What are the causes of subconjunctival hemorrhage. How can you identify the symptoms of a broken blood vessel in your eye. When should you seek medical attention for a subconjunctival hemorrhage. What are the risk factors and potential complications associated with this condition.

Understanding Subconjunctival Hemorrhage: A Common Eye Condition

A subconjunctival hemorrhage, often referred to as a broken blood vessel in the eye, is a relatively common and typically harmless condition. It occurs when a small blood vessel ruptures beneath the conjunctiva, the clear surface covering the white part of the eye. This results in a bright red patch on the eye’s sclera, which can appear alarming but is usually benign.

The trapped blood beneath the conjunctiva creates a visible red spot, similar to a bruise on the skin. Many people don’t realize they have a subconjunctival hemorrhage until they notice the redness in a mirror. Despite its striking appearance, this condition rarely causes any pain or vision changes.

Key Characteristics of Subconjunctival Hemorrhage

• Bright red patch on the white of the eye
• Usually painless
• No changes in vision
• Often occurs without obvious injury
• Typically resolves on its own within two weeks

Identifying Symptoms and Signs of Subconjunctival Hemorrhage

The primary symptom of a subconjunctival hemorrhage is the appearance of a bright red patch on the white part of the eye. This patch may vary in size, from a small dot to a larger area covering much of the visible sclera. Despite its dramatic appearance, the condition is generally painless and does not affect vision.

Can a subconjunctival hemorrhage cause discomfort. While most cases are painless, some individuals may experience a mild scratchy sensation on the eye’s surface. This is typically the only discomfort associated with the condition and should not be accompanied by pain, vision changes, or discharge.

Common Symptoms of Subconjunctival Hemorrhage

1. Bright red patch on the eye’s sclera
2. No pain or vision changes
3. Possible mild scratchy feeling
4. No discharge from the eye

Causes and Triggers of Subconjunctival Hemorrhage

The exact cause of a subconjunctival hemorrhage is not always identifiable. However, several common actions and conditions can trigger this eye condition. Understanding these potential causes can help individuals recognize and potentially prevent future occurrences.

Are there everyday activities that can cause a subconjunctival hemorrhage. Yes, surprisingly ordinary actions can lead to this condition. Violent coughing, powerful sneezing, intense straining, and vomiting are all potential triggers. These actions can create sudden pressure changes in the body, potentially rupturing small blood vessels in the eye.

Common Causes of Subconjunctival Hemorrhage

• Violent coughing fits
• Powerful sneezing episodes
• Intense physical straining
• Vomiting
• Roughly rubbing the eye
• Eye trauma from foreign objects

It’s important to note that in many cases, a subconjunctival hemorrhage can occur spontaneously, without any clear cause. This spontaneous occurrence is typically harmless and should not be a cause for immediate concern.

Risk Factors Associated with Subconjunctival Hemorrhage

While subconjunctival hemorrhages can occur in anyone, certain factors may increase an individual’s risk of experiencing this condition. Understanding these risk factors can help people take appropriate precautions and be more aware of their eye health.

Do certain medical conditions increase the risk of subconjunctival hemorrhage. Yes, some medical conditions can make individuals more susceptible to this eye condition. Diabetes and high blood pressure (hypertension) are two such conditions that can increase the likelihood of experiencing a subconjunctival hemorrhage.

Key Risk Factors for Subconjunctival Hemorrhage

• Diabetes
• Hypertension (high blood pressure)
• Use of blood-thinning medications (e.g., warfarin, aspirin)
• Blood-clotting disorders
• Advanced age

Individuals with these risk factors should be particularly vigilant about their eye health and consult with their healthcare provider if they experience recurrent subconjunctival hemorrhages.

Diagnosis and Medical Evaluation of Subconjunctival Hemorrhage

In most cases, a subconjunctival hemorrhage can be diagnosed through a simple visual examination. The characteristic bright red patch on the white of the eye is usually sufficient for a healthcare provider to identify the condition. However, in some instances, particularly if the hemorrhage is recurrent or associated with other symptoms, further evaluation may be necessary.

