Retinopathy
What Is It?
Retinopathy refers to diseases that affect the retina, the collection of light-sensitive cells lining the back half of each eye. The retina contains nerve cells that translate what you see into electrical impulses. These impulses are transmitted to the brain, where they are interpreted.
The retina contains many blood vessels. Abnormalities in these vessels cause several forms of retinopathy. Retinopathy can cause partial loss of vision or complete blindness. It can develop slowly or occur suddenly. Retinopathy can get better on its own at any time or it can cause permanent damage, depending on what's causing it and how far it has progressed.
Symptoms
Retinopathy of prematurity — There are no outward physical signs. Only an experienced ophthalmologist examining the eye through a dilated pupil can find signs of this illness.
Diabetic retinopathy — Symptoms may not be noticed until the late stages of the illness and can include:
* Blurred vision
* Sudden loss of vision in one or both eyes
* Black spots
* Flashing lights
* Difficulty reading or seeing detailed work
Hypertensive retinopathy — There are often no symptoms, though some people complain of blurred vision.
Central serous retinopathy — Symptoms include:
* Blurred or dim vision, sometimes coming on suddenly
* Blind spots
* Distorted shapes
* Reduced visual sharpness
Prevention
Retinopathy of prematurity — The first line of defense is regular prenatal care to prevent premature birth and complications during childbirth. Premature and low-birth-weight infants should be screened for retinopathy of prematurity if they are born at less than 36 weeks of gestation or weigh less than 4 pounds 6 ounces (2,000 grams) at birth. Because retinopathy of prematurity can be caused by or get worse from not having enough oxygen after birth or having too much, oxygen levels are monitored closely and adjusted accordingly.
Diabetic retinopathy — Controlling blood sugar and blood pressure are essential to prevent diabetic retinopathy. Doctors monitor blood sugar control by measuring a type of hemoglobin protein in the blood, hemoglobin A1C. If you are able to reduce your blood sugar average by the equivalent of one A1C point, you will reduce your risk for retinopathy by 35% over the next 10 years. Annual eye exams are crucial for people with diabetes. If proliferative and nonproliferative retinopathy are discovered during an annual exam, your doctor probably will recommend more frequent eye exams. Treatment can start before sight is affected and can delay vision impairment.
Hypertensive retinopathy — Avoid high blood pressure by getting regular exercise, maintaining proper body weight, eating a healthy diet and seeing your doctor for regular checkups. Many Americans do not control their blood pressure well enough. It is important to take blood pressure medications as directed by your doctor if your blood pressure remains high even after you have made lifestyle changes.
Central serous retinopathy — Because the possible causes of this disease are still not clearly known, prevention is difficult. Many cases of central serous retinopathy have been associated with prescription corticosteroid treatment, so this is one of several reasons that make it important to minimize as much as possible the dose of corticosteroids that is used and length of treatment.
Treatment
Retinopathy of prematurity — No treatment is recommended during the early stages, but close monitoring is essential. An ophthalmologist should examine high-risk infants before they are discharged from the newborn nursery and again at 8 weeks of age. If the disease is active, the infant should be examined every one to two weeks until he or she is 14 weeks old, and every one to two months after that. More advanced disease may require treatment to get rid of abnormal blood vessels. Treatment includes a procedure called cryotherapy, in which cold is used to destroy abnormal cells, and laser treatments. A detached retina can be reattached.
Diabetic retinopathy — To keep diabetic retinopathy from getting worse, blood sugar and blood pressure must be controlled to avoid complications. Specific treatment for diabetic retinopathy depends on the nature of the problem:
* Proliferative disease and macular edema (swelling or leaking of the main part of the retina) can be treated with laser therapy (photocoagulation).
* The formation of new blood vessels (neovascularization) is treated with laser surgery to create scars that slow the growth of new blood vessels. Laser surgery also is used to secure the retina to the back of the eye.
* Hemorrhaging that clouds vision can be treated by removing all or part of the vitreous material. Laser surgery may be used during the procedure.
* Retinal detachment requires surgery to reattach the retina to the back of the eye. All or part of the vitreous material may be removed at this time.
Hypertensive retinopathy — Medications can lower blood pressure and improve changes in the retina. People with very high blood pressure and swelling of the optic nerve require emergency treatment in a hospital.
Central serous retinopathy — This condition usually goes away on its own, but an ophthalmologist should monitor you closely for three to six months to make sure the condition improves. If it does not, laser treatment may be used to speed healing.
