DIABETIC RETINOPATHY: Your Questions Answered *

1. What is diabetic retinopathy?
2. What are the warning signs of diabetic retinopathy?
3. Who is affected by diabetic retinopathy?
4. How is diabetic retinopathy treated?
5. What research is underway at The Schepens Eye Research Institute?

WHAT IS DIABETIC RETINOPATHY?

A complication of diabetes mellitus, diabetic retinopathy is the leading cause of blindness in people ages 40 to 60 in the U.S. Diabetes is characterized by excessively high levels of glucose (blood sugar) in the blood, resulting from the body's inability to properly utilize certain food elements like sugar and starches. Diabetes manifests itself throughout the body and can cause kidney failure, heart disease, and blindness. While diabetes can affect many parts of the eye, its mostcommon manifestation takes the form of diabetic retinopathy.

Diabetic retinopathy affects the retina, the light-sensitive tissue that lines the eye's back wall. There are two forms of the disease; nonproliferative (or background) retinopathy and proliferative retinopathy. Background retinopathy can be a precursor to the more serious proliferative retinopathy. With background retinopathy, the blood vessels in the retina change in diameter -- some shrink and others swell. This disturbs blood flow in the retina; it may lead to hemorrhaging or to restriction of vital blood supply in other areas. This condition is usually not sight-threatening, but it can be a warning sign of further damage and should be monitored carefully. Fortunately, in about 60% of diabetic patients with background retinopathy, the condition does not worsen.

Proliferative retinopathy begins when areas of the retina no longer receive sufficient blood supply. The blood-starved tissue then produces molecules that stimulate the growth of new vessels near the surface of the retina. These delicate vessels can break and leak blood into the vitreous, the clear fluid that fills the eye's main chamber. When the vitreous is clouded, light cannot pass through to the retina and images become either distorted or blocked. Retinal detachment may occur if the scar tissue that forms around the leaking blood vessels pulls the retina away from the back wall of the eye. In addition, other eye problems like glaucoma can occur with severe cases of diabetic retinopathy.

WHAT ARE THE WARNING SIGNS OF DIABETIC RETINOPATHY?

Signs to seek immediate medical attention are: onset of blurred or hazy vision, floaters (moving spots) or other patterns in the visual field.

WHO IS AFFECTED BY DIABETIC RETINOPATHY?

Four-and-a-half million Americans are affected by diabetic retinopathy. Of the more than seven million diabetic individuals in the United States, 60% of those having diabetes for more than 15 years will experience some level of retinal disease in their lifetime. Particularly at risk are those individuals who develop diabetes during childhood.

HOW IS DIABETIC RETINOPATHY TREATED?

The course of proliferative retinopathy can be favorably influenced by photocoagulation using lasers, an intensly focused beam of light. In a procedure called panretinal photocoagulation, hundreds of burns are scattered throughout the retina. This leads to regression of new vessels and prevention of further vessel growth.

Laser surgery cannot be performed when the vitreous is very clouded with blood. In this case, a vitrectomy must be performed. During a vitrectomy, the clouded or diseased vitreous is removed and replaced with a clear artificial solution.

All diabetic patients should visit an ophthalmologist annually to monitor any changes in retinal blood vessels and receive treatment before sight is threatened.

DIABETIC RETINOPATHY RESEARCH AT THE SCHEPENS EYE RESEARCH INSTITUTE

Accomplishments

• Discovered that elevated blood sugar can damage cells lining retinal vessels by affecting the regulation of certain genes.

• Invented and used clinically a new instrument, the laser Doppler velocimeter, to monitor minute changes in retinal circulation.

• Pioneered and refined the most successful treatments, photocoagulation (even before the advent of lasers) and vitrectomy (removal of the vitreous).

• First demonstrated the central role played by the vitreous in the development of severe retinopathy.

Current Research

• Study of the genes that the high blood sugar stimulates to over -produce material in the cells of the fine retinal blood vessels. Identifying such genes may make it possible to develop interventions for the very early stages of diabetic retinopathy.
  
  
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* Content provided by THE SCHEPENS EYE RESEARCH INSTITUTE