How do doctors diagnose a subconjunctival hemorrhage. Typically, a healthcare provider will conduct a thorough eye examination, which may include:

1. Visual inspection of the eye
2. Review of medical history and current medications
3. Discussion of recent activities or potential triggers
4. Assessment of overall eye health

In cases where the subconjunctival hemorrhage is due to trauma or is recurrent, your doctor may perform additional tests to rule out other eye conditions or underlying health issues.

When to Seek Medical Attention

While most subconjunctival hemorrhages are harmless and resolve on their own, there are certain situations where medical attention is advised. You should consult a healthcare provider if:

• You experience recurrent subconjunctival hemorrhages
• The condition is accompanied by pain or vision changes
• You have a known blood clotting disorder
• The hemorrhage is a result of significant eye trauma
• You’re taking blood-thinning medications

Treatment and Management of Subconjunctival Hemorrhage

In the majority of cases, a subconjunctival hemorrhage does not require specific treatment. The condition typically resolves on its own within one to two weeks as the body reabsorbs the trapped blood. However, there are some steps individuals can take to manage any discomfort and promote healing.

What can be done to alleviate discomfort from a subconjunctival hemorrhage. While discomfort is usually minimal, some individuals may benefit from the following measures:

• Applying artificial tears to lubricate the eye and reduce any scratchy sensation
• Using a cool compress to soothe the eye and reduce any swelling
• Avoiding rubbing or touching the affected eye
• Protecting the eye from further irritation by wearing sunglasses

It’s important to note that topical treatments like eye drops containing vasoconstrictors or blood-absorbing agents are not typically recommended for subconjunctival hemorrhages, as they do not speed up the healing process and may cause unnecessary irritation.

Monitoring the Healing Process

As the subconjunctival hemorrhage heals, you may notice changes in its appearance. The bright red patch may change color, similar to a bruise, becoming darker or more yellowish before eventually fading completely. This color change is a normal part of the healing process and should not be a cause for concern.

Prevention Strategies for Subconjunctival Hemorrhage

While it’s not always possible to prevent a subconjunctival hemorrhage, there are several strategies individuals can employ to reduce their risk of experiencing this condition. These preventive measures are particularly important for those with known risk factors or a history of recurrent subconjunctival hemorrhages.

How can one reduce the risk of developing a subconjunctival hemorrhage. Consider the following preventive strategies:

1. Manage underlying health conditions: If you have diabetes or hypertension, work closely with your healthcare provider to keep these conditions under control.
2. Be gentle when rubbing your eyes: If you need to touch your eyes, do so gently to avoid causing minor trauma.
3. Protect your eyes: Wear protective eyewear during activities that pose a risk of eye injury.
4. Practice good eye hygiene: Keep your eyes clean and avoid touching them with dirty hands.
5. Manage allergies: If you suffer from allergies that cause eye irritation, work with your doctor to find effective treatments.

For individuals taking blood-thinning medications, it’s crucial to follow your doctor’s instructions carefully and attend regular check-ups to monitor your medication’s effects.

Lifestyle Modifications to Reduce Risk

In addition to the above strategies, certain lifestyle modifications may help reduce the risk of subconjunctival hemorrhage:

• Avoid straining during bowel movements
• Practice stress-reduction techniques to minimize tension
• Stay hydrated to maintain overall eye health
• Get regular eye check-ups, especially if you have risk factors

Long-term Outlook and Potential Complications

The long-term prognosis for individuals who experience a subconjunctival hemorrhage is generally excellent. In the vast majority of cases, this condition resolves completely on its own without any lasting effects or complications. However, it’s important to understand the potential for recurrence and any rare complications that may arise.

Can subconjunctival hemorrhages lead to serious complications. While complications are rare, they can occur in certain circumstances. These may include:

• Recurrent hemorrhages: If subconjunctival hemorrhages occur frequently, it may indicate an underlying health issue that requires medical attention.
• Prolonged healing: In some cases, particularly in individuals with certain medical conditions, the hemorrhage may take longer than usual to heal.
• Secondary infection: Although extremely rare, there is a slight risk of developing an infection if the eye is rubbed excessively or exposed to contaminants.

