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Diabetic Retinopathy

DESCRIPTION: The adult-onset form of diabetes is a metabolic disease which ultimately affects retinal blood vessels, causing intraretinal hemorrhaging and abnormal growth of new vessels into the vitreous; the vitreous then pulls away from the retina, and the vessels hemorrhage into the vitreous. This bleeding blocks the transmission of light through a normally transparent vitreous, and functional visual interference results (ranging from "floaters" to blindness). Symptoms of ocular involvement include: sensitivity to glare, diplopia, lack of accommodation, fluctuating acuity, diminishing of color vision, and lessening of visual fields; retinal detachment may follow; secondary complications include glaucoma and cataracts. Other associated systemic conditions include cardiovascular, skin, and kidney problems. If diabetes is well controlled in its early years, the onset of retinopathy is delayed, and its severity is reduced; ocular complications occur about 20 years after the onset, even when it is well controlled. Once retinopathy is established, it is little affected by the day-to-day control of diabetes. High blood pressure should be vigorously treated. In juvenile diabetes, severe retinopathy develops within 20 years in 60%-70% of the cases, even when the diabetes is well controlled. Cataracts are rare in juvenile diabetes, but form rapidly (within several weeks) if they occur. Senile cataracts are common in older diabetics.

TREATMENT: Control of the diabetes is essential (through diet, exercise, urine testing, and insulin therapy if needed), as is the control of high blood pressure. Photocoagulation may help when vision is affected by a focal area of retinal edema, and may delay the onset of proliferative retinopathy. It may also be used to alleviate drastic complications later, although not necessarily preserving macular function (central acuity). Trans-pars plane vitrectomy helps about 75% of patients who have sustained visual loss due to hemorrhaging. Retinal detachment may be treated with scleral buckling, Photocoagulation, and vitrectomy.

IMPLICATIONS: Low vision aids and increased illumination may be helpful when visual function is maintained.

Diabetic retinopathy is one of the leading causes of visual impairment. It is the most common cause of blindness in younger people throughout the world, although the visual outlook for the adult onset type is better than for the juvenile type. In a random population of diabetics, a little over one third will have some type of diabetic retinopathy, however less than 5% will develop the severest symptoms; 1% of these will become blind.

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