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Preventing Diabetic Retinopathy

What Is Diabetic Retinopathy?

What Is Diabetic Retinopathy?

Introduction Diabetic retinopathy is one of the major causes of blindness in both eyes. It is painless and it is found in those diabetics who had their condition for a long time and where diabetes control was not always achieved. It is important for diabetics to know that this eye condition can be prevented. This is achieved through a combination of at least yearly eye examinations by an eye specialist with blood sugar monitoring by the patient and ordering a hemoglobin A1C every few months by the regular physician. Signs, Symptoms and Diagnostic Tests When diabetes is not closely controlled, certain changes happen to the blood vessels in the body that can be visualized by the eye-specialist through eye examinations. The specialist will detect enlarged veins and small red dots in the retina, which starts the process of the diabetic retinopathy. The specialist will then see leakage of protein (exudate) and blood into the retina. This is called nonproliferative retinopathy. When the process continues over the years with poorly controlled diabetes new pathological blood vessels form, a process that is called "neovascularization". These vessels grow on the surface of the vitreous body and can involve the vitreous cavity. This is called proliferative retinopathy, a process which is indicating more advanced changes from diabetic neuropathy. There can be bleeding into the vitreous body and formation of fibrous tissue, which is why the vision of a patient with uncontrolled diabetes deteriorates. As the proliferative retinopathy forms scarring, this can cause retinal detachment resulting in sudden visual loss. Treatment Treatment of diabetic retinopathy depends on whether it is in an early or later stage and whether and how much neovascularization has taken place. The most impor Continue reading >>

Diabetic Retinopathy: Your Questions Answered

Diabetic Retinopathy: Your Questions Answered

Diabetic retinopathy is a common complication of diabetes and the leading cause of new-onset blindness in American adults. Effective treatments are available to preserve vision for eyes at risk of vision loss from diabetic retinopathy. The most opportune time for these treatments is before any vision has been lost, since even advanced diabetic retinopathy can be present when a person has no vision complaints or problems. What causes diabetic retinopathy? Diabetic retinopathy is caused by changes in the blood vessels of the retina, the thin, light-sensitive inner lining in the back of your eye. These changes are called diabetic retinopathy. How does diabetes damage the vessels in the retina? Elevated levels of blood glucose can damage the body in various ways, including harming the blood vessels in your eyes. Diabetes can affect the lining of the blood vessels in your eyes, causing them to thicken and develop leaks. Poor circulation in the retinal vessels can compound these problems by causing the production of fragile new vessels. What are the stages of retinopathy? Diabetic retinopathy is broadly classified as nonproliferative diabetic retinopathy and proliferative retinopathy. After 20 years of diabetes, most persons with diabetes will shows some signs of nonproliferative diabetic retinopathy, which is generally not sight-threatening itself unless macular edema is present. Proliferative diabetic retinopathy is a more serious stage of retinopathy and poses a greater risk of hemorrhage into the vitreous humor, the clear gel that fills the center of the eye, or detachment of the retina leading to severe vision loss. Diabetic macular edema can occur with either nonproliferative or proliferative diabetic retinopathy. There are various levels of nonproliferative diabetic re Continue reading >>

Prevention

Prevention

You can reduce your risk of developing diabetic retinopathy, or help stop it getting worse, by keeping your blood sugar levels, blood pressure and cholesterol levels under control. This can often be done by making healthy lifestyle choices, although some people will also need to take medication. Healthy lifestyle Adopting a few lifestyle changes can improve your general health and reduce your risk of developing retinopathy. These include: eating a healthy, balanced diet – in particular, try to cut down on salt, fat and sugar losing weight if you're overweight – you should aim for a BMI of 18.5-24.9; use the BMI calculator to work out your BMI exercising regularly – aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week; doing 10,000 steps a day can be a good way to reach this target stopping smoking if you smoke not exceeding the recommended alcohol limits – men and women are advised not to regularly drink more than 14 alcohol units a week You may also be prescribed medication to help control your blood sugar level (such as insulin or metformin), blood pressure (such as ACE inhibitors) and/or cholesterol level (such as statins). Know your blood sugar, blood pressure and cholesterol levels It can be easier to keep your blood sugar levels, blood pressure and cholesterol levels under control if you know what level they are and monitor them regularly. The lower you can keep them, the lower your chances of developing retinopathy are. Your diabetes care team can let you know what your target levels should be. Blood sugar If you check your blood sugar level at home, it should be 4 to 10mmol/l . The level can vary throughout the day, so try to check it at different times. The check done at your GP surgery is a measure of your a Continue reading >>

Nonproliferative Diabetic Retinopathy: How To Stop It From Stealing Your Eyesight

