Retinopathy in Diabetes


Retinopathy in Diabetes   (Citations: 67)
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iabetic retinopathy is the most fre- quent cause of new cases of blind- ness among adults aged 20 -74 years. During the first two decades of dis- ease, nearly all patients with type 1 diabe- tes and 60% of patients with type 2 diabetes have retinopathy. In the Wisconsin Epidemiologic Study of Diabetic Retinopa- thy (WESDR), 3.6% of younger-onset pa- tients (type 1 diabetes) and 1.6% of older- onset patients (type 2 diabetes) were legally blind. In the younger-onset group, 86% of blindness was attributable to diabetic reti- nopathy. In the older-onset group, in which other eye diseases were common, one-third of the cases of legal blindness were due to diabetic retinopathy. NATURAL HISTORY OF DIABETIC RETINOPATHY Diabetic retinopathy progresses from mild nonproliferative abnormalities, characterized by increased vascular per- meability, to moderate and severe non- proliferative d iabetic r etinopathy (NPDR), characterized by vascular clo- sure, to proliferative diabetic retinopathy (PDR), characterized by the growth of new blood vessels on the retina and pos- terior surface of the vitreous. Macular edema, characterized by retinal thicken- ing from leaky blood vessels, can develop at all stages of retinopathy. Pregnancy, puberty, blood glucose control, hyperten- sion, and cataract surgery can accelerate these changes. Vision-threatening retinopathy is rare in type 1 diabetic patients in the first 3-5 years of diabetes or before puberty. Dur- ing the next two decades, nearly all type 1 diabetic patients develop retinopathy. Up to 21% of patients with type 2 diabetes have retinopathy at the time of first diag- nosis of diabetes, and most develop some degree of retinopathy over time. Vision loss due to diabetic retinopathy results from several mechanisms. Central vision may be impaired by macular edema or capillary nonperfusion. New blood ves- sels of PDR and contraction of the accom- panying fibrous tissue can distort the retina and lead to tractional retinal de- tachment, producing severe and often ir- reversible vision loss. In addition, the new blood vessels may bleed, adding the fur- ther complication of preretinal or vitreous hemorrhage. Finally, neovascular glau- coma associated with PDR can be a cause of visual loss.
Published in 2004.
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