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Proliferative Diabetic Retinopathy Treatment

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 >>

Proliferative Retinopathy

Proliferative Retinopathy

Proliferative retinopathy occurs when weaker blood vessels form on the retina Proliferative retinopathy is a developed form of retinopathy whereby new but weak blood vessels begin to form on the retina to help restore blood supply. Proliferative retinopathy is the bodys attempt to save its retina but it can often lead scarring of the retina and can cause the retina to detach, leading to blindness. Modern eye treatment can help to prevent blindness from occurring as a result of proliferative retinopathy. Proliferative retinopathy can develop without causing symptoms so it is important to attend regular retinopathy screening checks. Symptoms may occur as a result of a haemorrhage or detached retina which may include: Sudden appearance of floaters (dots, specks or streaks) in your vision Effect similar to cobwebs across your vision If you experience a sudden worsening in your vision, contact your health team. If a significant number of blood vessels on the retina become damaged, your body will respond by releasing a growth hormone known as Vascular Endothelial Cell Growth Factor (VEGF). The growth hormone stimulates the growth of new blood vessels. However, these new blood vessels are particularly weak and prone to leaking which can lead to sight problems developing. Problems which could occur as a result of proliferative retinopathy include: Proliferative retinopathy can lead to new blood vessels growing out from the retina and into the vitreous humour (the gel within the eye ). If the vitreous humour shrinks it can pull on these blood vessels, causing them to bleed which can result in an appearance of cobwebs in your vision, making it more difficult to see. Blood from a vitreous haemorrhage will dissipate but treatment will be required to prevent further problems. Treat 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 >>

Diagnosis

Diagnosis

Print Diabetic retinopathy is best diagnosed with a dilated eye exam. For this exam, drops placed in your eyes widen (dilate) your pupils to allow your doctor to better view inside your eyes. The drops may cause your close vision to blur until they wear off, several hours later. During the exam, your eye doctor will look for: Abnormal blood vessels Swelling, blood or fatty deposits in the retina Growth of new blood vessels and scar tissue Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous) Retinal detachment Abnormalities in your optic nerve In addition, your eye doctor may: Test your vision Measure your eye pressure to test for glaucoma Look for evidence of cataracts Fluorescein angiography With your eyes dilated, your doctor takes pictures of the inside of your eyes. Then your doctor will inject a special dye into your arm and take more pictures as the dye circulates through your eyes. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid. Optical coherence tomography Your eye doctor may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working. Treatment Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping progression of the condition. Early diabetic retinopathy If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment. Work with 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 Retinopathy

Diabetic Retinopathy

Print Overview Diabetic retinopathy (die-uh-BET-ik ret-ih-NOP-uh-thee) is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness. The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication. Symptoms You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include: Spots or dark strings floating in your vision (floaters) Blurred vision Fluctuating vision Impaired color vision Dark or empty areas in your vision Vision loss Diabetic retinopathy usually affects both eyes. When to see a doctor Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Pregnancy may worsen diabetic retinopathy, so if you're pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy. Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy. Causes Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily. There are two types of diabetic retinopathy: Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy (NPDR) Continue reading >>

What Is Proliferative Retinopathy?

What Is Proliferative Retinopathy?

Enlarge side view: in proliferative retinopathy 'new blood vessels' grow on the surface of the retina and can bleed. In this condition very small blood vessels grow from the surface of the retina. The retina is the film at the back of your eye , and the tiny blood vessels are capillaries. These growing blood vessels are very delicate and bleed easily. Without laser treatment, the bleeding causes scar tissue that starts to shrink and pull the retina off, and the eye becomes blind. Laser treatment prevents blindness, but often some vision is lost. If you have had diabetes for years your retinae may develop this condition. As the retina is damaged by diabetes, the diseased retina releases special growth chemicals. These chemicals make tiny blood vessels grow: these are called 'new blood vessels'. See Animation, case with obvious new vessels, photo , photo Some details The new vessel growth in diabetes only occurs in the retina, nowhere else in the body. When a retina becomes damaged by a higher than normal sugar, over many years, it seems to release special growth hormones. VEGF is one of the main growth hormones; VEGF stands for Vascular Endothelial Cell Growth Factor. It seems to be manufactured and released by 'sick' retinal capillaries, and in turn makes other capillaries grow. This seems to be an exaggeration of one of the body's normal responses.... the retina becomes starved of nutrients, and then the retina makes chemicals that make new blood vessels grow to deliver more nutrients. There are other growth factors and processes involved. Description of events in proliferative retinopathy the mechanism of proliferative retinopathy (start at top) with laser treatment diabetes for years ^ retinal damage ^ retina releases growth chemicals ^ 'new vessels' grow ^ anti-VEGF Continue reading >>

New Research: Lucentis Is Effective In Treating Proliferative Diabetic Retinopathy And More Effective Than Traditional Laser Treatment

New Research: Lucentis Is Effective In Treating Proliferative Diabetic Retinopathy And More Effective Than Traditional Laser Treatment

