Proliferative Diabetic Retinopathy

Diabetes often leads to damage of the blood vessels, especially if the blood sugar levels are not well controlled. Swelling, leaking or blockage of the blood vessels in the eye causes a serious condition, proliferative diabetic retinopathy.

CAUSES OF DIABETIC RETINOPATHY
The retina is a light-sensitive tissue lining the back of the eye. In your eye, the light rays that pass through the pupil, are focused in the lens, and penetrate to the retina, where they are transformed into signals that are transmitted by the optic nerve to the brain and interpreted as images. Therefore, it is as essential for your vision, as a processor for a computer. Your retina has multiple delicate blood vessels that deliver oxygen and nutrients to sustain its function.
Elevated blood sugar leads to thinning of the blood vessel walls and clumping of the red blood cells. These two processes lead to blood leakage and vessel obstruction. Retina becomes swollen when the blood leaks from the vessels damaged by diabetes. When the blood vessels get blocked, retinal cells become deprived of oxygen and nourishment in the area of the blood vessel obstruction. A small specialized area in the center of the retina, called macula, is especially sensitive to the consequences of the blood vessel damage. Macula is essential for clearly seeing the details of the objects located in front of you. If macula becomes swollen (a condition called macular edema), it causes blurry vision, and an impairment of the ability to recognize faces or read.

THE FOUR STAGES OF DIABETIC RETINOPATHY
proliferative diabetic retinopathy
The National Eye Institute (NEI) defines four distinct stages, through which the diabetic retinopathy may progress. These are mild, moderate, and severe non-proliferative diabetic retinopathy, and proliferative retinopathy. The first three diabetic retinopathy stages differ by the number of the swollen, distorted, and blocked blood vessels in the retina. Macular edema may develop even at the second stage of the disease progression. During the third stage, oxygen and nutrient deprivation of the retina caused by the vessel blockage triggers secretion of a special molecule that stimulates the new blood vessel growth. This molecule is called vascular endothelial growth factor, VEGF in short. VEGF secretion promotes diabetic retinopathy to its most advanced, proliferative stage. It is characterized by the growth of the new blood vessels in the retina, a process called neovascularization.
Proliferative retinopathy is especially harmful for vision. The newly formed blood vessels are extra fragile, and the blood leaking from them is spilled from the retina to vitreous gel, a jelly-like transparent substance inside the eye, through which the light passes on its way from the lens to the retina. The blood accumulation in vitreous gel blocks vision partially, causing appearance of black “floaters” in your field of vision, or completely, causing blindness. Neovascularization of the retina can scar this delicate tissue, causing retinal detachment from the back of the eye. Detached Glucofort retina cannot convert the light rays to nerve signals, leading to partial or complete blindness.

SYMPTOMS OF RETINOPATHY
In summary, the diabetic retinopathy may cause macular edema even at the initial stages of development. In its advanced, proliferative stage, it causes the blood accumulation in the vitreous (vitreous hemorrhage), and retinal scarring and detachment. The retinopathy usually develops simultaneously in both eyes, causing the following symptoms:
• Blurry vision, or changes from clear to blurry vision and back
• Floaters and dark or black spots appearing in the field of vision
• Poor night vision
• Changes in color perception, with colors appearing faded or washed off

DETECTION AND DIAGNOSIS OF DIABETIC RETINOPATHY
Diabetic retinopathy is detected during a comprehensive eye exam. It may include the following tests, exams and procedures:
• Visual activity test. The eye chart reading measures your ability to see at various distances.
• Tonometry. A test that measures pressure inside the eye.
• Funduscopy. Its a fancy name of an eye exam performed using a magnifying glass. The drops placed on the eye surface widen (dilate) the pupil, so the physician can visually examine the “eyegrounds”, including the retina, retinal blood vessels, and the optic nerve. Fundoscopy detects changes in blood vessels (aneurisms), leaky blood vessels and fatty deposits, macular edema, and changes in the lens and abnormalities in the optic nerve.
• Optical coherence tomography (OCT). This test resembles an ultrasound exam but uses light instead of sound waves. OCT provides detailed images of eye tissues and complements the visual inspection of the retina.
• Fluorescein angiogram. In this procedure a fluorescent dye is injected into an arm vein. When the dye reaches the eye, multiple detailed pictures of the retinal blood vessels can be taken, revealing blood leaks and blood vessel changes that otherwise escaped detection.
The last two procedures are used if macular edema or progressive diabetic retinopathy are suspected.

DIABETIC RETINOPATHY TREATMENT
Many treatment methods for the diabetic retinopathy are focused on repairing or removing the damaged blood vessels and restoring the blood flow in the retina. For the best effect, two or more therapies may be combined

ANTI-VEGF INJECTION THERAPY
. VEGF, a vascular endothelial growth factor, is a key molecule that induces neovascularization, promoting advancement of diabetic retinopathy to its fourth stage, the proliferative retinopathy. Drugs that counteract VEGF action are injected in the vitreous gel of the eye every month for half a year. After that the frequency of the injections is gradually decreased, and the treatment is completed within five years. Anti-VEGF drugs include Avastin (bevacizumab), Lucentis (ranibizumab), and Eylea (aflibercept). Avastin is approved by the U.S. Food and Drug Administration (FDA) as an anti-cancer medication, but it is also used to treat eye conditions, including macular edema. Lucentis and Eylea are approved for treating macular edema and diabetic retinopathy. Anti-VEGF therapy is showing a great promise for treatment of macular edema and proliferative diabetic retinopathy.

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