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Moderate Diabetic Retinopathy Treatment

Diabetic Retinopathy Grading And Classification

Diabetic Retinopathy Grading And Classification

Accurately grading diabetic retinopathy can be a significant challenge for beginning ophthalmology residents. After nervously searching Google in the physicians workroom for the diabetic retinopathy grading scale more often than I care to admit, I have decided to summarize the classification criteria for diabetic retinopathy, at least in a way that makes sense to me. I hope you find this summary helpful. No retinopathy and mild NPDR Proposed Diabetic Retinopathy Severity Level Exam Findings No apparent diabetic retinopathy (No DR) No abnormalities (no microaneurysms) Mild nonproliferative diabetic retinopathy (Mild NPDR) Microaneurysms ONLY In reality, there is not much difference in risk between diabetic eyes with no retinopathy and those with mild retinopathy. Both have a very low risk of progressing to PDR; in fact, the Early Treatment Diabetic Retinopathy Study (ETDRS) did not examine those with no retinopathy nor mild NPDR. However, the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR) did include these individuals in its study, and found that the rate of progression to PDR after four years was less than 1% for both young and older patients with no diabetic retinopathy, compared to 4.1% in younger patients with a rare microaneurysm and hemorrhage and even less in older patients with these findings. In other words, a diabetic patient with no retinopathy has a <1% chance of developing PDR and a diabetic patient with a rare MA/DBH has a <5% chance of progressing to PDR in the next four years. All things considered, this is pretty low risk. These patients can be followed every 12 months. Moderate NPDR Proposed Diabetic Retinopathy Severity Level Exam Findings Moderate nonproliferative diabetic retinopathy (Moderate NPDR) More than just micro aneurysms (wi Continue reading >>

The Retina Group Of Washington

The Retina Group Of Washington

What is diabetic retinopathy? Diabetic retinopathy (DR) is the most common type of diabetic eye disease and the leading cause of blindness in American adults. Diabetes causes damage to the blood vessels of the retina, a thin and delicate tissue that is responsible for vision. In some people suffering from DR, blood vessels swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina that can lead to bleeding and retinal detachment. A healthy retina is necessary for good vision. If you have diabetic retinopathy, at first you may not notice changes to your vision. Yet over time, the condition can worsen and cause vision loss. Diabetic retinopathy usually affects both eyes, but early detection and prompt treatment can minimize vision loss. What are the four stages of diabetic retinopathy? The features of mild nonproliferative retinopathy are some of the earlier stages of diabetic retinopathy. At this point, small areas of balloon-like dilation of blood vessels, called microaneurysms, start to appear along with other findings such as small spot hemorrhages and cotton wool spots. It's important to note that not all patients with mild nonproliferative retinopathy will notice a change in their vision. Moderate nonproliferative retinopathy is essentially a progression from the mild stage. Many more microaneurysms, hemorrhages and cotton wool spots emerge and there is further damage to the retinal blood vessels. The danger is that such damage can result in reduced blood flow to the surrounding retinal tissue leading to vision loss. As the retinopathy progresses and more blood vessels have now been affected, larger areas of the retina are deprived of blood flow. This results in the retina producing new blood vessels in an attempt to enhance nouris Continue reading >>

What Is Diabetic Retinopathy?

What Is Diabetic Retinopathy?

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In others, normal new blood vessels grow on the surface of the retina. In the disease's early stages, a person may not notice changes to his or her vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes. The pictures below show how person with diabetic retinopathy sees: What are the stages of Diabetic Retinopathy? Diabetic retinopathy has four stages: Mild Nonproliferative Retinopathy. At this stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina's tiny blood vessels. Moderate Nonproliferative Retinopathy. This stage is when blood vessels that nourish the retina are blocked. Severe Nonproliferative Retinopathy. In this stage,Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result. Continue reading >>

Facts About Diabetic Eye Disease

Facts About Diabetic Eye Disease

Points to Remember Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness. Diabetic retinopathy involves changes to retinal blood vessels that can cause them to bleed or leak fluid, distorting vision. Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults. DME is a consequence of diabetic retinopathy that causes swelling in the area of the retina called the macula. Controlling diabetes—by taking medications as prescribed, staying physically active, and maintaining a healthy diet—can prevent or delay vision loss. Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year. Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss. Diabetic retinopathy can be treated with several therapies, used alone or in combination. NEI supports research to develop new therapies for diabetic retinopathy, and to compare the effectiveness of existing therapies for different patient groups. What is diabetic eye disease? Diabetic eye disease can affect many parts of the eye, including the retina, macula, lens and the optic nerve. Diabetic eye disease is a group of eye conditions that can affect people with diabetes. Diabetic retinopathy affects blood vessels in the light-sensitive tissue called the retina that lines the back of the eye. It is the most common cause of vision loss among people with diabetes Continue reading >>