New Research: Lucentis Is Effective in Treating Proliferative Diabetic Retinopathy and More Effective than Traditional Laser Treatment New Research: Lucentis Is Effective in Treating Proliferative Diabetic Retinopathy and More Effective than Traditional Laser Treatment Results from a new clinical trial have revealed that the injectable drug Lucentis is highly effective in treating proliferative diabetic retinopathy , a serious vision-related complication of diabetes. "These findings," said Dr. Paul Sieving, Director of the National Eye Institute (NEI), "provide crucial evidence for a safe and effective alternative to laser therapy against proliferative diabetic retinopathy." The clinical trial was funded by NEI, which described Lucentis as the first major advance in therapy for proliferative diabetic retinopathy in nearly 40 years. Although longer-term follow-up is needed, Lucentis may provide a reasonable treatment alternative, at least through two years, for persons with proliferative diabetic retinopathy. From The Journal of the American Medical Association The research, entitled Panretinal Photocoagulation [i.e., laser treatment] vs Intravitreous Ranibizumab [i.e., Lucentis injection] for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial , has been published online as an open-source article in the November 13, 2015 edition of The Journal of the American Medical Association and was timed to coincide with a presentation by the study authors at the 2015 Annual Meeting of the American Academy of Ophthalmology . The authors are the members of the Writing Committee for the Diabetic Retinopathy Clinical Research Network . The Diabetic Retinopathy Clinical Research Network (DRCR.net) is a collaborative research group that supports the identification, design, Continue reading >>

Diabetic Retinopathy Treatment & Management

Diabetic Retinopathy Treatment & Management

Approach Considerations 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] 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 >>

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 >>

Laser Treatment For Proliferative Diabetic Retinopathy

Laser Treatment For Proliferative Diabetic Retinopathy

Laser Treatment for Proliferative Diabetic Retinopathy If the amount of new vessels is great, laser treatment can often prevent loss of vision. The type of laser treatment that is done when there are a lot of vessels is called Panretinal Photocoagulation. This type of laser treatment is usually done in two or more separate sessions. The idea is to use the laser to destroy all of the dead areas of the retina where the blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to diminish or disappear. There are side effects of panretinal photocoagulation, and, for this reason, this treatment is not done when only a small amount of new vessels are present. It is important to remember, however, that when the amount is great enough to warrant laser treatment, the longer the eye remains untreated the more likely vision will be lost and blindness will occur. The earlier severe new vessels are discovered and the eye is treated, the more likely blindness can be prevented. If you have developed any of these abnormal new vessels, your doctor will help advise you about when panretinal photocoagulation should be done. Panretinal photocoagulation does not improve vision; it is just a means of holding vision stable to prevent further loss. After laser treatments, patients may still have reduced vision or may continue to lose more vision. But if laser is indicated, the chance are that laser treatment will prevent severe loss of vision. Panretinal photocoagulation is placed on the side of the retina, not the center, and side vision will definitely be diminished. These side areas are sacrificed in order to save as much of the central vision as possible and to save the eye itself. Continue reading >>

Treatment

Treatment

Diabetic retinopathy usually only requires specific treatment when it reaches an advanced stage and there's a risk to your vision. It's typically offered if diabetic eye screening detects stage three (proliferative) retinopathy, or if you have symptoms caused by diabetic maculopathy. At all stages, managing your diabetes is crucial. Read about the stages of diabetic retinopathy for more information about what these terms mean. Managing your diabetes The most important part of your treatment is to keep your diabetes under control. In the early stages of diabetic retinopathy, controlling your diabetes can help prevent vision problems developing. In the more advanced stages, when your vision is affected or at risk, keeping your diabetes under control can help stop the condition getting worse. Read about what you can do to reduce the risk of diabetic retinopathy progressing. Treatments for advanced diabetic retinopathy For diabetic retinopathy that is threatening or affecting your sight, the main treatments are: laser treatment – to treat the growth of new blood vessels at the back of the eye (retina) in cases of proliferative diabetic retinopathy, and to stabilise some cases of maculopathy eye injections – to treat severe maculopathy that's threatening your sight eye surgery – to remove blood or scar tissue from the eye if laser treatment isn't possible because retinopathy is too advanced Laser treatment Laser treatment is used to treat new blood vessels at the back of the eyes in the advanced stages of diabetic retinopathy. This is done because the new blood vessels tend to be very weak and often cause bleeding into the eye. Treatment can help stabilise the changes in your eyes caused by your diabetes and stop your vision getting any worse, although it won't usually 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 >>

Retina Today - Comparing Treatment Options For Proliferative Diabetic Retinopathy (march 2016)

Retina Today - Comparing Treatment Options For Proliferative Diabetic Retinopathy (march 2016)

Comparing Treatment Options for Proliferative Diabetic Retinopathy Study design and results of DRCR.net Protocol S. Peripheral scatter laser or panretinal photocoagulation (PRP) has been the standard treatment for proliferative diabetic retinopathy (PDR) for nearly 40 years.1 Although this laser treatment can reduce the incidence of severe vision loss, it carries the risk of notable side effects, including loss of peripheral and night vision, due to its destructive effects on the peripheral retina.2 The primary outcome of DRCR.net Protocol S was a noninferiority comparison of visual acuity at 2 years. Secondary outcomes assessed the potential benefits of treatment with ranibizumab over PRP. In both ranibizumab- and PRP-treated eyes, the greatest visual gains were seen in eyes with baseline DME. Intravitreal ranibizumab provided visual acuity outcomes at 2 years that were similar to or better than those achieved with PRP in the treatment of PDR with or without DME. Anti-VEGF injections have recently become a widely used treatment for diabetic macular edema (DME), and observations from many large interventional trials have suggested that the severity of diabetic retinopathy can be improved with anti-VEGF treatment.3-5 The Diabetic Retinopathy Clinical Research Network (DRCR.net) recently published 2-year outcome data from a randomized clinical trial, Protocol S, that evaluated the efficacy and safety of intravitreal ranibizumab (Lucentis, Genentech) vs. PRP for the treatment of PDR.6 Details of this study are reviewed herein. The primary outcome of Protocol S was a noninferiority comparison of visual acuity at 2 years. The potential benefits of 0.5 mg intravitreal ranibizumab treatment over PRP, including less peripheral visual acuity loss and less DME, were evaluated an Continue reading >>

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