It’s important to note that these complications are uncommon, and most people who experience a subconjunctival hemorrhage will not face any long-term issues.

Monitoring for Recurrence

If you experience recurrent subconjunctival hemorrhages, it’s advisable to keep a record of their frequency and any potential triggers. This information can be valuable for your healthcare provider in determining if further investigation is necessary. Recurrent hemorrhages may sometimes be an indication of an underlying health condition that requires attention.

Regular eye examinations are particularly important for individuals who have experienced multiple subconjunctival hemorrhages. These check-ups allow your eye care professional to monitor your overall eye health and detect any potential issues early.

Addressing Common Concerns and Misconceptions

Despite the generally benign nature of subconjunctival hemorrhages, their dramatic appearance can often lead to concerns and misconceptions. Addressing these common worries can help individuals better understand the condition and reduce unnecessary anxiety.

Is a subconjunctival hemorrhage a sign of a more serious eye problem. In most cases, no. While the bright red appearance can be alarming, a subconjunctival hemorrhage is typically a harmless condition that resolves on its own. However, if you experience recurrent hemorrhages or have other concerning symptoms, it’s always best to consult with a healthcare provider.

Debunking Common Myths

• Myth: Subconjunctival hemorrhages always require medical treatment.
  Reality: Most cases resolve on their own without any specific treatment.
• Myth: A subconjunctival hemorrhage is a sign of high blood pressure.
  Reality: While hypertension can increase the risk, many people with normal blood pressure can experience this condition.
• Myth: You should avoid all physical activity if you have a subconjunctival hemorrhage.
  Reality: Normal activities can usually be continued, but it’s best to avoid strenuous exercise until the hemorrhage heals.
• Myth: Subconjunctival hemorrhages are contagious.
  Reality: This condition is not contagious and cannot be spread from person to person.

Understanding these facts can help alleviate concerns and ensure appropriate management of subconjunctival hemorrhages.

Integrating Eye Health into Overall Wellness

While subconjunctival hemorrhages are often isolated incidents, they serve as a reminder of the importance of overall eye health. Integrating good eye care practices into your general wellness routine can help maintain healthy eyes and potentially reduce the risk of various eye conditions, including subconjunctival hemorrhages.

How can one maintain good eye health to potentially prevent conditions like subconjunctival hemorrhage. Consider the following practices:

1. Regular eye examinations: Schedule comprehensive eye exams as recommended by your eye care professional.
2. Protect your eyes: Wear appropriate protective eyewear during sports or other activities that pose a risk of eye injury.
3. Maintain a healthy diet: Consume foods rich in vitamins A, C, and E, as well as omega-3 fatty acids, which are beneficial for eye health.
4. Stay hydrated: Proper hydration is crucial for maintaining the eye’s natural lubrication.
5. Practice the 20-20-20 rule: Every 20 minutes, take a 20-second break and look at something 20 feet away to reduce eye strain, especially if you spend long hours looking at screens.
6. Manage chronic conditions: Keep conditions like diabetes and hypertension under control, as they can affect eye health.
7. Avoid smoking: Smoking can increase the risk of various eye problems.

By incorporating these practices into your daily routine, you can promote overall eye health and potentially reduce the risk of various eye conditions, including subconjunctival hemorrhages.

The Role of Regular Eye Check-ups

Regular eye examinations play a crucial role in maintaining eye health and detecting potential issues early. During these check-ups, your eye care professional can:

• Assess your overall eye health
• Screen for common eye conditions
• Update your vision prescription if needed
• Provide personalized advice on eye care based on your individual needs and risk factors

For most adults, an eye examination every one to two years is recommended. However, individuals with certain risk factors or existing eye conditions may need more frequent check-ups.