Diabetic Eye Disease: Non-proliferative Diabetic Retinopathy

Diabetic Eye Disease: Non-proliferative Diabetic Retinopathy

Diabetic Eye Disease: Non-Proliferative Diabetic Retinopathy What is Diabetic Eye Disease: Non-Proliferative Diabetic Retinopathy? Non-proliferative diabetic retinopathy, previously called background retinopathy, is the earliest stage of diabetic eye disease. Microscopic changes occur in the blood vessels of the eye in non-proliferative disease; however, the changes typically do not produce symptoms and are not visible to the naked eye. Non-proliferative disease progresses from mild to moderate to severe. Non-proliferative diabetic retinopathy is initially characterised by microaneurysms (microscopic blood-filled bulges in the artery walls) which may burst and leak into the retina. Tiny spots or dots of blood may accumulate in the retina, but they usually do not produce noticeable symptoms in the early stages of the disease. As the disease progresses, hard exudates (accumulations of fluid that has leaked from blood vessels), abnormalities in the growth of microscopic blood vessels in the retina, and bleeding from the veins that feed the retina may occur. While non-proliferative diabetic retinopathy is not itself a sight-threatening condition, it can trigger macular oedema or macular ischaemia, which are other forms of diabetic retinopathy that may cause rapid vision loss at any stage of non-proliferative disease. In addition, the vascular changes that occur in non-proliferative retinopathy lead to retinal ischaemia (lack of blood flow to the retina) and trigger progression to sight-threatening proliferative disease. As the severity of non-proliferative retinopathy increases, the risk of developing sight-threatening proliferative diabetic retinopathy also increases. Proliferative diabetic retinopathy is characterised by neovascularisation that is, the growth of abnormal Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy is a condition that occurs in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Diabetic retinopathy is a serious sight-threatening complication of diabetes. Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes. Over time, diabetes damages the blood vessels in the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness. Symptoms of diabetic retinopathy include: Seeing spots or floaters Blurred vision Having a dark or empty spot in the center of your vision Difficulty seeing well at night When people with diabetes experience long periods of high blood sugar, fluid can accumulate in the lens inside the eye that controls focusing. This changes the curvature of the lens, leading to blurred vision. However, once blood sugar levels are controlled, blurred distance vision will improve. Patients with diabetes who can better control their blood sugar levels will slow the onset and progression of diabetic retinopathy. Often the early stages of diabetic retinopathy have no visual symptoms. That is why the American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy. T Continue reading >>

12 Natural Tips For Diabetic Retinopathy Prevention & Management

12 Natural Tips For Diabetic Retinopathy Prevention & Management

by Katherine Brind’Amour, PhD Diabetic retinopathy is an eye disease that can affect people with any form of diabetes: Type 1, Type 2 or gestational diabetes. The condition is caused when blood sugar and blood pressure in the tiny blood vessels in the eye “spring a leak” and release blood into the eye. This leads to blurry vision, seeing floaters or even complete vision loss in severe cases. The tricky thing about diabetic retinopathy is that not everyone has symptoms right away. Many people may have some damage from this condition without realizing the cause, and still others may attribute the vision problem to something else, such as getting older. As many as 45 percent of the 29 million Americans with diabetes have some degree of diabetic retinopathy, and half of them may not even know it. (1, 2) The good news is that people with diabetes can prevent or delay diabetic retinopathy through a variety of natural approaches. And if the disease does begin, there are natural ways to manage the condition and keep it from getting worse. The bad news? It requires long-term effort, since vision loss from diabetic retinopathy is a lifelong risk for people with diabetes. What Is Diabetic Retinopathy? To define diabetic retinopathy, you first have to understand diabetes. Diabetes is a disease in which the body has difficulty making or using sugar (glucose). This leads to periods of high or low blood sugar, which can make it hard for the rest of the body to function at times. In diabetic retinopathy, high blood sugar starts to damage the tiny blood vessels in the retina, which is part of the eye. The blood vessels may close or swell and leak. (3) The eye may also start to grow new blood vessels. These changes in blood vessel health eventually cause changes in vision. (4) Ther Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

