Diabetic retinopathy treatment in Iran

Diabetic retinopathy treatment in Iran

Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes mellitus. It is a leading cause of blindness.

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.

The first sign of diabetic retinopathy

The condition is often at an advanced stage when symptoms become noticeable. On occasion, the only detectable symptom is a sudden and complete loss of vision. Signs and symptoms of diabetic retinopathy may include: blurred vision

Diabetic Retinopathy Symptoms

You can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, you will notice symptoms such as:

• seeing an increasing number of floaters,
• having blurry vision,
• having vision that changes sometimes from blurry to clear,
• seeing blank or dark areas in your field of vision,
• having poor night vision, and
• noticing colors appear faded or washed out losing vision.

What causes diabetic retinopathy?

Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy. The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or hemorrhage (bleed), distorting vision. In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina.

Diabetic retinopathy may progress through four stages:

1. Mild nonproliferative retinopathy.Small areas of balloon-like swelling in the retina’s tiny blood vessels, called microaneurysms, occur at this earliest stage of the disease. These microaneurysms may leak fluid into the retina.
2. Moderate nonproliferative retinopathy.As the disease progresses, blood vessels that nourish the retina may swell and distort. They may also lose their ability to transport blood. Both conditions cause characteristic changes to the appearance of the retina and may contribute to DME.
3. Severe nonproliferative retinopathy.Many more blood vessels are blocked, depriving blood supply to areas of the retina. These areas secrete growth factors that signal the retina to grow new blood vessels.
4. Proliferative diabetic retinopathy (PDR).At this advanced stage, growth factors secreted by the retina trigger the proliferation of new blood vessels, which grow along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye. The new blood vessels are fragile, which makes them more likely to leak and bleed. Accompanying scar tissue can contract and cause retinal detachment—the pulling away of the retina from underlying tissue, like wallpaper peeling away from a wall. Retinal detachment can lead to permanent vision loss.

Complications

Possible complications associated with diabetic retinopathy include the following:

Vitreous hemorrhage: A newly formed blood vessel leaks into the vitreous gel that fills the eye, stopping light from reaching the retina. Symptoms include loss of vision and sensitivity to light, or floaters in milder cases. This complication can resolve itself if the retina remains undamaged.

Detached retina: Scar tissue can pull the retina away from the back of the eye. This usually causes the appearance of floating spots in the individual's field of vision, flashes of light, and severe vision loss. A detached retina presents a significant risk of total vision loss if left untreated.

Glaucoma: The normal flow of fluid in the eye may become blocked as new blood vessels form. The blockage causes a buildup of ocular pressure, or pressure in the eye, increasing the risk of optic nerve damage and vision loss.

Risk factors

All people with diabetes mellitus are at risk – those with Type I diabetes and those with Type II diabetes. The longer a person has had diabetes, the higher their risk of developing some ocular problem. Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy.After 20 years of diabetes, nearly all patients with Type I diabetes and >60% of patients with Type II diabetes have some degree of retinopathy; however, these statistics were published in 2002 using data from four years earlier, limiting the usefulness of the research. The subjects would have been diagnosed with diabetes in the late 1970s, before modern fast-acting insulin and home glucose testing.

Prior studies had also assumed a clear glycemic threshold between people at high and low risk of diabetic retinopathy.

Published rates vary between trials, the proposed explanation being differences in study methods and reporting of prevalence rather than incidence values.

During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. NIH recommends that all pregnant women with diabetes have dilated eye examinations each trimester.

Can diabetic retinopathy be treated?

Laser surgery is often used in the treatment of diabetic eye disease, but each stage of diabetic retinopathy can be treated in a different way.

Background retinopathy has no treatment but patients will need regular eye examinations.
Maculopathy is usually treated with laser treatment (tiny burns that help to prevent new blood vessel growth and improve the nutrient and oxygen supply to the retina).