Diabetic Retinopathy at Spector Eye Care
in Connecticut
There are many patients with Diabetes Mellitus who believe that the underlying disease is simply an inability to effectively metabolize and process glucose. Unfortunately, the reality is that the effects of diabetes are considerably more widespread and actually affect many organs and tissues throughout your body. Diabetes causes damage to the small blood vessels throughout the body. When diabetes damages these small blood vessels it can impair the normal circulation of blood in organs and tissues. It is quite common for patients with diabetes to experience difficulty with the circulation in their legs, kidneys, heart, brain and eyes--especially the very small blood vessels of the eye found in the Retina. When diabetes causes damage to the small blood vessels in the retina, it is called Diabetic Retinopathy.
Diabetic Retinopathy is the most frequent cause of new cases of blindness among adults aged 20-74 years old. However, with early diagnosis and treatment, progression of the disease and its associated vision loss can at a minimum be slowed, and in many cases vision loss from Diabetic Retinopathy can be prevented.
Stages of Diabetic Retinopathy
Diabetic Retinopathy tends to appear and progress in Stages beginning with Mild Nonproliferative, progressing to Moderate Nonproliferative Retinopathy, further advancing to Severe Nonproliferative Retinopathy and without proper attention developing into the most severe stage, Proliferative Retinopathy.
Mild Nonproliferative Retinopathy
Mild Nonproliferative Retinopathy is the earliest stage of Diabetic Retinopathy. It is characterized by the presence of “dot” and “blot” hemorrhages and “microaneurysms” in the Retina during your eye examination. Microaneurysms are areas of balloon like swelling of the tiny blood vessels in the Retina caused by the weakening of their structure. Mild Nonproliferative Retinopathy can be present without any change in your vision. Mild Nonproliferative Retinopathy usually does not require treatment unless it progresses or if is accompanied by Diabetic Macular Edema. If you have Mild Nonproliferative Retinopathy, the eye doctors at Spector Eye Care will make specific recommendations about how often you will need to be reexamined and whether any additional testing might be required by our Retinal Specialist Paul Guerriero, M.D.
Moderate Nonproliferative Retinopathy
Moderate Nonproliferative Retinopathy is the second and slightly more severe stage of Diabetic Retinopathy. During this stage, some of the small blood vessels in the Retina may actually become blocked. The blockage of these tiny blood vessels causes a decrease in the supply of nutrients and oxygen to certain areas of the Retina.
In order to properly diagnose blockage of the small blood vessels in the Retina, it may be necessary for Dr. Guerriero to perform a diagnostic test called a Fluorescein Angiogram (FA). If this is necessary, prior to starting your Intravenous Fluorescein Angiogram drops will be placed in your eyes to dilate your pupils. Next, a fluorescent dye, called Sodium Fluorescein will be injected into a vein in your arm. After approximately 15 seconds the dye will begin to circulate throughout the retinal blood vessels. Using a specialized retinal camera, a series of photographs of the Retina are taken to study the circulation of blood through the retinal blood vessels. Using the Fluorescein Angiogram, it is possible for Dr. Guerriero to observe the circulation and the integrity of the blood vessels in the Retina so that he can identify any blood vessels that might be blocked.
top
Severe Nonproliferative Retinopathy
Severe Nonproliferative Retinopathy is the next stage of Diabetic Retinopathy. Severe Nonproliferative Retinopathy is characterized by a significant number of small blood vessels in the Retina actually becoming blocked. As more blood vessels become blocked, it results in areas of the Retina being deprived of nourishment and oxygen. A lack of sufficient oxygen supply to the Retina results in a condition called “Retinal Ischemia”. To attempt to compensate for “Retinal Ischemia”, these areas of the Retina then send signals to the body to stimulate the growth of new blood vessels in order to try and reestablish the supply of oxygen.
Proliferative Retinopathy
Proliferative Retinopathy is the most severe stage of Diabetic Retinopathy and carries a significant risk of vision loss. The Retina responds to a lack of oxygen, or “Retinal Ischemia”, by attempting to compensate for the reduced circulation by growing new, but abnormal blood vessels-a process called “neovascularization”. When Retinal Neovascularization is present, you have progressed into the stage of Diabetic Retinopathy called Proliferative Retinopathy. It might seem that new blood vessel growth or neovascularization is a desirable event, as it will provide the Retina with greater blood flow and thus more oxygen and nutrients. However this is not the case at all. Retinal Neovascularization is formed from new blood vessels that are extremely fragile and tend to break easily and hemorrhage into the Vitreous. If left untreated, Proliferative Retinopathy may lead to bleeding into the Vitreous and Retinal Detachment with profound vision loss.
Dr. Guerriero treats Proliferative Retinopathy with either Retinal Laser Photocoagulation Treatment alone or Retinal Laser Photocoagulation Treatment in conjunction with a surgical procedure called a Vitrectomy. During a Vitrectomy, Dr. Guerriero will microscopically remove the Vitreous that has been filled with blood or scar tissue.
It may be possible for patients to have Proliferative Retinopathy and Retinal Neovascularization and yet still have good vision. Even if Proliferative Retinopathy and Retinal Neovascularization do not appear to be causing any vision loss, it is critical that they be treated as quickly as possible in order to stop the progression and preserve good vision.
Diabetic Macular Edema
Normally, the small blood vessels in the Retina do not leak. One of the early effects of diabetes is to cause the blood vessels in the Retina to begin to leak by weakening the inner lining of the blood vessels so that they become porous. Leakage from the retinal blood vessels causes the center of the Retina, the Macula, to actually swell, a condition called Diabetic Macular Edema. Diabetic Macular Edema can occur in any stage of Diabetic Retinopathy.