NATURAL HISTORY OF DIABETIC RETINOPATHY Diabetic retinopathy progresses from mild nonproliferative abnormalities, characterized by increased vascular permeability, to moderate and severe nonproliferative diabetic retinopathy (NPDR), characterized by vascular closure, to proliferative diabetic retinopathy (PDR), characterized by the growth of new blood vessels on the retina and posterior surface of the vitreous. Macular edema, characterized by retinal thickening from leaky blood vessels, can develop at all stages of retinopathy. Pregnancy, puberty, blood glucose control, hypertension, and cataract surgery can accelerate these changes. Vision-threatening retinopathy is rare in type 1 diabetic patients in the first 3–5 years of diabetes or before puberty. During the next two decades, nearly all type 1 diabetic patients develop retinopathy. Up to 21% of patients with type 2 diabetes have retinopathy at the time of first diagnosis of diabetes, and most develop some degree of retinopathy over time. Vision loss due to diabetic retinopathy results from several mechanisms. Central vision may be impaired by macular edema or capillary nonperfusion. New blood vessels of PDR and contraction of the accompanying fibrous tissue can distort the retina and lead to tractional retinal detachment, producing severe and often irreversible vision loss. In addition, the new blood vessels may bleed, adding the further complication of preretinal or vitreous hemorrhage. Finally, neovascular glaucoma associated with PDR can be a cause of visual loss. RISK FACTORS AND TREATMENTS Duration of disease The duration of diabetes is probably the strongest predictor for development and progression of retinopathy. Among younger-onset patients with diabetes in the WESDR, the prevalence of any retinopathy wa Continue reading >>

Treatment Of Diabetic Retinopathy And Macular Edema

Treatment Of Diabetic Retinopathy And Macular Edema

On this page: Lasers for diabetic retinopathy treatment • Preparing for laser treatment • Non-laser treatment of diabetic macular edema • Vitrectomy and other treatments • Steroid eye drops Millions of Americans each year face vision loss related to diabetes. In fact, according to recent data from the U.S. Centers for Disease Control and Prevention (CDC), nearly 26 million Americans — roughly 8.3 percent of the U.S. population — have diabetes, and more than 28 percent of diabetics age 40 or older in the U.S. have diabetic retinopathy (DR) and related diabetic eye disease. To make matters worse, a significant number of cases of diabetes and diabetic eye disease go undetected or untreated because people fail to have routine comprehensive eye exams as recommended by their optometrist or ophthalmologist. Most laser and non-laser treatments for diabetic eye disease depend on the severity of the eye changes and type of vision problems you have. Diabetic retinopathy is diabetes-related damage to the light-sensitive retina in the back of the eye. As diabetes progresses, chronic high blood sugar levels cause changes that damage the tiny blood vessels in the retina, which makes them leak fluid or hemorrhage (bleed). Eventually, this leads to vision problems that cannot be corrected with eyeglasses or contact lenses. [Enlarge] The appearance of diabetic retinopathy is associated with the proliferation of a protein called vascular endothelial growth factor (VEGF) in the retina. VEGF stimulates the production of new blood vessels in the retina to bring more oxygen to the tissue because retinal blood circulation is inadequate due to diabetes. Unfortunately, these tiny new blood vessels that form in the retina in response to VEGF are fragile and increase in number, leading Continue reading >>

Diabetic Retinopathy - Treatment Overview

Diabetic Retinopathy - Treatment Overview

There is no cure for diabetic retinopathy. But laser treatment (photocoagulation) is usually very effective at preventing vision loss if it is done before the retina has been severely damaged. Surgical removal of the vitreous gel (vitrectomy) may also help improve vision if the retina has not been severely damaged. Sometimes injections of an anti-VEGF (vascular endothelial growth factor) medicine or an anti-inflammatory medicine help to shrink new blood vessels in proliferative diabetic retinopathy. Because symptoms may not develop until the disease becomes severe, early detection through regular screening is important. The earlier retinopathy is detected, the easier it is to treat and the more likely vision will be preserved. You may need treatment for diabetic retinopathy if: It has affected the center (macula) of the retina. Abnormal new blood vessels have started to appear. Your side (peripheral) vision has been severely damaged. If the macula has been damaged by macular edema, anti-VEGF medicine, such as Lucentis, may help. Steroids may be injected into the eye. Sometimes an implant, such as Iluvien, may be placed in the eye to release a small amount of corticosteroid over time. If the retina hasn't been severely damaged, laser treatment or vitrectomy may help with macular edema. Surgical removal of the vitreous gel (vitrectomy) is done when there is bleeding (vitreous hemorrhage) or retinal detachment, which are rare in people with early-stage retinopathy. Vitrectomy is also done when severe scar tissue has formed. Treatment for diabetic retinopathy is often very effective in preventing, delaying, or reducing vision loss. But it is not a cure for the disease. People who have been treated for diabetic retinopathy need to be monitored frequently by an eye doctor to Continue reading >>

