Retinopathy 101

(Everything you wanted to know about retinopathy, but were afraid to ask)

In my last post I promised that I would share with

Second person, plural

"y’all" -- if you’re from the South,
"yous" -- if you’re from Philly, and
"yinz" -- if you’re from Pittsburgh/Western PA
close

you all I have learned about retinopathy and give some details on my own experience with laser therapy for treating retinopathy. This post first goes over what I’ve learned and provides some good resources for more information that I’ve found.

There are several stages/types of diabetic retinopathy. The most common is known as nonproliferative diabetic retinopathy or “background” retinopathy. This is when the tiny capillaries in the retina start to weaken and show signs of

Or:

Small bulges, like an over-inflated balloon or bike tire.
close

microaneurysms and perhaps even small blot hemorrhages when these microaneurysms rupture. This shows up in almost all diabetics after 20 years duration. Things can remain stable at this stage for a very long time, and the risk of progression of the retinopathy can be greatly reduced with tight blood sugar control.

The next stage in the progression of the disease is when these tiny capillaries become blocked, and show signs of retinal

Or:

An inadequate supply of oxygen.
close

ischemia in the form of “cotton wool spots.” This diminished oxygen flow to the retina then triggers the growth of new capillaries. This new capillary growth is called “neovascularization” and this is when nonproliferative retinopathy moves into the proliferative retinopathy realm.

One would think that getting more blood flow to a starving region of the body would be a good thing, but

It's no good for cancer, either

You don’t want to feed a tumor, though sometimes the body will do just that.
close

unfortunately that isn’t always the case. These new capillaries tend to be fragile and nebulous, thus they are even more prone to leaking than the microaneurysms. The growth and hemorrhage of these new capillaries are what increases the risk of having significant vision loss. Sometimes the loss can be temporary and the blood from the hemorrhage will clear over time, but other times it can be permanent.

Another type of retinopathy is called diabetic

Defns:

The macula is the central part of the retina and is the part of your retina responsible for (you guessed it!) your central vision. Edema simply means swelling.
close

macular edema. This can happen at either the nonproliferative or the proliferative stage and lead to separation between the retina and the back of the eye, which again leads to vision loss.

Laser therapy has been used very successfully to treat diabetic retinopathy. Having laser treatment, however, is essentially doing some controlled damage to hopefully prevent significant future vision loss. Studies have found that laser treatment for proliferative diabetic retinopathy reduces the risk of significant vision loss by about 50%. My understanding is that the risk over a two year period of having a significant hemorrhage resulting in some temporary or potentially permanent vision loss is about 7%, and laser treatment cuts this risk in half.

There are a few different types of laser treatment used, but for proliferative retinopathy, the most common procedure is called “panretinal photocoagulation“ (yep, that’s a mouthful). This procedure basically involves shooting a little over 1,000 laser burns in a grid-like pattern in the periphery of your retina (away from the macula where the central vision takes place). There are two reasons for this: First, the lasers cutoff and cauterize the new capillary growth. Second, the laser burns hopefully slow down or stop more capillary growth. This happens because the laser actually destroys bits of your retina, which then reduces the overall oxygen demand of the retina (if there’s less there, there’s less demand for oxygen). This should then decrease the signals being sent to create new capillaries. At least that’s the theory.

The most common side effects listed for panretinal photocoagulation are “decreased night vision”, and “decreased peripheral vision”. These two phrases are SO frustratingly vague to anyone about to under go said treatment, it’s enough to drive one bananas with fear. In my next post, I’ll go over what the actual treatment was like for me and describe the side effects I’ve been experiencing.

Here are some really good resources that I’ve found on retinopathy and diabetes complications in general. (I hope you find this useful, and not just a scary lecture).

The Basics

NIH
Mayo Clinic

Current Research

Focus on Retinopathy
Quality of Life after Laser Treatment

Diabetes Complications in General

Pathobiology of Diabetic Complications
Diabetic Microvascular Complications