The Macula is responsible for central vision, and thus Diabetic Macular Edema can result in vision loss of varying severity. The most effective and accurate ways to observe and diagnose Diabetic Macular Edema are to perform a careful dilated examination with a Fluorescein Angiogram (FA) and with Ocular Coherence Tomography (OCT). Using the Fluorescein Angiogram, Dr. Guerriero will be able to precisely and directly observe the severity and location of “leaky” blood vessels. By using OCT, Dr. Guerriero can detect very slight thickness changes in the Macula that may indicate the presence of leakage. It is important that leaking blood vessels be found as early as possible so that they can be most effectively sealed with Retinal Laser Photocoagulation Treatment. In most cases, early laser treatment will reduce the swelling and prevent further vision loss, but will not restore vision that has already been compromised.
It is also possible to have Diabetic Macular Edema and not have vision loss. Any diagnosis of Diabetic Macular Edema is an indication that breakdown of the retinal blood vessels from diabetes is beginning and requires careful monitoring. In the discussions of your Fluorescein Angiography Study, Dr. Guerriero will also make specific recommendations about how often you will need to return for eye examinations and the need for additional photographs, Fluorescein Angiograms or OCT Studies. Please be sure to keep these appointments as they are critical in helping you maintain your eye health and vision.
top
Treatment of Diabetic Retinopathy
It is critical for all patients with diabetes to have regular eye exams since with early and aggressive treatment of Diabetic Retinopathy it is often possible to maintain vision and prevent severe vision loss.
The National Institutes of Health and the National Eye Institute have funded a number of large scale, multi-center, controlled studies that have produced clinical care guidelines for diabetic retinopathy used by our Connecticut Retinal Specialist Paul Guerriero, M.D.
These include:
Dr. Guerriero uses the results of these studies to guide patients in the treatment of Diabetic Retinopathy since with early treatment it is possible for patients with Diabetic Retinopathy to have only half the likelihood of losing vision as compared to those patients who fail to receive early treatment.
About Diabetic Laser Treatment
Nonproliferative Retinopathy & Laser Treatment
During the early stages of Mild Nonproliferative Retinopathy, Moderate Nonproliferative Retinopathy and the beginning of Severe Nonproliferative Retinopathy, it is not likely that you will need Laser Treatment, unless you have Diabetic Macular Edema.
However, in order to prevent the progression of Diabetic Retinopathy it is quite important to maintain good overall health. First, tight control of blood sugar levels is key for protecting the health of the small blood vessels. Patients should work to reduce any and all risk factors for vascular disease including controlling their blood pressure, not smoking, reducing dietary fat consumption to lower cholesterol and trigycerides and exercising regularly.
Proliferative Retinopathy & Laser Treatment
Proliferative Retinopathy is treated with a Retinal Laser Photocoagulation procedure called “Scatter Laser Treatment”. The goal of Scatter Laser Treatment is to shrink abnormal blood vessels. Dr. Guerriero will place approximately 1,000 to 2,000 laser spots in areas of the Retina away from the Macula, causing the abnormal blood vessels to shrink. Since Scatter Laser Treatment requires a large number of laser spots, often it may be necessary to use two or more sessions to complete the laser treatment.
Sometimes patients who have had Scatter Laser Photocoagulation will experience some loss of their side or peripheral vision, some loss of night vision and a decrease in color vision. However, Scatter Laser Treatment is necessary to preserve the rest of your vision and stop the progression of the disease.
Scatter Laser Treatment works best when it is applied before the fragile new blood vessels have started to bleed. This is why it is critical to have regular, comprehensive dilated eye exams. Even when bleeding has started, Scatter Laser Treatment may still be possible, depending on the amount of bleeding.
Diabetic Macular Edema & Laser Treatment
Diabetic Macular Edema is best treated with one of two types of Retinal Laser Photocoagulation procedures: “Focal Laser Treatment” and “Grid Laser Treatment”. Focal Laser treatment is used to close leaking micro aneurysms in a limited area and Grid Laser treatment is used to treat a more general swelling in the Macula.
With either type of Laser Treatment for Macular Edema, Dr. Guerriero will place as many as several hundred laser spots in the areas of retinal leakage surrounding the Macula. These spots act to slow the leakage of fluid and reduce the amount of fluid in the Retina. It is usually possible to complete these Laser Treatments in one session, however depending on the results additional treatment may be necessary.
You may need to have Laser Treatment for Macular Edema more than once to control the leaking fluid. If you have Macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.
Laser treatment of Diabetic Macular Edema works to stabilize vision. In fact, Laser Treatment may reduce the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it may be improved.
Diabetic Retinopathy is a common eye disease that affects a large number of patients with Diabetes Mellitus. With early detection and treatment, vision loss from Diabetic Retinopathy can be prevented.
top
Spector Eye Care and our Connecticut Retinal Specialist Paul Guerriero, M.D. provide consultation, diagnosis and treatment of Diabetic Retinopathy in Norwalk and Stamford and are conveniently located for patients concerned about Diabetic Retinopathy in Connecticut from Norwalk, Westport, Stamford, Stratford, Greenwich, Darien, Wilton, Weston, Ridgefield, Bridgeport, Danbury, Fairfield, Milford, Trumbull, New Canaan or Shelton Connecticut. To schedule an appointment for a Diabetic Retinopathy Consultation please call us at 203.853.9900.
