Diabetic Retinopathy
Diabetic Retinopathy is the leading cause of blindness in the United States for people under the age of 55? It occurs in stages from Non Proliferative Diabetic Retinopathy (NPDR) to Proliferative Diabetic Retinopathy (PDR) and beyond. It is very preventable but most patients are not seen early on in the disease process. Younger patients have a more aggressive disease and can easily go from 20/20 vision to complete blindness in a matter of months.
Non Proliferative Diabetic Retinopathy (NPDR)
Non Proliferative Diabetic Retinopathy (NPDR) starts with early formation of tiny new blood vessels in the retina. These blood vessels start to leak fluid or fatty deposits called exudates and begin to blur vision. At this stage simple office based laser can close off these vessels and reverse the symptoms. The retina is like a sponge and fluid leaking will cause it to swell creating what's called "Diabetic Macular Edema". In addition to laser, steroids and anti-VEGF agents like Avastin can be injected to the eye to complement the treatment. Blood vessels are tightly held together with junctions and membranes on a microscopic level. High blood sugars start to damage these areas and the vessels become "leaky". This leads to Diabetic Macular Edema.
Proliferative Diabetic Retinopathy (PDR)
Over time less and less blood and therefore oxygen is carried to the retina leading to ischemia. Ischemia is the destruction of tissue that occurs when blood flow is cut off. Think of tying a tourniquet on your arm and never taking it off. It would eventually die. The retina's response to this in the eye is to form new blood vessels. Unfortunately these blood vessels don't do the same job as the original and are very small and fragile. They tend to bleed and cause scar tissue. This phase is caused Proliferative Diabetic Retinopathy or PDR. Treatment of PDR involves heavy laser to the peripheral retina in the office. Laser effectively destroys the unhealthy ischemic retina. This shuts off the signal in the eye to form blood vessels and these fragile neovascular blood vessels begin to shrink and resolve over a few months time. This treatment is called Panretinal Photocoagulation (PRP) and is one of the most important treatments in preventing blindness from diabetes.
Vitreous Hemorrhage/Tractional Retinal Detachment
Without treatment these proliferative neovascular blood vessels begin to bleed into the eye causing a significant drop in vision and ultimately create scar tissue and tractional retinal detachments. At this point surgery is needed to remove the blood and scar tissue and to try and restore sight.
