Diabetes
Diabetic Retinopathy
Diabetes
• Diabetes mellitus (or diabetes) is a chronic, lifelong
condition that affects your body's ability to use the
energy found in food. There are three
major types: type 1, type 2 diabetes, and gestational
diabetes.
• Normally, your body breaks down the sugars and
carbohydrates you eat into a special sugar called
glucose. Glucose fuels the cells in your body. But the
cells need insulin, a hormone, in your bloodstream in
order to take in the glucose and use it for energy. With
diabetes mellitus, either your body doesn't make
enough insulin, it can't use the insulin it does produce,
or a combination of both
Diabetes
• Type 1-It used to be called juvenile-onset diabetes, because it often
begins in childhood. It is an autoimmune condition. It's caused by
the body attacking its own pancreas with antibodies. In people
with type 1 diabetes, the damaged pancreas doesn't make insulin.
• Type 2-the most common form of diabetes is type 2 diabetes,
accounting for 95% of diabetes cases in adults. With Type 2
diabetes, the pancreas usually produces some insulin. But either
the amount produced is not enough for the body's needs, or the
body's cells are resistant to it.
• Diabetes that's triggered by pregnancy is called gestational
diabetes (pregnancy, to some degree, leads to insulin resistance). It
is often diagnosed in middle or late pregnancy. Because high blood
sugar levels in a mother are circulated through the placenta to the
baby, gestational diabetes must be controlled to protect the baby's
growth and development.
Diabetes
• A few rare kinds of diabetes can result from specific
conditions. For example, diseases of the pancreas,
certain surgeries and medications, or infections can
cause diabetes. These types of diabetes account for
only 1% to 5% of all cases of diabetes.
• A periodic test called the A1C blood test estimates
glucose levels in your blood over the previous three
months. It's used to help identify overall glucose level
control and the risk of complications from diabetes,
including organ damage.
• What Your A1C Results Say About Your Blood
Glucose, Diabetes Control, and Health Risk A1C (%)
Average Degree of Control Health Risk Blood Glucose
Diabetes
• Non-Proliferative diabetic retinopathy (NPDR)-Normal
retinal blood vessels are watertight and do not leak. In
diabetes, the retinal blood vessels can become
damaged and develop tiny leaks. This is called nonproliferative diabetic retinopathy (NPDR).
• Proliferative diabetic retinopathy (PDR) mainly occurs
when many of the blood vessels in the retina close,
preventing enough blood flow. In an attempt to supply
blood to the area where the original vessels closed, the
retina responds by growing new blood vessels. This is
called neovascularization.
Diabetes
• Stage 1: Mild non-proliferative retinopathy
• At this stage, tiny blood vessels swell in the retina.
Some early leakage may take place.
• Stage 2: Moderate non-proliferative retinopathy
• Some of the blood vessels that feed the retina become
blocked. Leaky blood vessels are more likely.
• Stage 3: Severe non-proliferative retinopathy
• More blood vessels are being blocked and other areas
of the retina are not being nourished as a result.
Signals are sent to the body to grow new blood vessels.
Diabetes
• Stage 4: Proliferative retinopathy
• At this advanced stage, new abnormal blood vessels grow
(“proliferate”) along the retina and the clear, vitreous gel inside the
eye. These begin to replace old blood vessels that feed the retina.
The abnormal vessels have thin fragile walls that leak easily, causing
blurred vision, severe vision loss or blindness.
• Vision loss can occur quickly at this stage. The advanced stages of
diabetic retinopathy can also increase your vulnerability to
developing other eye conditions such as a detached retina, which
requires surgery, or glaucoma.
• Macular edema may also occur at any stage of diabetic retinopathy.
In this associated condition, blood and fluid leaks into the macula,
causing it to swell. Macular edema causes vision loss in the central
retina, which allows us to see fine detail.
Diabetes
NPDR can cause changes in the eye, including:
• Microaneurysms: small bulges in blood vessels of the retina that
often leak fluid.
• Retinal hemorrhages: tiny spots of blood that leak into the retina.
• Hard exudates: deposits of cholesterol or other fats from the blood
that have leaked into the retina.
• Macular edema: swelling or thickening of the macula caused by
fluid leaking from the retina's blood vessels. The macula doesn't
function properly when it is swollen. Macular edema is the most
common cause of vision loss in diabetes.
• Macular ischemia: small blood vessels (capillaries) close. Your
vision blurs because the macula no longer receives enough blood to
work properly.
Diabetes
• Vitreous hemorrhage: delicate new blood vessels bleed
into the vitreous — the gel in the center of the eye —
preventing light rays from reaching the retina. If the
vitreous hemorrhage is small, you may see a few new,
dark floaters.
• Traction retinal detachment: scar tissue from
neovascularization shrinks, causing the retina to wrinkle
and pull from its normal position.
• Neovascular glaucoma: if a number of retinal vessels are
closed, neovascularization can occur in the iris (the colored
part of the eye). In this condition, the new blood vessels
may block the normal flow of fluid out of the eye. Pressure
builds up in the eye, a particularly severe condition that
causes damage to the optic nerve.
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• Intravitreal anti-VEGF agents(Lucentis, Eylea,
Avastin)
• Intravitreal corticosteroids(Ozurdex, Iluvien,
Triescence)
• Focal Laser (Macula)-sealing leaking blood
vessels in the back of the eye
• Panretinal Photocoagulation (Periphery)-The
goal is to prevent the development of new
vessels over the retina and elsewhere.
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