Subconjunctival hemorrhage (broken blood vessel in eye) – Symptoms & causes

Overview

A subconjunctival hemorrhage (sub-kun-JUNK-tih-vul HEM-uh-ruj) occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva). In many ways, it’s just like having a bruise on your skin. The conjunctiva can’t absorb blood very quickly, so the blood gets trapped. You may not even realize you have a subconjunctival hemorrhage until you look in the mirror and notice that the white part of your eye is bright red.

Broken blood vessel in the eye

A broken blood vessel in the eye may look alarming, but it’s usually harmless.

A subconjunctival hemorrhage often occurs without any obvious harm to your eye. Even a strong sneeze or cough can cause a blood vessel to break in the eye. You don’t need to treat it. A subconjunctival hemorrhage may look alarming, but it’s usually a harmless condition that disappears within two weeks or so.

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Symptoms

The most obvious sign of a subconjunctival hemorrhage is a bright red patch on the white (sclera) of your eye.

Despite its bloody appearance, a subconjunctival hemorrhage looks worse than it is and should cause no change in your vision, discharge or pain. Your only discomfort may be a scratchy feeling on the surface of the eye.

When to see a doctor

If you have recurrent subconjunctival hemorrhages or other bleeding, talk to your doctor.

Causes

The cause of a subconjunctival hemorrhage isn’t always known. The following actions may cause a small blood vessel to rupture in your eye:

• Violent coughing
• Powerful sneezing
• Straining
• Vomiting

In some cases, a subconjunctival hemorrhage may result from an eye injury, including:

• Roughly rubbing your eye
• Trauma, such as a foreign object injuring your eye

Risk factors

Risk factors for a subconjunctival hemorrhage include:

• Diabetes
• High blood pressure (hypertension)
• Certain blood-thinning medications, such as warfarin (Coumadin, Jantoven) and aspirin
• Blood-clotting disorders

Complications

Health complications from a subconjunctival hemorrhage are rare. If your condition is due to trauma, your doctor may evaluate your eye to ensure you don’t have other eye complications or injury.

Prevention

If the bleeding on the surface of your eye has a clearly identifiable cause, such as a bleeding disorder or blood-thinning medication, ask your doctor if you can take any steps to reduce the risk of a subconjunctival hemorrhage.

If you need to rub your eyes, rub them gently. Rubbing too hard can cause minor trauma to your eyes, which may lead to a subconjunctival hemorrhage.

Subconjunctival hemorrhage (broken blood vessel in eye) – Symptoms & causes

Overview

A subconjunctival hemorrhage (sub-kun-JUNK-tih-vul HEM-uh-ruj) occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva). In many ways, it’s just like having a bruise on your skin. The conjunctiva can’t absorb blood very quickly, so the blood gets trapped. You may not even realize you have a subconjunctival hemorrhage until you look in the mirror and notice that the white part of your eye is bright red.

Broken blood vessel in the eye

A broken blood vessel in the eye may look alarming, but it’s usually harmless.

A subconjunctival hemorrhage often occurs without any obvious harm to your eye. Even a strong sneeze or cough can cause a blood vessel to break in the eye. You don’t need to treat it. A subconjunctival hemorrhage may look alarming, but it’s usually a harmless condition that disappears within two weeks or so.

Products & Services

Symptoms

The most obvious sign of a subconjunctival hemorrhage is a bright red patch on the white (sclera) of your eye.

Despite its bloody appearance, a subconjunctival hemorrhage looks worse than it is and should cause no change in your vision, discharge or pain. Your only discomfort may be a scratchy feeling on the surface of the eye.

When to see a doctor

If you have recurrent subconjunctival hemorrhages or other bleeding, talk to your doctor.

Causes

The cause of a subconjunctival hemorrhage isn’t always known. The following actions may cause a small blood vessel to rupture in your eye:

• Violent coughing
• Powerful sneezing
• Straining
• Vomiting

In some cases, a subconjunctival hemorrhage may result from an eye injury, including:

• Roughly rubbing your eye
• Trauma, such as a foreign object injuring your eye

Risk factors

Risk factors for a subconjunctival hemorrhage include:

• Diabetes
• High blood pressure (hypertension)
• Certain blood-thinning medications, such as warfarin (Coumadin, Jantoven) and aspirin
• Blood-clotting disorders

Complications

Health complications from a subconjunctival hemorrhage are rare. If your condition is due to trauma, your doctor may evaluate your eye to ensure you don’t have other eye complications or injury.

