An Overview of Proliferative Diabetic Retinopathy

November 12, 2012

An Overview of Proliferative Diabetic Retinopathy

Diabetics have to keep their diabetes under control in order to prevent serious blood vessel complications. Proliferative diabetic retinopathy can cause permanent loss of vision if untreated.

Diabetic retinopathy is a major concern for doctors when treating their diabetic patients. Proliferative diabetic retinopathy is the advanced case of this eye disease and needs to be closely regulated by a healthcare professionally. Many diabetics visit their optometrist on a regular basis so that changes to eye shape, vision, and eye pressure can be watched. The key to preserving vision in these patients is to catch problems early so that treatment options can be implemented as soon as possible.

How it happens

Proliferative diabetic retinopathy occurs when the retinal blood vessels in the eye become damaged as a result of the pathophysiology of diabetes. Changes in the vessels make it difficult for blood to adequately reach the area which makes that part of the eye oxygen and nutrient deprived. This retinal ischemia is thought to be the initial step to the development of full blown retinopathy. In an attempt to increase nutrient delivery, the retina sends out chemical signals which result in the formation of new vessels. Unfortunately, the new blood vessels are abnormal. The abnormal vessels may begin to grow in a number of places throughout the eye include the iris, over the optic nerve, and along the actual retina. This neovascularization can even spread into the vitreous jelly (the gel) inside the eye.

Severe Cases

While the creation of new blood vessels in the eye may seem like a good thing, it can have a number of negative results. As proliferative diabetic retinopathy progresses, it is possible for the abnormal vessels to burst. They are much more sensitive than normal the cells and are also unable to correct the retina nutrient deficiency. There are three main concerns:

  • High internal eye pressure- This is a possible side effect of abnormal vessels growing along the iris of the eye. The vessels have a chance to block the draining channels of the eye. These channels allow the fluid to go through its normal cycle. Once they are blocked, the fluid has nowhere to go leading to a rise in pressure also known as glaucoma.

  • Vitreous hemorrhage- Because the new vessels are so fragile, it is common for them to begin bleeding into the eye. This causes a “bruise” inside the eye.

  • Traction retinal detachment- With continued growth of the new vessels, scar tissue may begin to pull on nearby structures. As the traction gets stronger, the shape of the retina can be distorted or even completely detached.

Patients may not exhibit any symptoms of this abnormal growth until something bad happens. A person’s vision may be fine one moment and suddenly very bad. Changes in the vitreous gel can have a very fast effect on vision. The changes range from just a few floaters to complete loss of vision. See your eye doctor if there are any sudden vision changes.

Treating Proliferative Diabetic Retinopathy

One of the most important ways to prevent severe retinopathy problems is to keep your blood sugar levels under control. Macrovascular and microvascular changes lead to blood flow problems in the extremities. These changes can also affect the vessels at the back of the eye. The chance of suffering from these effects is reduced if diabetes is controlled through:

  • Healthy diet

  • Exercise

  • Insulin or glucose tolerance medications as necessary

  • Regular visits to the doctor

In some cases, proliferative diabetic retinopathy simply cannot be avoided. Treatment for this specific disorder involves:

  • Panretinal photocoagulation if caught early

  • Special medication can be injected directly into the eye if caught early

  • Vitrectomy is a surgical procedure used to clear out blood in the vitreous gel and/or flatten the retina

  • Sometimes the body will clear up bloody vitreous gel on its own

In general, make sure to keep your regular eye exams and appointments so that the condition can be accurately monitored.

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