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Encyclopedia > Diabetic retinopathy
Diabetic retinopathy
Classification & external resources
ICD-10 H36. (E10.3 E11.3 E12.3 E13.3 E14.3)
ICD-9 250.5
DiseasesDB 29372
MedlinePlus 000494 001212
eMedicine oph/414  oph/415

Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all diabetics who have had diabetes for 15 years or more[citation needed]. Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there was proper and vigilant treatment and monitoring of the eyes[citation needed]. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // H00-H59 - Diseases of the eye and adnexa (H00-H06) Disorders of eyelid, lacrimal system and orbit (H00) Hordeolum and chalazion (H000) Hordeolum and other deep inflammation of eyelid (H001) Chalazion (H01) Other inflammation of eyelid (H010) Blepharitis (H011) Noninfectious dermatoses of eyelid (H02) Other disorders of eyelid (H020) Entropion... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. ... Human eye cross-sectional view. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Blindness is the condition of lacking visual perception due to physiological or psychological factors. ... Many systemic diseases have symptoms or manifestations related to the eye or visual system. ...

Normal vision. Courtesy NIH National Eye Institute
Normal vision. Courtesy NIH National Eye Institute
The same view with diabetic retinopathy.
The same view with diabetic retinopathy.


human eyesight two children and ball normal vision Copyright: public domain, US gov. ... human eyesight two children and ball normal vision Copyright: public domain, US gov. ... The National Institutes of Health (NIH) is the primary agency of the United States government responsible for medical research. ... The National Eye Institute (NEI) is one of the US National Institutes of Health that was established in 1968. ... human eyesight two children and ball with diabetic retinopathy Copyright: public domain, US gov. ... human eyesight two children and ball with diabetic retinopathy Copyright: public domain, US gov. ...

Contents

Signs and symptoms

Diabetic retinopathy often has no early warning signs. Even macular edema, which may cause vision loss more rapidly, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read and drive. In some cases, the vision will get better or worse during the day. Macular edema occurs when fluid and protein deposits collect on or under the macula, causing it to thicken and swell. ...


As new blood vessels form at the back of the eye as a part of proliferative diabetic retinopathy (PDR), they can bleed (haemorrhage) and blur vision. The first time this happens, it may not be very severe. In most cases, it will leave just a few specks of blood, or spots, floating in a person's visual field, though the spots often go away after a few hours. Hemorrhage (alternate spelling is Haemorrhage) is the medical term meaning bleeding. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ...


These spots are often followed within a few days or weeks by a much greater leakage of blood, which blurs vision. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from the inside of the eye, and in some cases the blood will not clear. These types of large hemorrhages tend to happen more than once, often during sleep. A child sleeping Sleep is the state of natural rest observed in humans and throughout the animal kingdom, including in all mammals and birds, and in many reptiles, amphibians and fish. ...


On fundoscopic exam, a doctor will see cotton wool spots, flame hemorrhages, and dot-blot hemorrhages. The ophthalmoscope is an instrument used to examine the eye. ... Cotton wool spots are an abnormal finding on fundoscopic exam of the retina. ...

Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes

Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of diabetes mellitus. ... See diabetes mellitus for further general information on diabetes. ... Gestational diabetes is a form of diabetes found in pregnant women. ... Impaired fasting glycaemia (IFG) is a pre-diabetic state of dysglycemia, associated with insulin resistance and increased risk cardiovascular pathology, although of lesser risk than Impaired glucose tolerance (IGT). ... Impaired Glucose Tolerance (IGT) is a pre-diabetic state of dysglycemia, that is associated with insulin resistance and increased risk of cardiovascular pathology. ...

