Diabetic retinopathy (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
Diabetic retinopathy is a complication of long-term diabetes and a leading cause of blindness. It is caused by changes in the blood vessels of the retina. In early stages, patients with diabetic retinopathy may not notice changes in vision. However, over time, diabetic retinopathy can get worse and cause floaters, shadows or missing areas of vision, difficulty seeing at nighttime, and even vision loss or blindness. Diabetic retinopathy can affects both eyes. A dilated eye exam and fluorescein angiography test are necessary for disgnosis. Treatments include quitting smoking; tight control of blood sugar, blood pressure, and cholesterol; laser eye surgery; and vitrectomy. For patients with diabetes, having regular eye exams under an ophthalmologist's direction is very important.

What are the symptoms of Diabetic retinopathy?
Early diabetic retinopathy does not have any symptoms. With the devolpment, people may notice one or more of the following symptoms:


 * Bleeding
 * Blurred vision and gradual vision loss, and even blindness.
 * Floaters
 * Shadows or missing areas of vision
 * Difficulty seeing at nighttime


 * Primary detachment of retina can present with similar symptoms.

Who is at highest risk?

 * All people with either Type 1 or Type 2 diabetes
 * The longer the patient has diabetes, the more likely he/she will get diabetic retinopathy.

When to seek urgent medical care?
If you have diabetes and you have not seen an ophthalmologist in the past year, you need to schedule and appointment for a check up. Additionally, call your doctor if any of the following symptoms are new or are becoming worse:

Other health problems may also cause these symptoms. Only an ophthalmologist or physician can provide diagnosis. It is important to tell the doctor of these symptoms as soon as possible so that the problems can be treated as early as possible.
 * You cannot see well in dim light.
 * You have blind spots.*You have double vision
 * Your vision is blurry and you cannot focus.
 * You have pain in one of your eyes.
 * You are having headaches.
 * You see spots floating in your eyes.
 * You cannot see things on the side of your field of vision.
 * You see shadows.

Diagnosis

 * Visual acuity test: This eye chart test measures how well you see at various distances.
 * Dilated eye exam: Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
 * Retinal photography or fluorescein angiography test: During this test, the doctor injects a special dye into the patient's arm and collects pictures as the dye passes through the blood vessels in the retina. The test can identify any leaking blood vessels.

Treatment options

 * Keeping a healthy lifestyle, including quitting smoking.
 * Treatment of diabetes: Tight control of blood sugar, blood pressure, and cholesterol.
 * Drugs: Now doctors inject corticosteroids into the eyeball to prevent abnormal blood vessels from growing.
 * Laser eye surgery: Laser surgery includes focal and scatter laser treatment. Focal laser photocoagulation is used to treat macular edema. And scatter laser treatment treats a large area of your retina. Before the procedure, the doctor dilates your pupil and applies drops to numb the eye. Then the doctor uses laser to keep vessels from leaking, or to get rid of abnormal, fragile vessels. After surgery, you will need to wear a pair of sunglasses and someone will have to drive you home.
 * Vitrectomy: Vitrectomy is used to treat bleeding in the center of the eye and to repair retinal detachment. This procedure is done under anesthesia. The doctor makes a tiny incision in your eye and replaces the vitreous gel that is clouded with blood with a salt solution. After the surgery, you may have to wear an eye patch for a few days or weeks to protect your eye. Additionally, eyedrops are needed to prevent infection.

Where to find medical care for Diabetic retinopathy?
Directions to Hospitals Treating diabetic retinopathy

Prevention

 * Tight control of blood sugar, blood pressure, and cholesterol
 * Quitting smoking
 * Avoiding resistance or high-impact exercises
 * Having regular check yearly under your ophthalmologist's direction
 * The following people are particularly advised to have a complete eye exam:
 * Children older than 10 years who have had diabetes for 3 or more years
 * Adults and adolescents with type 2 diabetes soon after diagnosis
 * Adolescents and adults with type 1 diabetes within 5 years of diagnosis
 * If you are beginning a new exercise program or are planning to get pregnant

What to expect (Outlook/Prognosis)?
Prognosis of diabetic retinopathy depends on:
 * Whether your blood sugar and blood pressure are controlled well.
 * Whether your retinopathy is treated early

Possible complications
If left untreated it can lead to permanent blindness.

Additional Links
http://nihseniorhealth.gov/diabeticretinopathy/toc.html

http://www.nlm.nih.gov/medlineplus/ency/article/001212.htm

http://www.nei.nih.gov/health/diabetic/retinopathy.asp