Diabetic Retinopathy, 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 is non proliferative or background stage. 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 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. Recently some 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 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 pressure which is associated with it. Unfortunately, most people with this type of glaucoma end
up losing their sight despite all the efforts.
Treatment depends 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 - 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 or 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.
diagnosis and treatment options.
|EYE CENTER of MISSOURI
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
A treatment decision is often based on clinical appearance as well as results
of these tests.