Nonproliferative Diabetic Retinopathy: How To Stop It From Stealing Your Eyesight

When you’re diagnosed with diabetes, suddenly there’s a lot to think about: insulin, medications, carb counting, and exercise often are at the top of the list. But slowly losing your vision until eventually you can’t see? For most people who’ve had diabetes for 10 or more years, that’s a very scary – and very real – possibility. Most of us know about the connection between diabetes and heart health. But a lot of people don’t know about the massive toll it can take on your whole body – including your eyes. Nonproliferative diabetic retinopathy is just one of the dangerous ways that prolonged diabetes can affect your wellbeing. When you have long-term diabetes, it can gradually deteriorate your vision, and even strip you of your sight entirely. The good news is that you can prevent vision damage, but it takes hard work, dedication, and lifestyle modifications to do it. Whether you or someone you know has diabetes, it’s important to know how to stop nonproliferative diabetic retinopathy before it begins. Let’s take a look at the basics first. The Essentials of Eyesight Your ability to see is the result of a pretty magnificent and complicated process that converts light signals into images in your brain. Light comes in through your eye lens where it is focused and then passed into the retina, where photoreceptors translate it into a series of electrical impulses that your brain interprets into images. The retina gets its blood supply through very small capillaries in the back of the eye which help it function correctly and allow us to see. Diabetic Nonproliferative Retinopathy Diabetic retinopathy occurs as a result of damage to the retina, and more specifically due to swelling and fluid retention in the blood vessels that support the retina. How does Continue reading >>

Preventing Diabetic Retinopathy

Preventing Diabetic Retinopathy

In diabetes, there is too much sugar in the blood. When the blood sugar is constantly or frequently high, many complications occur: eyesight can suffer, heart attacks, stroke, and other blood vessel problems can occur, and one’s life span can be shortened. When the blood sugar is maintained at a normal level, between 80 and 120 mg/dl, the complications of diabetes can be reduced, including serious diabetic retinopathy. Controlling blood sugar is the single most important thing a person with diabetes can do to prevent or reduce the complications of diabetes and diabetic retinopathy. Type 1 diabetes usually begins at a young age. People with Type 1 diabetes must take insulin to survive and to control blood sugar. Most people with Type 1 diabetes take an intermediate-acting type of insulin, such as human NPH or Lente, or a long-acting type of insulin, such as human Ultralente, to provide a small, constant level of insulin throughout the day. In addition, they often take quick-acting regular human insulin before meals to control the rise in blood sugar that occurs with meals. Some people with diabetes wear insulin pumps. People with Type 1 diabetes should test their own blood sugar with a blood sugar-monitoring device or meter several times daily so they can adjust their diet, exercise, and insulin doses to keep the blood sugar level between 80 and 120 mg/dl most of the time. They should follow a controlled diet of carbohydrates and foods that are low in fat and cholesterol. Regular exercise is also very important as it helps reduce blood sugar. Type 2 diabetes usually starts in adult life and is often not dependent on insulin for control of blood sugar. Maintaining normal weight and a diet low in calories, fat, and cholesterol is very important. Blood sugar can be contro Continue reading >>

What Are Dangerous Blood Sugar Levels?

What Are Dangerous Blood Sugar Levels?

The best way to keep blood sugar low is to eat a healthy diet and do regular exercise. Just 20 minutes of walking 4 or 5 times a week can do wonders for lowering blood sugar. Eating a healthy diet is also very important. Do your best to limit the number of calories you eat each day. Put smaller portions of food on your plate and eat more slowly so that your body has a chance to let you know when it’s had enough to eat. Often, diet and exercise alone are not enough to control blood sugar. In this case, medicine is needed to bring the blood sugar down further. Often pills are enough, but sometimes insulin injections are needed. If medicines to lower blood sugar are started, it is still very important to keep doing regular exercise and eating a healthy diet. Another very important way to keep track of diabetes is with a blood test, which is called the “Hemoglobin A1c” test. This test is often abbreviated as “Hb A1c.” The Hb A1c test is a measure of what the average blood sugar has been over the past 3 months. It is thus a very powerful way to get an overall sense of how well diabetes has been controlled. Everyone with diabetes should have this test 2 to 4 times per year. The only way to tell if kidney damage has occurred is to test the urine for protein. This should be done once per year. The biggest risk to people with numbness from neuropathy is that they will injure their feet and will not be able to feel it. Such an injury can lead to ulcers or gangrene, and occasionally to amputation. For this reason, it is very important that patients with neuropathy learn to take special care of their feet and wear the right shoes. Diabetic retinopathy is caused by weakening and scarring of the blood vessels which lie on top of the retina, the thin lining at the back of th 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 >>

