Diabetic retinopathy can appear in three forms, macular edema, background retinopathy (BDR), and proliferative diabetic retinopathy (PDR). Macular edema is swelling in the center of the retina without involvement of the periphery. BDR is leakage of blood vessels around the macula and the optic nerve in an irregular scattered fashion. It tends to be slow but may be a forerunner of either macular edema or proliferative changes.

PDR is characterized by sprout of new blood vessels growing from the surface of the retina or optic nerve directly into the fluid vitreous cavity. This new blood vessel formation is called neovascularization and can also grow from areas in the peripheral retina. The consequences are the same; the blood vessels grow along with scar tissue, which may contract and pull off the retina (retinal detachment). Therefore PDR is the most serious diabetic complication in the eye.

PDR is associated with:
Increased severity of disease
Increased duration of disease
Elevated HbA1c
Protein in the urine
Men
Increased diastolic blood pressure (the lower number)
Family history

Blurred vision may not be recognized immediately but if the fragile new blood vessels bleed, blurred vision is sudden. And if the retina becomes torn and pulled off, a curtain comes down across the vision. Therefore, annual dilated eye exams are imperative for diabetics so that complications such as BDR and PDR can be detected early.

The standard treatment for PDR without bleeding is pan retinal photocoagulation (PRP) laser. The basis for making a concentric series of small laser burns all around the periphery of the retina is to kill off enough cells to extinguish the low oxygen supply to them. By removing the low oxygen stimulus surprisingly these new blood vessels disappear and even background changes may fade. The laser light is absorbed by either the pigment under the retina or the blood cells in the blood vessels enabling the focal scar to occur. The peripheral location of the scars does not affect central vision but does reduce the peripheral visual field and night vision (adaptation to the dark).

Given the choice of progressive deterioration in vision and destruction of the retina, PRP has much more benefit than risk. The treatments may be done in one or several sessions and are approximately 55% immediately successful. In many instances, the success rate is much higher when performed by a qualified retina specialist.

Dr. Abel


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