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Diabetic Retinopathy One of the most frequent causes of vision impairment in the United States and throughout the rest of the world is diabetic retinopathy. Diabetic retinopathy is a complication of diabetes that causes damage to the blood vessels of the retina—the light-sensitive tissue that lines the back part of the eye, allowing you to see fine detail. Diabetic retinopathy occurs in more than half of the people who develop diabetes. The longer someone has diabetes, and the less his or her blood sugars are controlled, the more likely the possibility that person will develop diabetic retinopathy. There are generally 2 causes of vision loss from diabetic retinopathy: diabetic macular edema and proliferative diabetic retinopathy. Diabetic macular edema Diabetic macular edema is the term used for swelling in the central part of the retina. The macula—or center part—of the retina is used for sharp, straight-ahead vision. It is nourished by blood vessels that are weakened or begin to leak as a result of diabetes. This causes the central part of the retina to become thickened or swollen and can lead to decreased vision. Proliferative diabetic retinopathy Diabetes can cause damage to the small blood vessels in the retina, resulting in poor circulation to the retina. Vision may be lost because some of the retina tissue may die as a result of this inadequate blood supply. Unlike skin tissue, which might grow back if it is lost, retina tissue is like brain tissue and does not grow back once it is lost. Furthermore, the poor circulation may lead to the development of growth factors that can cause new blood vessels and scar tissue to grow on the surface of the retina. This stage of diabetic retinopathy is called proliferative diabetic retinopathy (PDR). It is referred to as “proliferative” because at this stage of the disease, new, abnormal blood vessels and scar tissue begin to grow on the surface of the retina. The vessels bleed into the middle cavity of the eye, causing vision loss because light cannot reach the retina. Scar tissue formation can also pull on the retina, detaching it from the back of the eye, resulting in vision loss. Occasionally, these blood vessels and scar tissue may grow in the front of the eye, where fluid normally exits. When the fluid cannot escape, pressure can build in the eye, creating a rare type of glaucoma (neovascular glaucoma) that can damage vision even further and cause eye pain. Video: Vision Treatment Breakthrough: People With Diabetic Eye Disease Have a New Option That Could Preserve or Improve Their Vision Symptoms It is possible to have diabetic retinopathy for a long time without noticing symptoms until substantial damage has occurred. Symptoms may include blurred or double vision, difficulty reading, or the appearance of spots—known as “floaters”—in your vision. A person with diabetic retinopathy may also notice a shadow across the field of vision, eye pain or pressure, or difficulty with color perception. Some patients may experience a partial or total loss of vision. It is important to note that diabetic retinopathy usually affects both eyes. Causes The primary cause of diabetic retinopathy is diabetes—a condition in which the levels of glucose (sugar) in the blood are too high. Elevated sugar levels from diabetes can damage the small blood vessels that nourish the retina and may in some cases block them completely. As a result, the blood supply to the retina from these damaged blood vessels is cut off and vision is affected. In response to the lack of blood supply, the eye may create growth factors that lead to diabetic macular edema, which can lead to decreased vision, or proliferative diabetic retinopathy, which can lead to retinal detachment and vision loss. Risk factors Anyone who has diabetes is at risk of developing diabetic retinopathy. There are, however, additional factors that can increase the risk: - Disease duration: the longer someone has diabetes, the greater the risk of developing diabetic retinopathy. - Poor control of blood sugar levels over time. - High blood pressure - High cholesterol levels - Pregnancy in someone with diabetes can result in changes in the retina as well. Complications People with type 2 diabetes who use certain prescription medicines, such as pioglitazone and rosiglitazone, to treat their diabetes may be at greater risk for problems with