Diabetic Retinopathy By The Numbers

Diabetic Retinopathy By The Numbers

A guide to following and educating patients who face this sight-threatening diagnosis. Today, optometrists play a crucial role in managing diabetes, a leading—and growing—instigator of vision loss. With management of this disease now firmly in optometry’s wheelhouse, the depth of research into its ocular impact has provided the ability to delineate its progression using various categories. In the case of diabetic retinopathy, these are divided, chiefly, into two: proliferative diabetic retinopathy and nonproliferative diabetic retinopathy. These categories are each further split by severity. It may seem like minutiae, but even minor distinctions can be valuable as they inform our treatment protocol and, ultimately, prevent significant visual impairment for our patients. This article explains the care diabetes patients require and details the biological processes that indicate where to classify a patient with diabetic retinopathy, as well as what treatment should follow. Risk Factors Two particular aspects of diabetes can put patients at risk for developing diabetic retinopathy: duration and glycemic control. • Duration. Approximately 25% of Type 1 patients have some retinopathy after five years.7,8 These numbers increase to almost 60% after 10 years and greater than 80% after 15 years.7,8 In Type 2 patients older than age 30 with a known duration of diabetes of less than five years, 40% of patients taking insulin and 24% of those not taking insulin are found to have retinopathy. After 10 years, the numbers increase to 84% and 53%, respectively. Proliferative diabetic retinopathy is found in approximately 2% of type 2 patients who have diabetes for less than five years, and 25% who have had diabetes for 25 years or more.9 • Glycemic control. Multiple clinical s Continue reading >>

Diabetic Retinopathytreatment & Management

Diabetic Retinopathytreatment & Management

Diabetic RetinopathyTreatment & Management Author: Abdhish R Bhavsar, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Controlling diabetes and maintaining the HbA1c level in the 6-7% range are the goals in the optimal management of diabetes and diabetic retinopathy. If the levels are maintained, then the progression of diabetic retinopathy is reduced substantially, according to The Diabetes Control and Complications Trial. [ 11 ] The Early Treatment for Diabetic Retinopathy Study [ 21 ] has found that laser surgery for macular edema reduces the incidence of moderate visual loss (doubling of visual angle or roughly a 2-line visual loss) from 30% to 15% over a 3-year period. Two-year results from the Diabetic Retinopathy Clinical Research network (DRCR.net) Randomized Trial Evaluating Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone Plus Prompt Laser for Diabetic Macular Edema, known as the Laser-Ranibizumab-Triamcinolone for DME Study,demonstrated that ranibizumab paired with prompt or deferred focal/grid laser treatment achieved superior visual acuity and optical coherence tomography (OCT) outcomes compared with focal/grid laser treatment alone. In the ranibizumab groups, approximately 50% of eyes had substantial improvement (10 or more letters) and 30% gained 15 or more letters. Intravitreal triamcinolone combined with focal/grid laser did not result in superior visual acuity outcomes compared with laser alone, but did appear to have a visual acuity benefit similar to ranibizumab in pseudophakic eyes. [ 26 ] The Diabetic Retinopathy Study has found that adequate scatter laser panretinal photocoagulation reduces the risk of severe visual loss (< 5/200) by more than 50%. [ 22 ] The Diabetes Control and Complications Trial has found that intensive gluc Continue reading >>

