About Diabetic Retinopathy
Diabetic Retinopathy tends to progress in stages. It begins with Mild Nonproliferative Retinopathy and then becomes Moderate Nonproliferative Retinopathy. In later stages, Diabetic Retinopathy advances to Severe Nonproliferative Retinopathy. Without proper attention, this will develop into the most extreme stage of Diabetic Retinopathy, Proliferative Retinopathy.
Mild Nonproliferative Retinopathy
Characterized by the presence of microaneurysms in the Retina, Mild Nonproliferative Retinopathy is the earliest stage of Diabetic Retinopathy. These microaneurysms are areas of swelling of the tiny blood vessels in the Retina, caused by the weakening of their structure. Mild Nonproliferative Retinopathy can be present without any change in your vision. It usually does not require treatment unless it progresses or is accompanied by Diabetic Macular Edema. If you have Mild Nonproliferative Retinopathy, your eye doctor will make specific recommendations about reexamination, and whether any additional testing might be required.
Moderate Nonproliferative Retinopathy
Moderate Nonproliferative Retinopathy is the second and slightly more severe stage of Diabetic Retinopathy. During this stage, some of the small blood vessels in the Retina may become blocked. The blockage of these tiny blood vessels causes a decrease in supply of nutrients and oxygen to certain areas of the Retina.
In order to properly diagnose blockage of the small blood vessels in the Retina, it may be necessary to have a diagnostic test called a Fluorescein Angiogram (FA). If this is necessary, prior to starting your Fluorescein Angiogram, your pupils will be dilated through the use of eye drops. Next, doctors inject your arm with a fluorescent dye, Sodium Fluorescein. After approximately 15 seconds, the dye will begin to circulate throughout the retinal blood vessels. Using a specialized Retinal camera, the Retina is photographed to study the circulation of blood through the retinal blood vessels. Using the Fluorescein Angiogram, it is possible for the doctor to observe the circulation and the integrity of the blood vessels in the Retina so that he can identify any blood vessels that might be blocked.
Severe Nonproliferative Retinopathy
The next stage of Diabetic Retinopathy, Severe Nonproliferative Retinopathy, occurs when a significant number of small blood vessels in the Retina become blocked. As more blood vessels become blocked, it results in areas of the Retina being deprived of nourishment and oxygen. A lack of sufficient oxygen supply to the Retina results in a condition called “Retinal Ischemia”. To attempt to compensate for “Retinal Ischemia”, these areas of the Retina then send signals to the body to stimulate the growth of new blood vessels in order to try and reestablish the supply of oxygen.
Proliferative Retinopathy is the most severe stage of Diabetic Retinopathy and carries a significant risk of vision loss. The Retina responds to a lack of oxygen, or “Retinal Ischemia”, by attempting to compensate for the reduced circulation. It grows new, but abnormal blood vessels-a process called “neovascularization”. When Retinal Neovascularization is present, you have progressed into the stage of Diabetic Retinopathy called Proliferative Retinopathy. It might seem that new blood vessel growth or neovascularization is a desirable event, however, this is not the case. Retinal Neovascularization is formed from extremely fragile, new blood vessels that tend to break easily, and hemorrhage into the Vitreous. If left untreated, Proliferative Retinopathy may lead to bleeding into the Vitreous and Retinal Detachment with profound vision loss.
Proliferative Retinopathy is treated with either Retinal Laser Photocoagulation alone or in conjunction with a surgical procedure called a Vitrectomy. During a Vitrectomy, a Vitreoretinal Surgeon removes the Vitreous, filled with blood or scar tissue.
It may be possible for patients to have Proliferative Retinopathy and Retinal Neovascularization, yet still have good vision. Even if Proliferative Retinopathy and Retinal Neovascularization do not appear to be causing vision loss, quick treatment is critical to stop progression.
Diabetic Retinopathy is a common eye disease that affects a large number of patients with Diabetes Mellitus. With early detection and treatment, vision loss from Diabetic Retinopathy can be prevented. The Eye Center in Denver provides comprehensive diagnostic testing and treatment for Diabetic Retinopathy.
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If you have been diagnosed with diabetes, or if you are glucose intolerant, you should have a thorough diabetic eye examination at The Eye Center.