Lifestyle Changes Are Key To Preventing Diabetic Retinopathy

Lifestyle Changes Are Key To Preventing Diabetic Retinopathy

Did you know that diabetes increases your risk for many serious health problems? If you have had diabetes for a long time and have poor control of your blood sugar level, you’re at higher risk of developing disabling complications like diabetic retinopathy. Diabetic retinopathy is a potentially blinding condition that occurs when there are chronic high levels of blood sugar in the retina. According to Asian Eye Institute retina and vitreous disease specialist Dr. Patricia Quilendrino, having too much blood sugar can cause a blockage in the tiny blood vessels that nourish the retina. “When this happens, the blood supply to the retina is cut off. As a response, the eye attempts to grow new blood vessels. These new blood vessels don’t develop properly and can leak fluid, leading to distorted vision,” she explained. “Anyone with diabetes is at risk of diabetic retinopathy, but it is more common in people who have had diabetes for at least 10 years. The longer you’ve had it, the higher your chances of getting this condition,” she added. Pregnant women, as well as those who smoke and have poor control of blood sugar, blood pressure or cholesterol, are also at risk. Diabetic retinopathy has no symptoms in the early stages, so patients are not usually aware they have it. “When it advances, they start seeing floaters. These are the clear, gray or black strings that they see floating across their vision. They may also experience blurry or fluctuating vision, impaired colored vision or worse, vision loss,” Quilendrino said. However, patients should not wait for these symptoms to manifest before seeking medical treatment. “A comprehensive eye exam can diagnose diabetic retinopathy,” Quilendrino noted. “Diabetics should monitor their eye condition by visiting Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

All people with diabetes are at risk of developing diabetic retinopathy. Vision loss or blindness may be preventable through early detection and timely treatment. Good control of diabetes, blood pressure and cholesterol as well as regular eye examinations may prevent vision loss. It is important to take action before you notice any eye problems. On this page: Diabetic retinopathy is a complication of diabetes that damages blood vessels inside the retina at the back of the eye. Regular eye exams will reduce the risk of vision loss and blindness caused by diabetic retinopathy. Laser treatment is used successfully to treat retinopathy. All people with diabetes are at risk of developing diabetic retinopathy. Types of diabetic retinopathy There are three main types of diabetic retinopathy: Non-proliferative retinopathy is an early form of the disease, where the retinal blood vessels leak fluid or bleed. Macular oedema is a swelling of the macula, caused by the leakage of fluid from retinal blood vessels. It can damage central vision. Proliferative retinopathy is an advanced form of the disease and occurs when blood vessels in the retina disappear and are replaced by new fragile vessels that bleed easily, and that can result in a sudden loss of vision. Retinopathy is a high risk for diabetics It is important to understand your risk of diabetic retinopathy. Anyone with diabetes is at risk of developing retinopathy. People with diabetes (type 1 and type 2) are 25 times more likely to experience vision loss than people without diabetes. Without treatment, diabetic retinopathy can cause loss of vision and blindness. Unfortunately, only half of the people with diabetes have regular eye exams, and one-third have never been checked. Symptoms There are no early-stage symptoms of diab Continue reading >>

Preventing Diabetic Retinopathy: Red Lesions Detection In Early Stages

Preventing Diabetic Retinopathy: Red Lesions Detection In Early Stages

Preventing Diabetic Retinopathy: Red Lesions C. Mariño, J. Novo, N. Barreira and M.G. Penedo Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in industrialized countries. For example, several studies have provided data of its prevalence in several countries like Spain (values between 44.7% and 26.11% depending on the area and the type of diabetes) Fernandez-Vigo et al. (1993); RA et al. (2010), Australia (overall 15.3% of patients with diabetes had retinopathy) Tapp et al. (2003) or USA (40.3% crude prevalence among diabetic patients) Kempen et al. (2004). Moreover, several worlwide programs like sharing of knowlege and resources to avoid blindness, like the caused by diabetic retinopathy. Diabetic retinopathy is caused by changes in the blood vessels of the retina. For the most of the cases its detection in an early stage would allow for a treatment with a high healing rate. This is why the screening processes are a very valuable method for prevention of this pathology. Typically, a large amount of fundus images (photo of the back of the inside of the eye) have to be analyzed as diabetic patients have both their eyes examined at least once a year. These photos are then examined by an ophthalmologist (eye-doctor) who can determine if there are any visible signs of the disease present. To effectively manage all this information and the workload it produces, automatic techniques for analyzing the images would represent a major improvement, since manual analysis of this amount of information is a very complex and error prone process. These techniques must be robust, sensitive and specific to be implemented in Fig. 1. Digital color retinal image used as input for the diagnosis. Whoops! There was a problem loading this page. Retr Continue reading >>

