Diabetic Retinopathy
The retina is dependent upon good blood flow. High blood glucose levels seen in diabetes eventually cause damage to the blood vessels in the retina as well as to other systemic blood vessels. This retinal damage is called diabetic retinopathy or DR. DR is a leading cause of blindness in the US and is expected to increase as more people are diagnosed every year. DR usually develops after several years of poorly controlled blood glucose levels and often is not associated with visual symptoms until late in the disease process. Early detection and treatment are key in preventing permanent visual loss.
There are two main stages of diabetic retinopathy. The disease begins as Non-Proliferative Diabetic Retinopathy (NPDR) often with diabetic macular edema (DME) as the disease progresses.
Diabetic Macular Edema, by Ratimir Lazic, MD, PhD from Retina Image Bank.
Diabetic Macular Edema seen with Optical Coherence Tomography (OCT)
Proliferative Diabetic Retinopathy (PDR) occurs in the more advanced stages and involves the growth of abnormal blood vessels due to lack of oxygen in the retina. These abnormal vessels are fragile and may hemorrhage leading to sudden onset of loss of vision. If not treated, tractional retinal detachments may develop which can lead to total permanent blindness.
Proliferative Diabetic Retinopathy, by Gabriela Lopezcarasa Hernandez, MD from Retina Image Bank, 2012
Treatment
The primary goal is to maintain blood glucose levels within normal range, ideally with a hemoglobin A1C less than 7.0, to prevent or halt diabetic retinopathy. Maintaining normal blood pressure and cholesterol levels is also important as well as discontinuation of smoking to control disease complications and improve effectiveness of treatment.
Certain criteria are used to determine when treatment is indicated. While historically laser treatment was the mainstay of treatment, new treatment options involving intraocular injections of medications began in 2005. These injections have been performed by Dr. Keithahn since then and have become the standard of care for many manifestations of the disease. Laser treatment is still useful in certain disease scenarios.
In more advanced phases of the disease, surgical intervention involving vitrectomy is necessary. Dr. Keithahn has been performing vitrectomy surgery since 1994 and has been privileged to witness a remarkable evolution in the field with improvements in surgical instrumentation and technology allowing enhanced surgical success.