Disease Management
Diabetes management:
Diabetic diet
•Anti-diabetic drugs
Conventional insulinotherapy
Intensive insulinotherapy
Other Concerns
Cardiovascular disease

Diabetic comas:
Diabetic hypoglycemia
Diabetic ketoacidosis
Nonketotic hyperosmolar This article is about the management of diabetes mellitus. ... The diet recommended for people who suffer from diabetes mellitus is one that is high in dietary fibre, especially soluble fibre, but low in fat (especially saturated fat) and sugar. ... An anti-diabetic drug or oral hypoglycemic agent is used to treat diabetes mellitus. ... Conventional insulinotherapy is a therapeutic regimen for diabetes mellitus treatment. ... Intensive insulinotherapy or flexible insulin therapy is a therapeutic regimen for diabetes mellitus treatment. ... Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). ... Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of three acute complications of diabetes: Severe diabetic hypoglycemia Advanced diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion Hyperosmolar nonketotic... Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a person with diabetes mellitus. ... Diabetic ketoacidosis (DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ... Nonketotic hyperosmolar coma is a type of diabetic coma associated with a high mortality seen in diabetes mellitus type 2. ...


Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ... Photomicrography of nodular glomerulosclerosis in Kimmelstein-Wilson syndrome. ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ...


Diabetes and pregnancy For women with diabetes mellitus, pregnancy can present some particular challenges for both mother and child. ...

Blood tests
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin

Fructosamine, also known as Glycated Serum Protein (GSP) or Glycated Albumin, is used primarily to identify the plasma glucose concentration over time and so assess diabetic control . ... A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ...

Pathogenesis

Small blood vessels – such as those in the eye – are especially vulnerable to poor blood glucose control. An overaccumulation of glucose and/or fructose damages the tiny blood vessels in the retina. During the initial stage, called nonproliferative diabetic retinopathy (NPDR), most people do not notice any changes in their vision. f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... In medicine, blood sugar is glucose in the blood. ... Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ... Fructose (or levulose) is a simple sugar (monosaccharide) found in many foods and is one of the three most important blood sugars along with glucose and galactose. ...


Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision. Macular edema occurs when fluid and protein deposits collect on or under the macula, causing it to thicken and swell. ... A polyunsaturated triglyceride. ... Human eye cross-sectional view. ...


As the disease progresses, severe nonproliferative diabetic retinopathy enters an advanced, or proliferative, stage. The lack of oxygen in the retina causes fragile, new, blood vessels to grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina. Fibrovascular proliferation can also cause tractional retinal detachment. The new blood vessels can also grow into the angle of the anterior chamber of the eye and cause Neovascular Glaucoma. Nonproliferative diabetic retinopathy shows up as cotton wool spots, or microvascular abnormalities or as superficial retinal hemorrhages. Even so, the advanced proliferative diabetic retinopathy (PDR) can remain asymptomatic for a very long time, and so should be monitored closely with regular checkups. General Name, Symbol, Number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Standard atomic weight 15. ... Vitreous refers to a material in a glassy state. ... Strictly, Cotton wool is the silky fibers from cotton plants in their raw state. ... In medicine, a disease is asymptomatic when it is at a stage where the patient does not experience symptoms. ...


Risk factors

All people with diabetes mellitus are at risk – those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset). The longer a person has diabetes, the higher the risk of developing some ocular problem. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. [1] After 20 years of diabetes, nearly all patients with type 1 diabetes and >60% of patients with type 2 diabetes have some degree of retinopathy.[2]


During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision. A pregnant woman near the end of her term Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ... Traditional Snellen chart used for visual acuity testing. ... The human gestation period of approximately 40 weeks between the time of the last menstrual cycle and delivery is traditionally divided into three periods of three months, or trimesters. ...


Diagnosis

Diabetic retinopathy is detected during an eye examination that includes: Traditional Snellen chart used for visual acuity testing. ...