Diabetic Retinopathy: Prevention And Treatment

Diabetic Retinopathy: Prevention And Treatment

INTRODUCTION Diabetic retinopathy is one of the largest causes of visual loss worldwide and is the principal cause of impaired vision in patients between 25 and 74 years of age [1]. The prevalence of diabetic retinopathy increases with duration of diabetes. Additional risk factors include the level of glycemic control, the type of diabetes (historically, type 1 more than type 2), and the presence or absence of associated conditions such as hypertension, smoking, dyslipidemia, nephropathy, and pregnancy. Several preventive and therapeutic interventions have been evaluated in an attempt to minimize the morbidity associated with diabetic retinopathy. Treatment of diabetic retinopathy is directed both at prevention (primarily by good glycemic control) and at treatment of established disease. Strict glycemic control early in the course of diabetes and photocoagulation for vision-threatening disease are of primary importance. Vitrectomy can also be used to preserve vision in advanced cases and certain circumstances. Intravitreal pharmacologic therapies are important new modalities for the treatment of diabetic retinopathy. Prevention and treatment of diabetic retinopathy will be reviewed here. The screening, pathogenesis, and clinical features of diabetic retinopathy are discussed elsewhere. (See "Diabetic retinopathy: Screening" and "Diabetic retinopathy: Classification and clinical features" and "Diabetic retinopathy: Pathogenesis".) RISK FACTORS The prevalence of diabetic retinopathy increases with the duration of diabetes (figure 1). Additional risk factors include a lesser degree of glycemic control, the type of diabetes (historically, type 1 more than 2), and the presence of associated conditions such as hypertension, smoking, nephropathy, dyslipidemia, and pregnancy [2 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

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 >>

Diabetic Eye Disease

Diabetic Eye Disease

What is diabetic eye disease? Diabetic eye disease is a group of eye problems that can affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma. Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness. But you can take steps to prevent diabetic eye disease, or keep it from getting worse, by taking care of your diabetes. The best ways to manage your diabetes and keep your eyes healthy are to Often, there are no warning signs of diabetic eye disease or vision loss when damage first develops. A full, dilated eye exam helps your doctor find and treat eye problems early—often before much vision loss can occur. How does diabetes affect my eyes? Diabetes affects your eyes when your blood glucose, also called blood sugar, is too high. In the short term, you are not likely to have vision loss from high blood glucose. People sometimes have blurry vision for a few days or weeks when they’re changing their diabetes care plan or medicines. High glucose can change fluid levels or cause swelling in the tissues of your eyes that help you to focus, causing blurred vision. This type of blurry vision is temporary and goes away when your glucose level gets closer to normal. If your blood glucose stays high over time, it can damage the tiny blood vessels in the back of your eyes. This damage can begin during prediabetes, when blood glucose is higher than normal, but not high enough for you to be diagnosed with diabetes. Damaged blood vessels may leak fluid and cause swelling. New, weak blood vessels may also begin to grow. These blood vessels can bleed into the middle part of the eye, lead to scarring, or cause dangerously high pressure inside your eye. Most serious diabetic eye d Continue reading >>

How Can Diabetic Patients Save Their Eyes From Retinopathy?

How Can Diabetic Patients Save Their Eyes From Retinopathy?

A2A How can diabetic patients save their eyes from retinopathy? I’ll divide the answer into two parts: 1. Prevent or delay the retinopathy Keep your blood sugars under control. This is by far the most important thing, and should include both lifestyle modifications (diet changes, physical exercise) and medications. Be in regular touch with your doctor (physician/endocrinologist) for the same. The recommended ADA Diabetes Guidelines for HbA1C levels are to keep them under 7%. Keep a check on other diseases that you might have, hypertension (increased blood pressure) and dyslipidemia (abnormal cholesterol levels) being the biggest culprits. Many landmark studies have seen that patients with co-existing uncontrolled hypertension and dyslipidemia have a higher chance of developing retinopathy, both in terms of an earlier onset and increased severity. But the problem is there is only so much one can do. I do not intend to discourage anyone, but even despite the best efforts some people still develop retinopathy. Duration of diabetes is one of the major risk factors, and as it is obvious, it is not modifiable. So that brings us to the second point. 2. Regular screening with the ophthalmologist A routine dilated fundus (retinal) examination is a must. For people with type 1 diabetes, the initial evaluation should be around five years after the diagnosis, not later than that. But for people with type 2 diabetes, it should be done as soon as possible after it is diagnosed. Here’s a screenshot of the recommended guidelines: So even in the absence of any signs of a retinopathy, an annual screening is recommended. And the frequency of examinations is increased as the severity of disease progresses. This helps in detecting retinopathy at the earliest stage possible, when it is a Continue reading >>

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