DIABETIC RETINOPATHY

    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
    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

    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.

    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