the center of the retina (the macula). The US Food and Drug Administration (FDA) has warned that taking some medicines could cause swelling in the macula, a condition known as macular edema. Check with your physician for more information about prescription medications that could put you at risk. Diagnostic tests The best way to diagnose diabetic retinopathy is with a dilated eye exam. During the exam, the physician will place drops in the eyes to make the pupils dilate (open widely) to allow a better view of the inside of the eye, especially the retina tissue. The physician will look for swelling in the retina (diabetic macular edema), abnormal blood vessels that may predict an increased risk of developing new blood vessels, and the actual presence of new blood vessels or scar tissue on the surface of the retina (proliferative diabetic retinopathy). Three other diagnostic tools are also used to detect and manage diabetic retinopathy: Fundus photography The physician may take photographs of the back of the eye to facilitate detection of diabetic retinopathy and to document the retinopathy. These photos make it easier for the physician to track the disease on subsequent visits to determine if it is worsening. Fluorescein angiography To supplement the eye exam, the physician may conduct a retinal photography test called fluorescein angiography. After dilating the pupils, a dye will be injected into the patient's arm and circulate through the eyes. It is like a food coloring, however, it does not affect the kidneys and is unlike the dye that is used with MRIs or CAT scans. As the dye circulates, pictures are taken of the retina, allowing the physician to accurately detect blood vessels that are closed, damaged, or leaking fluid. The pictures are black and white to facilitate the detection of these changes, but the process is not the same as having an x-ray. Prior to examination, ask the physician to discuss the risks and benefits of obtaining these images. Optical coherence tomography The physician may suggest an optical coherence tomography (OCT) exam. This test provides cross-sectional images of the retina that show its thickness, helping determine whether fluid has leaked into retinal tissue. Treatment and drugs As a result of major government and industry-sponsored studies, there now are many surgical treatments for diabetic retinopathy, including lasers to the retina or miniscule injections of medications into the middle cavity of the eye. These procedures can be done in the office or hospital setting to prevent, treat, or reverse damage from diabetes in the retina. Researchers have shown that eye injections often—but not always in combination with laser treatment—result in better vision than laser treatment alone for diabetes-associated swelling of the retina. This condition is known as diabetic macular edema. The key to these treatments is the blocking by eye injections of vascular endothelial growth factor (VEGF), a chemical signal in the body that stimulates blood vessel growth. Repeated doses of anti-VEGF medications may be needed to prevent blood vessels from leaking fluid and causing damage to the eye. With proper examinations, the earliest signs of diabetic retinopathy in the retina can be detected before vision loss begins. This detection is facilitated by an eye exam in which eye drops, given in the office, dilate the pupil of the eye. Regular dilated eye exams by an ophthalmologist are important, especially for those who are at a higher risk for diabetic retinopathy or diabetes. Over age 50, an exam every one to two years is a good idea to look for signs of diabetes or diabetic retinopathy before any vision loss has occurred. If the physician detects signs of diabetic retinopathy, she/he often can determine how frequently follow-up examinations will be required in order to detect changes that would require treatments. Even if not all vision loss from diabetic retinopathy can be prevented or treated at this time, patients usually are able to find ways to live with diminished vision. If you have been diagnosed with diabetic retinopathy or diabetes and have vision loss, a retina specialist can help you find a support group and suggest access to rehabilitation with a variety of tools to make everyday living with this disease a little bit easier. Prevention Patients with diabetes frequently ask, is there anything I can do to keep from getting diabetic