Prevention

If the bleeding on the surface of your eye has a clearly identifiable cause, such as a bleeding disorder or blood-thinning medication, ask your doctor if you can take any steps to reduce the risk of a subconjunctival hemorrhage.

If you need to rub your eyes, rub them gently. Rubbing too hard can cause minor trauma to your eyes, which may lead to a subconjunctival hemorrhage.

Macular degeneration – EuroEyes

How can you diagnose macular degeneration and how can EuroEyes help you?

Macular degeneration is a degenerative change in the macula of the retina. The macula is the central part of the retina at the back of the eye that allows you to see objects clearly and engage in activities such as reading and driving. When macular dysfunction occurs, blurred central vision and dark spots appear, and straight lines appear crooked.

Macular degeneration affects vision near and far, making it difficult or even impossible for you to read or thread a needle. Macular degeneration affects only central vision, but does not affect lateral (peripheral) vision. For example, you can see the contours of a clock, but you cannot see what the clock hands are showing. Macular degeneration by itself does not lead to total blindness. Even in more severe cases, patients have partial vision and can often take care of themselves. In many cases, the impact of macular degeneration on vision can be minimal.

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• REASONS
• SYMPTOMS
• DEFINITION
• DIAGNOSIS
• TREATMENT

WHAT ARE THE REASONS FOR THE DEVELOPMENT OF MACULODYSTROPHY?

Macular degeneration in most older people is part of the body’s natural aging process. There are several types of macular degeneration, but the most common type is age-related macular degeneration (AMD). At the moment, it is impossible to accurately determine the causes of the development of the disease and, unfortunately, there is no sufficiently effective method of treatment. Macular degeneration is the most common cause of blindness in people over 65 years of age.

There are two types of AMD – “dry” (atrophic) and “wet” (exudative):

“Dry” (atrophic) macular degeneration

Most people develop the “dry” form of AMD. This form develops with age in 90% of cases due to thinning of the macular tissue of the retina. The loss of vision in this form of macular degeneration occurs gradually.

“Wet” (exudative) macular degeneration

“Wet” form develops in 10% of all cases of AMD, but most of these patients almost completely lose their sight. Wet WDM occurs when there is a compensatory growth of pathological blood vessels that grow under the retina from the underlying choroid. Newly formed vessels secrete fluid or bleed under the retina, tearing it away from the back of the eye. As a result, there is a rapid deterioration of central vision, and then blindness may occur.

The most common signs of macular degeneration are small deposits inside the retina, the so-called senile plaques (or drusen). Plaques do not in themselves lead to vision loss, but an increase in their size or number may increase the risk of developing wet AMD. An increased risk of developing blindness is possible with a significant increase in senile plaques in the “dry” form of AMD or with the growth of pathological blood vessels under the macula in the “wet” form of AMD.

WHAT ARE THE SYMPTOMS OF MACULODYSTROPHY?

Different patients experience different symptoms of macular degeneration. This disease can be practically asymptomatic in the early stages of development. Sometimes the loss of vision occurs in only one eye, while the other eye can see well for many years. But if both eyes are damaged, the loss of central vision can be immediately noticeable.

Consult your EuroEyes doctor if you notice the following symptoms:

HOW TO DETECT MACULODYSTROPHY?

The main symptoms of macular degeneration are blurry text or curvature of straight lines. You can check your vision with the Amsler grid.

How to use the mesh:

• If you wear reading glasses, wear them and hold the mesh 30-40 cm away from your face in good light.

• Cover one eye.

• Look directly at the center point with an open eye.

• Observe if any of the lines become crooked, blurry or darker.

