Retinopathy refers to a general condition in which the retina of the eyes is damaged. The most common condition is an affected blood supply to the retina and is associated with diabetes or another systemic disease. The blood vessels supply nutrition to the retina to keep it healthy, when they are damaged or destroyed, vision impairment or blindness can result.
The primary causes of retinopathy are diabetes (referred to as diabetic retinopathy, arterial hypertension (referred to as hypertensive retinopathy), sickle cell anemia, intense sunlight exposure (referred to as solare retinopathy), medications (referred to as drug-related retinopathy) and retinal vein or artery occlusion. An occlusion is a blockage. Premature infants can have poorly developed blood vessels in the eyes referred to as retinopathy of prematurity or ROP.
Retinopathy can be progressive and result in blindness especially if the macula is involved. The macula is a thin screen that connects the blood vessels with the retina.
For premature infants, the symptoms are not present. For adults with a systemic cause, retinopathy presents with these initial symptoms: spiders or cobwebs or tiny specks called floaters, dark streaks or red film that impairs vision, blurred vision, dark or empty spot of vision, poor night vision, and problems adjusting from a bright light to a dim light. Unfortunately this disease can progress to an advanced stage without any prior noticeable symptoms.
Diabetic retinopathy is diagnoses as either non-proliferative or proliferative. Non-proliferative retinopathy is a mild form that is common and does not impair vision too badly. Problems are only in the retina and not in the macula. If it is not treated it may develop into proliferative retinopathy. Proliferative retinopathy is a serious form or retinopathy. New blood vessels begin to branch out or grow in and around the retina, which can cause bleeding into the center of the eye, retina swelling and blindness.
An eye doctor will examine the eye and look for these signs:
leaking blood vessels
fatty deposits called exudates in the retina
microaneruysms (tiny burst blood vessels)
neofaxcularizatin or growth of new blood vessels
scar tissue with retinal detachment
changes in blood vessels – loops, beading or closures
nerve fiber damage known as cotton-wool spots
A diagnostic test called a fluorescein angiography is used to diagnose leaking blood vessels. In this procedure dye is injected into the arm. When the dye circulates into the eyes, the blood vessels become easily identified. The eye doctor can then determine where the typical blood vessels may have closed or broken down and are leaking fluid. A camera will take a series of images every few seconds for several minutes.
Another test is called an optical coherence tomography or OCT examination. This procedure is non invasive imaging and provides a high resolution picture of the retina. Thickness of the retina and leaking fluid can be seen easily. An OCT is used for both diagnosis and monitoring the progression or development of the disease.
Treatment depends on the type of retinopathy, whether it is proliferative or non-proliferative and the health of the patient. If the retinopathy is non-proliferative monitoring is definitely part of treatment.
Two primary treatments exist for retinopathy, photocoagulation and vitrectomy. The treatments are effective most of the time and can slow or stop progression, but they are not a complete cure, in some cases, depending on the underlying systemic cause.
Photocoagulation is known as laser treatment. It is used to help seal leaks in the eye. The procedure occurs in the eye doctor’s office. The eye is numbed and the pupil is dilated. A metal contact lens is placed in the eye to help focus the laser.
Macular edema or swelling is treated with photocoagulation by focusing on the blood vessels which are leaking near the macula. Patients cannot drive after this procedure; the vision will be blurry for about twenty-four hours. Follow up visits will monitor the success and the need for anymore treatments.
Panretinal photocoagulation is used to treat the entire retina except the macula. The treatment is aimed at the abnormal newly developed blood vessels; the goal is to make them shrink or disappear. It reduces the possibility of vitreous leakage and traction retinal detachment. The procedure usually requires two or more visits to the office.
A vitrectomy may restore site and provide a change for laser treatment. The surgeon removes blood filled vitreous (the fluid in the eye). The tissue is removed and replaced with a special solution that retains theshape and pressure within the eye. A vitrectomy is performed to remove scar tissue as well, especially when it is pulling at the retina. A detached retina can the return to the back of the eye and flatten out to normal. If the scar tissue is located away from the macula and not growing, your eye doctor may choose not to perform this procedure. A vitrectomy can be performed in the doctor’ office. In some vitrectomies, the doctor injects a small bubble into the eye and the patient is required to keep their head in a face down position for up to two weeks. The bubble will then rest in the back of the eye and push the retina back into place. Full recovery can take up to a month or more.
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