  • Visual acuity test: This test uses an eye chart to measure how well a person sees at various distances (i.e., visual acuity).
  • Pupil dilation: The eye care professional places drops into the eye to widen the pupil. This allows him or her to see more of the retina and look for signs of diabetic retinopathy. After the examination, close-up vision may remain blurred for several hours.
  • Ophthalmoscopy: This is an examination of the retina in which the eye care professional: (1) looks through a device with a special magnifying lens that provides a narrow view of the retina, or (2) wearing a headset with a bright light, looks through a special magnifying glass and gains a wide view of the retina. Note that hand-held ophthalmoscopy is insufficient to rule out significant and treatable diabetic retinopathy.
  • Tonometry: A standard test that determines the fluid pressure (intraocular pressure) inside the eye. Elevated pressure is a possible sign of glaucoma, another common eye problem in people with diabetes.
  • Digital Retinal Screening Programs: Systematic programs for the early detection of eye disease including diabetic retinopathy are becoming more common, such as in the UK, where all people with diabetes mellitus are offered retinal screening at least annually. This involves digital image capture and transmission of the images to a digital reading center for evaluation and treatment referral. See Vanderbilt Ophthalmic Imaging Center [1] and the UK National Screening Committee [2]
  • Slit Lamp Biomicroscopy Retinal Screening Programs: Systematic programs for the early detection of diabetic retinopathy using slit-lamp biomicroscopy. These exist either as a standalone scheme or as part of the Digital program (above) where the digital photograph was considered to lack enough clarity for detection and/or diagnosis of any retinal abnormality.

The eye care professional will look at the retina for early signs of the disease, such as: (1) leaking blood vessels, (2) retinal swelling, such as macular edema, (3) pale, fatty deposits on the retina (exudates) – signs of leaking blood vessels, (4) damaged nerve tissue (neuropathy), and (5) any changes in the blood vessels. Traditional Snellen chart. ... Traditional Snellen chart used for visual acuity testing. ... The human eye The pupil is the central transparent area (showing as black). ... In medicine, a sign is a feature of disease as detected by the doctor. ... In medicine the ophthalmoscope was invented by Hermann von Helmholtz and is an instrument that is used to look into the human eye. ... Intraocular pressure is the fluid pressure inside the eye. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Nerves (yellow) Nerves redirects here. ... Neuropathy is usually short for peripheral neuropathy, meaning a disease of the peripheral nervous system. ...


Should the doctor suspect macular edema, he or she may perform a test called fluorescein angiography. In this test, a special dye is injected into the arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows the doctor to find the leaking blood vessels. Macular edema occurs when fluid and protein deposits collect on or under the macula, causing it to thicken and swell. ... Fluorescein angiography, or fluorescent angiography, is a technique for examining the circulation of the retina. ... Look up dye in Wiktionary, the free dictionary. ... Look up ARM in Wiktionary, the free dictionary. ... For images in Wikipedia, see Wikipedia:Images. ...


Management

There are three major treatments for diabetic retinopathy, which are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they get treatment before the retina is severely damaged. Still, the best way of addressing diabetic retinopathy is to monitor it vigilantly and ensure that it does not happen in the first place by careful blood glucose control and limitation of dietary fructose. Fructose (or levulose) is a simple sugar (monosaccharide) found in many foods and is one of the three most important blood sugars along with glucose and galactose. ...


These three treatments are laser surgery, injection of triamcinolone into the eye and vitrectomy. It is important to note that although these treatments are very successful, they do not cure diabetic retinopathy. Caution should be exercised in treatment with laser surgery since it causes a loss of retinal tissue. It is often more prudent to inject triamcinolone. In some patients it results in a marked increase of vision, especially if there is an edema of the macula. Vitreous humour is the clear gel that fills the eyeball, lying between the lens and the retina in the eye. ...


Avoiding tobacco use and correction of associated hypertension are important therapeutic measures in the management of diabetic retinopathy. [3]


Laser surgery

A type of laser surgery called panretinal photocoagulation, or PRP, is used to treat severe macular edema and proliferative retinopathy. The goal is to create 1 000 - 2 000 burns in the retina with the hope of reducing the retina's oxygen demand, and hence the possibility of ischemia. In treating advanced diabetic retinopathy, the burns are used to destroy the abnormal blood vessels that form at the back of the eye.


Before the surgery, the ophthalmologist dilates the pupil and applies anesthetic drops to numb the eye. In some cases, the doctor also may numb the area behind the eye to prevent any discomfort. The lights in the office are also dimmed to aid in dilating the pupil. The patient sits facing the laser machine while the doctor holds a special lens to the eye. During the procedure, the patient may see flashes of light. These flashes may eventually create an uncomfortable stinging sensation for the patient. After the laser treatment, patients should be advised not to drive for a few hours while the pupils are still dilated. Vision may remain a little blurry for the rest of the day, though there should not be much pain in the eye. Ophthalmology is the branch of medicine which deals with the diseases of the eye and their treatment. ... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... This article does not cite any references or sources. ...