• Repeat this with the other eye

If the grid lines become crooked, you should see one of our doctors immediately. You will undergo a medical examination in which an image of the retina is taken to look for abnormal blood vessels, fluid, and blood under the retina.

HOW IS MACULODYSTROPHY DIAGNOSED?

Many people are not even aware of the occurrence of pathological changes in the macula until they begin to notice a violation of the central visual field. Our ophthalmologists can detect AMD in the early stages using the following types of diagnostics:

• Amsler mesh;

• Examination of the macula with special lenses;

• Specialized photographs of the eye such as fluorescein angiography (FA) and optical coherence tomography (OCT). These types of diagnostics allow you to determine the presence of abnormal blood vessels, fluid or blood under the retina.

HOW IS MACULODYSTROPHY TREATED?

Laser surgery, photodynamic therapy (PDT), and anti-VEGF therapy

Some types of wet macular degeneration are amenable to laser treatment, a rapid outpatient procedure in which newly formed blood vessels are destroyed by a laser beam. After the procedure, the blood vessels that destroy the macula stop bleeding and secrete fluid.

Photodynamic therapy is carried out by intravenous administration of a special drug in combination with laser therapy. This method also slows down or stops the bleeding of blood vessels.

In severe cases of the development of the disease, a special drug is used that acts on a protein that stimulates the growth of pathological vessels under the retina. This protein is called vascular endothelial growth factor (VEGF). Anti-VEGF therapy is carried out with the help of the drug Lucentis, injected into the cavity of the eyeball. This drug blocks vascular growth factor, reducing the growth of abnormal blood vessels and reducing the permeability of their walls.

Adaptation to low vision

To help you adjust to low vision, your EuroEyes ophthalmologist can prescribe a special optical device for you or refer you to a low vision specialist or similar centre. There are many assistive devices and rehabilitation programs available to help people with macular degeneration maintain a fulfilling lifestyle.

Since peripheral vision is preserved, it can be very helpful. People can continue to enjoy their favorite activities using visual aids for low vision, such as magnifiers, closed-circuit television, large-format printouts, and voice-enabled computer devices.

If you or someone you know is experiencing symptoms of macular degeneration, please contact Euroeyes.

Wyomissing Diabetes Eye Care, Pottsville, Pottstown, Lebanon

Overview:

Things to Know and Remember:

• Diabetic eye disease includes a group of eye diseases that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataracts and glaucoma.
• All forms of diabetic eye disease can lead to severe vision loss and blindness.
• Diabetic retinopathy includes changes in the blood vessels of the retina that can cause bleeding or fluid leakage that distorts vision.
• Diabetic retinopathy is the most common cause of vision loss among people with diabetes and the leading cause of blindness among adults of working age.
• DME is a consequence of diabetic retinopathy, which causes swelling in an area of ​​the retina called the macula.
• Controlling diabetes—taking your medications as prescribed, staying physically active, and eating a healthy diet—may prevent or delay vision loss.
• Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should have a comprehensive eye examination with enhanced vision at least once a year.
• Early detection, timely treatment, and appropriate follow-up of diabetic eye disease can protect against vision loss.
• Diabetic retinopathy can be treated with several therapies, used alone or in combination.

About diabetic eye disease

What is diabetic eye disease?

Diabetic eye disease is a group of eye diseases that can affect people with diabetes.

Diabetic retinopathy is the most common diabetic eye disease. Diabetic retinopathy affects the blood vessels in the light-sensitive tissue called the retina, which lines the back of the eye. It is the most common cause of vision loss in people with diabetes and the leading cause of visual impairment and blindness in adults of working age.

Diabetic macular edema (DME). A consequence of diabetic retinopathy, DME, is the accumulation of fluid (edema) in an area of ​​the retina called the macula. The macula is important for sharp, direct vision, which is used for reading, recognizing faces, and driving. DME is the most common cause of vision loss in people with diabetic retinopathy. About half of all people with diabetic retinopathy develop DME. Although DME occurs more frequently as diabetic retinopathy worsens, it can occur at any stage of the disease.