retinopathy or to prevent or treat vision loss once it occurs? The answer is a resounding yes. The following are ways to prevent diabetic retinopathy and vision loss caused by it: Control blood sugars, blood pressure, and lipid levels Control those blood sugar levels through diet, exercise, and medications. The better control of these levels, the less likely one will develop diabetic retinopathy or have worsening of any pre-existing retinopathy. One of the best ways to monitor your sugar levels is by having the health care provider who manages your diabetes evaluate your hemoglobin A1C, which is measured through a blood test obtained in the office. This will help you keep your blood sugar levels in a target range. Second, control of your blood pressure and possibly your lipid levels can affect the impact of diabetes on your retina. follow your eye exam schedule It is extremely important for diabetic patients to maintain the eye examination schedule put in place by the retina specialist. Regular dilated eye exams may not prevent diabetic retinopathy, but it certainly can reduce the risk of developing more severe complications from the disease. By detecting it early, the retina specialist can begin a treatment regimen to help prevent vision loss and slow the disease’s progression.
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dijabetička retinopatija uzrokuje gubitak vida na dva različita načina . U proliferativna dijabetička retinopatija , koji jenajnapredniji oblik (faza 4 ) bolesti , abnormalne krvne žile razvijaju u oku . Ove krvne žile su krhke i lako razbiti , što uzrokuje krvarenje u oku i uzrokuje gubitak vida . U makularne edema , curi krvne žile uzrokovati oticanje u središnjem dijelu mrežnice - dio koji je potreban za oštar vid . U mnogim pacijentima oba uvjeta postoje u isto vrijeme , a može i treba biti tretirana na zasebnom laserska kirurgija sessions.Laser kirurgije u liječenju i dijabetička retinopatija i edem makule se izvodi u liječničkoj ordinaciji . Učenici moraju biti raširene i za laserske tretmane ibolesnik mora sjesti na laser ; .Laser postava sliči biomicroscope slit lampe PRP Scatter laserski tretman , također poznat kao panretinal fotokoagulacijom (PRP ) , koristi se za proliferativnu dijabetičku retinopatiju . Laserska zraka se koristi da uzrokuju male opekline na periferiji mrežnice . Ove opekline uzrokuju abnormalne krvne žile se smanjiti i nestati . Natjecati tretman sadrži između 1000 i 1200 laserske točke i obično završi u nekoliko sesija . To traje nekoliko tjedana za krvnih žila u potpunosti shrink.A kontaktnih leća koje se održava od oka se koriste tijekom postupka laserom , ovaj objektiv donosi periferiju mrežnice u boljem fokusu Focal Laser Za makularne edema ,tehnika se zove žarišna laserski tretman ili fotokoagulacija je zaposlen . Testiranje se provodi prije postupka pokazati liječniku točno gdje curi krvne žile su u makule . Tijekom operacije laser , specifični Propustljiv posude su tretirani s laserom ih zapečatiti i zaustavitipostupak leakage.Focal laser kirurgija je preciznija od raspršeni laserske terapije . Ovaj postupak se obavlja putem kontaktnih leća , kao i, ovaj objektiv pomaže uvećali središnji dio mrežnice paliječnik može liječiti curi krvne žile . Oticanje makule i treba vremena da se poboljša . Rizici Glavni rizici povezani s laserske operacije za dijabetičke retinopatije uključuju slijepe pjege od laser opeklina . U raspršeni laserska terapija , slijepe pjege se nalazi u perifernim vidom , nakon žarišne liječenja , oni se nalaze u središnjem vizualnom field.Generally ove slijepe pjege su privremeni ipacijent ih neće primijetiti tijekom vremena . Neki ljudi mogu primijetiti neke gubitak noćni vid nakon rasuli laserske operacije . Prevencija /Solution Međutim uspješna laserska kirurgija u liječenju dijabetičke retinopatije i sprečavanje daljnje gubitak vid , ovaj tretman se ne može dohvatiti vida koja je prethodno izgubljena zbog dijabetesa . Ta činjenica čini sprečavanje dijabetesa i uske upravljanje dijabetičke bolesti svevažnija . Redoviti pregledi oka također su ključni u upravljanju dijabetes retinopathy.More važnije , jer ne postoji lijek za dijabetes , dijabetes bolest oka može ponovno pojaviti u bilo kojem trenutku u budućnosti . Laserski tretmani mogu ponavljati koliko je potrebno , ali to ne riješi temeljne probleme . From:http://hr.265health.com/surgeries-operations/laser-eye-surgery/1016024369.html