Hello. I’m Dr Croley and welcome to Case of the Day. Today we’re going to discuss a lady who came in, complaining of her vision and it turns out that she had Diabetic Retinopathy. Her vision was 20/25 in one eye and 27 in the other eye. For the condition of her retina, actually it was pretty good vision. So we’re gonna go over a little bit about what Diabetic Retinopathy is and what this lady had in her retina.
So she’s had a history of damage to her retina in the past and has been followed by a retinal specialist who had treated her with a laser treatment in the past for her Diabetic Retinopathy. She’s not been backed for a while and came in complaining about her vision and so when we looked inside her eye, then I could see the damage from her Diabetes and what it does to the retina.
First thing that we noticed was that she had a lots of spots in her retina where the doctor put in the laser treatment for Proliferative Diabetic Retinopathy. So there are two types of Diabetic Retinopathy, what we call Background Diabetic Retinopathy and Proliferative Diabetic Retinopathy.
Background Diabetic Retinopathy is characterized by you have little dot hemorrhages, flame-shape hemorrhages in the retina and there could be areas where there’s little yellow deposits that are what we call hard exudates, where the serum part of the blood is leaking out into the retina and then the lipid collects that and forms these into white or yellowish spots. And then you can have dimmer swelling in the retina and if it involves the macula, then the macula can swell which then leads to loss of vision. So you cannot get significant loss of vision from Background Diabetic Retinopathy due to damage to the macula. If the macula is normal, people don’t even notice they have Diabetic Retinopathy cause the little hemorrhage is out to the side don’t really interfere with the vision.
This particular person had Proliferative Diabetic Retinopathy, where actually the retina has now become ischemic, that is, it’s not getting enough blood. So what happens in diabetics is that the capillaries in your body start breaking down because the abnormal sugar levels damage the cells in those capillaries. The capillaries breakdown and you lose blood flow and so what happens is, the retina gradually losses the blood flow because the capillary circulation is diminished. What the retina does is, once it senses that it’s ischemic, it produces a chemical that causes blood vessels to proliferate. So now new blood vessels start growing into the retina from Proliferative Diabetic Retinopathy. So in the beginning, you think okay that’s a good thing, we’re growing in new blood vessels, that’s gonna help the situation. The problem is, those blood vessels are abnormal, they don’t grow in the right areas at the right spot and they’re very fragile, they break open and bleed.
People who have Proliferative Diabetic Retinopathy are at a much higher risk of losing their vision from Diabetes because these vessels bleed into the eye. And a lot of times, these vessels grow out on top of the retina, they actually also bring fibrous traction tissue along with them and then you get what’s called Traction Retina Detachments where these fibrous tissue pulls on the retina and detaches it in a localized area which is different from where you tear a hole in your retina where the whole retina detaches. In the beginning with Diabetes, it’s Traction Localized Retinal Detachments.
This person we treat, people who have Proliferative Diabetic Retinopathy with the laser treatment. Laser treatment scattered all through the retina and actually is destroying partly your retina, but, that means there’s less oxygen demand in your retina. Therefore your retina does not release that chemical to produce new blood vessels. So that’s actually how a laser treatment works for Proliferative Diabetic Retinopathy.
Unfortunately, because of her vascular disease and her Diabetes, she was still in one eye having hemorrhaging, even though she had laser treatment and she actually had what are called ghost blood vessels. What do we mean by ghost blood vessels? Well, her blood vessels and her disease in her vessels were so bad that there’s no blood flowing through the vessel. When we look in your retina, we can actually see the blood vessels and she actually had several blood vessels in both eyes that were white – like a ghost. And so this is due to severe ischemia and atherosclerosis and diabetic damage to the blood vessels. So when you see that, you know that someone’s gonna get severe loss in their vision from the loss of blood flow. She had a significant amount of Diabetic Retinopathy. She’s losing her vision in one eye because she still has this process going on and she is gonna need further treatment to her retina to settle down the Diabetic Retinopathy.
In some cases so severe and nothing’s working, sometimes injection of Cortisone on the eye to calm the eye down are done. Now, also the drug is used for diabetic or for Macular Degeneration is also injected inside the eye for Diabetic Retinopathy because the same thing that happens with Wet Macular Degeneration with abnormal blood vessel. These drugs decrease or shrink blood vessels. They now also inject these anti-VEGF drugs into eye to shrink these abnormal vessels.
Diabetic Retinopathy is the number one cause of blindness in the United States in people under age 65. Macular Degeneration is when we get older typically takes over the top spot. But as Diabetes is rapidly becoming more common in the United States, this is gonna be a significant problem as far as vision loss in the future. It’s very important that if you have Diabetes to have your eyes examined every year and have them dilated and a thorough exam done because early intervention can prevent a lot of this problem.
So if have questions about Diabetic Retinopathy, you can always try to contact us through the website. If not, may God grant you with healthy eyes and great vision.