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Diabetic retinopathy is a complication of diabetes that can often result in blindness. It is estimated that in 2002, diabetic retinopathy accounted for about 5% of world blindness, or almost 5 million blind. As the incidence of diabetes gradually increases, there is the possibility that more individuals will suffer from eye complications, which if not properly managed, may lead to permanent eye damage.
Centers for Disease Control and Prevention’s Division of Diabetic Translation presented some alarming statistics:
- 26 million Americans suffer from diabetes and 79 million more have pre-diabetes.
- One in three U.S. adults could have diabetes by 2050 if current trends continue.
- Diabetic retinopathy is the leading cause of new cases of legal blindness among adults ages 20 to 74 in the U.S.
Diabetic retinopathy is composed of a characteristic group of lesions found in the retina of individuals having had diabetes mellitus for several years. The abnormalities that characterize diabetic retinopathy occur in predictable progression with minor variations in the order of their appearance. Diabetic retinopathy is considered to be the result of vascular changes in the retinal circulation.
In the early stages vascular occlusion and dilations occur. It progresses into a proliferative retinopathy with the growth of new blood vessels. Macular edema (the thickening of the central part of the retina) can significantly decrease visual acuity. [Diabetic Retinopathy, WHO, 2013 http://www.who.int/blindness/causes/priority/en/index6.html]
Current Treatments and Issues
Treatment largely depends on the stage of the disease with the goal of trying to stop or slow the progression. During the early stages of non-proliferative retinopathy, treatment other than routine exams and monitoring may not be required. As the disease progresses, there are several treatment options:
- Focal laser treatment. This treatment is helpful at reducing the risk for further vision loss but does not typically reverse damage or improve vision. The procedure is done in a doctor’s office with the use of a topical anesthetic and only takes a few minutes. During the procedure, leaks from abnormal blood vessels are treated with laser burns to prevent or reduce leakage. The most common side effect is the appearance of spots in the vision, which typically appear just to the sides of central vision. Complications of laser treatment can lead to permanent blindness.
- Scatter laser treatment. This laser treatment is applied to the retina to slow or stop tiny blood vessels from leaking. During the procedure, up to 2,000 laser burns are carefully placed away from the central retina, causing abnormal blood vessels to shrink. Scatter laser treatment is usually done in one or two sessions and is also performed in a doctor's office or eye clinic. Similar to other laser treatments, this procedure will not restore vision but helps prevent further loss. Possible side effects include loss of peripheral, night and color vision.
- Vitrectomy. Surgical removal of the vitreous gel is done when there has been bleeding or a retinal detachment, or severe scar tissue has formed. During the procedure, a doctor uses specialized instruments to remove the gel and replace it with a saline solution. Vitrectomy is performed in a hospital under local or general anesthesia, and can also be accompanied or followed by laser treatments. Common complications of vitrectomy include high intraocular pressure, bleeding in the eye, and cataracts, which are the most frequent complication of this surgery. Many patients will develop a cataract within the first few years after the procedure.