Diabetic Retinopathy Treatment

Diabetic Retinopathy Treatment

Your treatment is based on what your ophthalmologist sees in your eyes. Treatment options may include: Medical control Controlling your blood sugar and blood pressure can stop vision loss. Carefully follow the diet your nutritionist has recommended. Take the medicine your diabetes doctor prescribed for you. Sometimes, good sugar control can even bring some of your vision back. Controlling your blood pressure keeps your eye’s blood vessels healthy. Medicine One type of medication is called “anti-VEGF” medication. This helps to reduce swelling of the macula, slowing vision loss and perhaps improving vision. This drug is given by injections (shots) in the eye. Steroid medicine is another option to reduce macular swelling. This is also given as injections in the eye. Your doctor will recommend how many medication injections you will need over time. Laser surgery Laser surgery might be used to help seal off leaking blood vessels. This can reduce swelling of the retina. Laser surgery can also help shrink blood vessels and prevent them from growing again. Sometimes more than one treatment is needed. Vitrectomy If you have advanced PDR, your ophthalmologist may recommend surgery called vitrectomy. Your ophthalmologist removes vitreous gel and blood from leaking vessels in the back of your eye. This allows light rays to focus properly on the retina again. Scar tissue also might be removed from the retina. Preventing vision loss from diabetic retinopathy If you have diabetes, talk with your primary care doctor about controlling your blood sugar. High blood sugar damages retinal blood vessels. That causes vision loss. Do you have high blood pressure or kidney problems? Ask your doctor about ways to manage and treat these problems. See your ophthalmologist regularly for dilat Continue reading >>

Diabetic Retinopathy:

Diabetic Retinopathy:

From One Medical Student to Another Classification Diabetic retinopathy falls into two main classes: nonproliferative and proliferative. The word "proliferative" refers to whether or not there is neovascularization (abnormal blood vessel growth) in the retinaEarly disease without neovascularization is called nonproliferative diabetic retinopathy (NPDR). As the disease progresses, it may evolve into proliferative diabetic retinopathy (PDR), which is defined by the presence of neovascularization and has a greater potential for serious visual consequences. NPDR – Hyperglycemia results in damage to retinal capillaries. This weakens the capillary walls and results in small outpouchings of the vessel lumens, known as microaneurysms. Microaneurysms eventually rupture to form hemorrhages deep within the retina, confined by the internal limiting membrane (ILM). Because of their dot-like appearance, they are called "dot-and-blot" hemorrhages. The weakened vessels also become leaky, causing fluid to seep into the retina. Fluid deposition under the macula, or macular edema, interferes with the macula's normal function and is a common cause of vision loss in those with DR. Resolution of fluid lakes can leave behind sediment, similar to a receding river after a flood. This sediment is composed of lipid byproducts and appears as waxy, yellow deposits called hard exudates. As NPDR progresses, the affected vessels eventually become obstructed. This obstruction may cause infarction of the nerve fiber layer, resulting in fluffy, white patches called cotton wool spots (CWS). NPDR is further subdivided based on retinal findings: Early NPDR – At least one microaneurysm present on retinal exam. Moderate NPDR – Characterized by multiple microaneurysms, dot-and-blot hemorrhages, venous be Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Diabetes can damage the small blood vessels in the retina. Retinal blood vessels can break down, leak, or become blocked – affecting oxygen and nutrient delivery to the retina – impairing vision over time. More damage to the retina can occur when abnormal new blood vessels grow on the surface of the retina and leak fluid or bleed. This can result in blurring of vision initially and in late stages, retinal detachment and/or glaucoma. High blood sugar damages retinal vessels and leads to decrease in oxygen and nutrients to the retina. Untreated diabetic retinopathy progresses through four stages: Mild non-proliferative diabetic retinopathy Moderate non-proliferative diabetic retinopathy Severe non-proliferative diabetic retinopathy Proliferative diabetic retinopathy Any of these stages can have no or few symptoms, therefore getting comprehensive dilated eye examinations annually or as advised by the eye care professional for detection of diabetic retinopathy at the earliest possible stage is very important. Diabetic macular edema can develop at any of these stages due to damaged, leaky blood vessels. Diabetic macular edema may cause blurry vision that is not correctable with glasses alone. Non-proliferative diabetic retinopathy (NPDR): Non-proliferative diabetic retinopathy (NPDR) is the early stage of this disease. Small blood vessels bulge in mild NPDR, followed by blood vessel blockage in moderate NPDR, and greater vessel blockage and loss of blood supply in severe NPDR. Non-proliferative diabetic retinopathy (Credit: National Eye Institute, National Institutes of Health) Proliferative diabetic retinopathy (PDR): The most advanced stage of diabetic retinopathy is proliferative diabetic retinopathy (PDR). It is marked by the growth of new, fragile, abnormal blood ve Continue reading >>

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