Diabetic Retinopathy in Atlanta, Georgia

Non-proliferative Diabetic Retinopathy

Diabetic retinopathy is the most common cause of blindness in the 24-70 year age group. Diabetes affects not only the blood sugar level but also causes damage to the small blood vessels throughout the body. These changes occur very gradually, and become more common as a person has had the disease for a longer period of time. Because a person with early diabetes may have no symptoms, one may have had the disease for several years before it is diagnosed.

With time, the circulation to the kidneys, the peripheral nerves, the feet, the heart and the eyes are especially affected. If you have numbness, tingling or loss of sensation in the feet, it is likely that you are beginning to have what is referred to as peripheral neuropathy. This means there is damage to peripheral nerves from reduced blood supply. Often when a person has neuropathy, they may have diabetic retinopathy as well. Atlanta, Georgia residents do not experience pain or discomfort when living with retinopathy, which may cause significant damage to the retina before you become aware of it. The retina is like the film in the back of a camera. In particular, there is a small spot in the center of the retina called the macula, and this spot is critical for central vision, to read and see details. In some patients, more peripheral areas of the retina are damaged, before the macula, and in these cases, the person's central vision may not yet be affected. By the time symptoms develop, the degree of retinal damage can be quite extensive. If you are diabetic, the American Academy of Ophthalmology recommends that you have your eyes dilated with drops, and the retina examined at least annually.

To learn more about diabetic retinopathy and schedule a visit with one of our Georgia ophthalmologists, call us toll-free at 888-GA-RETINA.

Proliferative Diabetic Retinopathy

There are no drugs or medications proven to be of benefit to prevent or treat diabetic retinopathy for our Atlanta, Georgia patients, although a number of medicines are being studied. While our doctors have been involved in studying these drugs, they have not come into general clinical usage. At present, the most effective thing you can do is to control your blood sugar, and to monitor it yourself at least daily. While you must seek the advice of your personal physician regarding the best routine in your individual case, there is evidence that keeping the blood sugar down, consistently to the level of 130 or less, will significantly reduce the vascular (blood vessel) complication of the disease. This includes the damage to the kidneys and the eyes. Your doctor can also do a test called a hemoglobin A_1C, or glycosylated hemoglobin, which reflects the average degree of blood sugar control over the preceding few months.

There are two basic stages of diabetic retinopathy. These are "background," or "non-proliferative" retinopathy (NPDR) and "proliferative" retinopathy (PDR). The non-proliferative form is the earlier form, and the proliferative stage is the more advanced stage. The "proliferation" refers to the growth of abnormal new blood vessels, which grow in the back of the eye, like weeds, where they're not supposed to grow. These blood vessels are weak, and can break and bleed, causing vitreous hemorrhage, and "floaters." That is, spots floating in the vision. If the bleeding is more severe, the entire inside of the eyeball can be filled with blood, partially or totally blocking the vision.

In the non-proliferative forms, the small capillaries in the back of the eyes develop tiny bulges called microaneurysms. In these spots, the walls of the vessels are weakened, and they leak a clear plasma-like fluid. This may make the retina wet and swollen, a condition known as "edema." If the center of the retina is affected, as it usually is, the condition is known as macular edema.

Laser Treatment

PDR Angiogram

Macular edema can often be helped with a treatment known as focal laser treatment, to attempt to seal off the leaky points. When the leakage is more diffuse, sometimes a grid pattern of laser treatment is done. Laser eye surgery in Georgia is a non-invasive form of treatment done in the office in which there are no incisions or cutting, no stitches and usually no anesthesia, other than an eye drop. This type of treatment results in an improvement in vision about 20-25% of the time, but mostly is intended to stabilize the situation, and reduce the likelihood that the vision will worsen. The benefit of this type of treatment was proven in a large, multicenter, randomized study known as the ETDRS (the Early Treatment of Diabetic Retinopathy Study). Laser actually is an acronym standing for "Light Amplification by Stimulated Emission of Radiation," but is basically a very intense light. The light energy is absorbed by the pigment under the retina, causing a small burn. Although the procedure is highly complex from a technical standpoint, it is quite simple from the patient's perspective and usually only takes 10-15 minutes. Afterward, the patient can go home immediately. On some occasions, it is necessary to give an injection of anesthetic around the eye, to completely freeze the area and immobilize the eye, so that the treatment may be performed more accurately and comfortably. In that case, a patch would be applied to keep the eye protected and this can be removed at home within about 4 hours.

The proliferative form of the disease is treated with a different kind of Georgia laser eye surgery, known as panretinal photocoagulation or (PRP). This treatment involves a greater number of applications, and is sometimes done in two or three separate sessions. The peripheral portion of the retina is treated, which can result in the side effects of constriction of visual field, as well as reduction in night vision. These side effects are relatively uncommon, and when they occur, are necessary tradeoffs to attempt to preserve the central vision. The benefit of this treatment was proven in another large multicenter randomized study known as the DRS (Diabetic Retinopathy Study). These treatments are not intended to improve the vision, but rather, to cause the abnormal blood vessels to shrivel up so they will be less likely to bleed.

Surgery

PDR Angiogram

In the event that there is severe hemorrhage into the vitreous (the clear gel that fills the central cavity of the eye), surgery can be done to remove the vitreous jelly, and the blood. This is known as vitrectomy surgery. This type of surgery may also be required if the abnormal blood vessels in the back of the eye form scar tissue, which pulls on the retina. This scar tissue may pull hard enough to lift the retina off the back of the eye like a tent. This situation is called a tractional retinal detachment. The surgery is done in the hospital operating room, under a microscope. It is usually done under local anesthesia, but can also be done under general anesthesia. Usually no overnight stay is required. During this surgery, scar tissue may be removed from the back of the eye, and laser treatment may be done at the time of the surgery. With education, careful follow up, and tight management of the blood sugar, as well as early laser treatment when needed, most blindness from diabetes can be prevented.

To learn more about diabetic retinopathy in north Georgia and schedule a visit with one of our Atlanta ophthalmologists, call us toll-free at 888-GA-RETINA.