Diabetic Retinopathy

How is diabetic retinopathy diagnosed?

It is extremely important that patients with diabetes receive screening by a retina specialist, because retinopathy is most treatable at its earliest, and often asymptomatic, stages. The diagnosis requires examination of the retina by ophthalmoscopy through a dilated pupil, and also the use of other tests such as Fluorescein Angiography and Optical Coherence Tomography (OCT). Macular edema is treated with laser, drugs, and occasionally vitreous surgery, and the appropriate choice of therapy is complex.

In addition to a complete medical history and eye examination, your eye care professional may perform the following tests to diagnose diabetic retinopathy:

  • Visual acuity test - the common eye chart test (see right), which measures vision ability at various distances.
  • Pupil dilation - the pupil is widened with eyedrops to allow a close-up examination of the eye's retina.
  • Tonometry - a standard test to determine the fluid pressure inside the eye.
  • Ophthalmoscopy - a physician performs a detailed examination of the retina using a special magnifying glass.
  • Treatment for diabetic retinopathy:

    In other patients with diabetes, the retinal changes evolve into proliferative retinopathy, in which abnormal new blood vessels (neovascularization) grow out of the retina into the vitreous. These abnormal new vessels cause enormous problems for the eye and vision, because they bleed and contract, causing severe problems including vitreous hemorrhage and traction retinal detachment. Again, patients with diabetes require lifelong periodic screening examinations, because proliferative retinopathy is usually highly treatable by laser in its early stages. For patients with established visual loss due to vitreous hemorrhage or retinal detachment, surgery is often effective, but the surgery can be quite complex and multiple operations may be needed.

    Specific treatment will be determined by your physician(s) based on:

    • your age, overall health, and medical history
    • extent of the disease
    • your tolerance for specific medications, procedures, or therapies
    • expectations for the course of the disease
    • your opinion or preference

    According to the National Eye Institute, part of the National Institutes of Health, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they seek treatment before the retina becomes severely damaged. Treatment for diabetic retinopathy may include:

    • Laser surgery - often used to treat macular edema and proliferative retinopathy; involves shrinking the abnormal blood vessels, or sealing the leaking ones.
    • Vitrectomy - a type of procedure that involves removing the cloudy vitreous (the clear, jelly-like substance that fills the center of the eye) and replacing it with a salt solution. Vitrectomies are particularly effective in persons with insulin-dependent diabetes, who may be at a greater risk of blindness due to a hemorrhage in the eye.

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