper fluorescence

can indicate leakage from blood vessels or

neovascularization; pooling can indicate serous retinal

detachment; and staining may represent drusen. Causes of

hypo fluorescence

may include blood that is causing blockage; filling defect from

capillary non-perfusion or artery and vein occlusions.

The test takes only few minutes and once complete, our physician will review the digital photos with the patient and discuss the

diagnosis

and treatment options.

EYE CENTER of MISSOURI

St. Louis STL

3535 SOUTH JEFFERSON
ST. LOUIS, MO 63118 PHONE 314-771-3000

DIAGNOSIS AND TESTING

If signs of diabetic retinopathy are detected in one or both eyes, a careful

evaluation

is done to determine the extent of the disease.

As part of the evaluation, some tests may be done which include

photographs

fluorescein angiography

laser scanning of the retina

(

OCT

)

and

possibly ultrasound.

In fluorescein angiography, a small amount of dye is injected into a vein

which

appears in the retinal blood circulation and a series of photographs

are taken.

These

photographs show in fine detail the extent of the disease

process that

is going on in

the retina.

Another test, OCT uses

scanning laser

to measure the thickness and other

abnormalities

of the retina and results are compared with normal database .

Central part of the

retina, called Macula, often becomes swollen and

edematous and these tests are

extremely valuable in their diagnosis and

management.

A treatment decision is often based on clinical appearance as well as results

of these

tests.

Usually the central
vision becomes
blurred in macular
edema, a form of
diabetic retinopathy
effecting central
portion of the
retina

3535 S. Jefferson, Suite S-4
Saint Louis, MO 63118
Phone 314-771-3000