Retina (Vascular Disease)

Diabetes retinopathy

                Diabetes causes damage to the blood vessels in the back of the eye called retina.  Damaged blood vessels cause bleeding, lipid and fluid leakage into the retina. It is the leading cause of blindness in working-age Americans.  Not everybody with diabetes get the retinopathy in the back of their eye.  However, the risk of getting one is significantly higher if the diabetes is uncontrolled and has it for longer period of time, more than 10 years.   There are multiple stages of retinopathy and two major types.

  1. 1.Non-proliferative retinopathy, which comes first.
  2. 2.Proliferative retinopathy, which is more advanced and severe.
  3. 3.With or without macula edema.

Management of non-proliferative diabetes retinopathy is simply to keep tight control of your blood sugar, blood pressure, cholesterol, and stop smoking.   Either focal laser or panretinal photocoagulation is needed for proliferative retinopathy and diabetes macula edema.  Neither of these treatments does not reverse the damage that has already occurred.  It can just prevent the retinopathy from further damaging the retina.   These lasers burn small area of the retina and create a scar which stops the growth of abnormal blood vessels due to diabetic retinopathy.   Anti-vegf injection is also needed in addition to lasers in advanced cases of diabetes retinopathy.

Facts are if diabetic retinopathy damages the retina, any treatment doesn’t reverse the damage that has already occurred.   Treatment can reduce vision loss but rarely gain back the vision.  If no treatment, one can lose the whole eye if retinopathy is out of control.  

Hypertensive retinopathy

                Similar to diabetes, high blood pressure can damage blood vessels in the retina.  The higher the blood pressure, the longer the high blood pressure, the more severe the damage it will have on the retina.  High blood pressure, together with diabetes, high cholesterol, and smoking can cause severe damage to the blood vessels in the eye.  There are four stages of retinopathy.  Patients may not have any symptoms in the first three stages of the retinopathy.  If the blood pressure continues to be uncontrolled, it can progress to stage 4 retinopathy.   The bleeding in the retina can be quite extensive with swelling of the optic nerve and macula, leading to sudden decreased in vision.  Treatment is simply to control the blood pressure.   When the blood pressure is uncontrollably high, patient may be directed straight to emergency room to lower down the blood pressure.

With hypertensive retinopathy several other problems can also occur such as

  1. 1.Ischemic optic neuropathy
    1. a.It is associated with sudden, painless vision loss, more ofWhen there is loss of blood flow to the optic nerve due to vascular disease and arteriolosclerosis, the cells and tissue in the optic nerve died off and causes sudden decreased in vision.   The prognosis is guarded but much better than conditions described below.   There is no direct treatment for ischemic optic neuropathy.    The treatment is to control the systemic risk factors.  We will gladly refer you to your primary care physician in controlling the systemic vascular disease.
    2. 2.Retinal artery occlusion
      1. a.This condition is an ocular emergency, and it will present with sudden, painless, significant unilateral visionThe main cause of arterial occlusion is due to lodging of embolism blocking the blood flow in the central or branch retinal artery.   Patients usually have systemic illness such as high cholesterol, hypertension and/or diabetes.   If the embolus didn’t dislodge from the blood vessels within 90 minutes, they can lose the vision forever.   The management includes digital globe massage, reducing eye pressure and inducing vasodilation in the eye, in order to attempt to dislodge the embolus
      2. 3.Retinal vein occlusion
        1. a.This condition can also cause the sudden loss of vision in the eye but not as severe as retinal arteryWhen there is an obstruction of the central retina vein or branch retina vein, the blood will spill throughout the retina, covering the retinal tissue that receives the vision signal.  The risk factors and etiologies are pretty much the same as retinal artery occlusion, such as hypertension, diabetes and high cholesterol.   The treatment is to control the risk factors first and a visit to retina specialist for further treatment, including retinal lasers, and injections.

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