Scatter laser treatment

Rather than focus the light on a single spot, the eye care professional may make hundreds of small laser burns away from the center of the retina, a procedure called scatter laser treatment or panretinal photocoagulation. The treatment shrinks the abnormal blood vessels. Patients may lose some of their peripheral vision after this surgery, but the procedure saves the rest of the patient's sight. Laser surgery may also slightly reduce colour and night vision.


A person with proliferative retinopathy will always be at risk for new bleeding as well as glaucoma, a complication from the new blood vessels. This means that multiple treatments may be required to protect vision.


Vitrectomy

Instead of laser surgery, some people need an eye operation called a vitrectomy to restore vision. A vitrectomy is performed when there is a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a saline solution made up of salt and water. Because the vitreous is mostly water, there should be no change between the saline solution and the normal vitreous. Vitreous humour is the clear gel that fills the eyeball, lying between the lens and the retina in the eye. ... Vitreous humour is the clear aqueous solution that fills the space between the lens and the retina of the vertebrate eyeball. ... For other uses, see Salt (disambiguation). ... Impact from a water drop causes an upward rebound jet surrounded by circular capillary waves. ...


Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than someone who waits to have the operation. Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.


Vitrectomy is often done under local anesthesia. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye to remove the vitreous and insert the saline solution into the eye. Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. ... Schematic diagram of the human eye. ...


Patients may be able to return home soon after the vitrectomy, or may be asked to stay in the hospital overnight. After the operation, the eye will be red and sensitive, and patients usually need to wear an eyepatch for a few days or weeks to protect the eye. Medicated eye drops are also prescribed to protect against infection. For the record label, see Hospital Records. ... Red is any of a number of similar colors evoked by light consisting predominantly of the longest wavelengths of light discernible by the human eye, in the wavelength range of roughly 625–750 nm. ... An infection is the detrimental colonization of a host organism by a foreign species. ...


References

  1. ^ NIHSeniorHealth: Diabetic Retinopathy - Causes and Risk Factors. Diabetic Retinopathy. NIHSenior Health (2005).
  2. ^ Screening for Diabetic Retinopathy. Diabetic Retinopathy. American Diabetes Association (2002).
  3. ^ Diabetes Ocular complications. Chronic Complications of Diabetes. Armenian Medical Network (2006).
  • The original text of this document was taken from the public domain resource document "Facts About Diabetic Retinopathy", at http://www.nei.nih.gov/health/diabetic/retinopathy.asp See the copyright statement at http://www.nei.nih.gov/order/index.htm, which says "Our publications are not copyrighted and may be reproduced without permission. However, we do ask that credit be given to the National Eye Institute, National Institutes of Health."
  • Basic ophthalmology for medical students and primary care residents, 7th edition
  • Kawasaki T, Ogata N, Akanuma H, Sakai T, Watanabe H, Ichiyanagi K, Yamanouchi T. Postprandial plasma fructose level is associated with retinopathy in patients with type 2 diabetes. Metabolism 2004;53:583-8. Fulltext. PMID 15131761.
  • Eye Care for Diabetics

Shortcut: WP:PD There are many resources available on the net that are in the public domain, and therefore freely usable without restrictions for Wikipedia content. ...

External Links

  • National Diabetes Information Clearinghouse
  • Lions Eye Institute, Perth, Australia
  • Educational website on Diabetic Retinopathy

  Results from FactBites:
 
Diabetic retinopathy - Wikipedia, the free encyclopedia (1659 words)
Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness.
Still, the best way of addressing diabetic retinopathy is to monitor it vigilantly and ensure that it does not happen in the first place by careful blood glucose control and limitation of dietary fructose.
In treating advanced diabetic retinopathy, the burns are used to destroy the abnormal blood vessels that form at the back of the eye.
  More results at FactBites »


 

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