Diabetic eye disease can also include cataracts and glaucoma. Adults with diabetes are 2 to 5 times more likely to develop cataracts than people without diabetes. Cataracts also tend to develop at an earlier age in people with diabetes. In glaucoma, diabetes almost doubles the risk of glaucoma in adults.

All forms of diabetic eye disease can lead to severe vision loss and blindness. This is why early diagnosis and treatment is always the best option for diabetic patients. In fact, because diabetic eye disease often goes unnoticed until vision loss occurs, people with diabetes should have their diabetic eye examined at least once a year.

What are the types of diabetic retinopathy?
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Diabetic retinopathy is usually classified into two stages: non-proliferative and proliferative. Non-proliferative diabetic retinopathy (NPDR), the most common type of diabetic retinopathy, occurs when the blood vessels in a person’s retina weaken and tiny bulges protrude from their walls. Proliferative diabetic retinopathy (PDR) is a more severe type of diabetic retinopathy and occurs when abnormal blood vessels grow. This can lead to bleeding or scar tissue, which can lead to retinal detachment and permanent vision loss. Both NPDR and PD can cause diabetic macular edema (DME), which can lead to loss of central vision.

Who is at risk for diabetic retinopathy?
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Anyone with type 1 or type 2 diabetes can develop diabetic retinopathy. The longer a person has diabetes and the less blood sugar is controlled, the more likely they are to develop the disease. Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy, although only about half are aware of it. Women who develop or develop diabetes during pregnancy may experience a rapid onset or worsening of diabetic retinopathy. While it may cause no symptoms or cause mild vision problems, it should not be forgotten that diabetic retinopathy can still lead to blindness and requires treatment.

What causes diabetic retinopathy?
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Chronically high blood sugar in diabetes is associated with damage to tiny blood vessels in the retina, leading to diabetic retinopathy. The retina picks up light and converts it into signals that are sent through the optic nerve to the brain. Diabetic retinopathy can cause fluid to leak from the retinal blood vessels or hemorrhage (bleeding), resulting in blurred vision. In the most advanced stage, new abnormal blood vessels proliferate (enlarge) on the surface of the retina, which can lead to scarring and loss of retinal cells.

Diabetic retinopathy can progress in four stages:

1. Mild non-proliferative retinopathy. At this early stage of the disease, small areas of balloon-like swelling develop in tiny retinal blood vessels called microaneurysms. These microaneurysms can leak fluid into the retina.
2. Moderate non-proliferative retinopathy. As the disease progresses, the blood vessels that feed the retina may swell and become deformed. They may also lose their ability to transport blood. Both conditions cause characteristic changes in the appearance of the retina and may contribute to DME.
3. Severe non-proliferative retinopathy. Many other blood vessels are blocked, cutting off blood supply to the retinal area. These areas release growth factors that signal the retina to grow new blood vessels.
4. Proliferative diabetic retinopathy (PDR). At this late stage, growth factors secreted by the retina cause the proliferation of new blood vessels that grow along the inner surface of the retina into the vitreous humor, the fluid that fills the eye. New blood vessels are fragile, making them more likely to leak and bleed. The accompanying scar tissue can shrink and cause retinal detachment—the retinal detachment from the underlying tissue, much like wallpaper peels off a wall. Retinal detachment can lead to permanent loss of vision.

symptoms

What are the symptoms?

The early stages of diabetic retinopathy are usually asymptomatic. The disease often progresses insidiously until it affects vision. Bleeding from abnormal retinal vessels can cause floating spots. Sometimes these spots disappear on their own. But without timely treatment, bleeding often recurs, increasing the risk of irreversible vision loss. If diabetic macular edema (DME) occurs, it can cause blurred vision.

How are diabetic retinopathy and DME diagnosed?
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Diabetic retinopathy and DME are identified during a comprehensive dilated eye exam that includes:

• Visual acuity testing. This vision chart test measures a person’s ability to see at various distances.
• Tonometry. This test measures the pressure inside the eye.
• Pupil dilation. Drops placed on the surface of the eye dilate (dilate) the pupil, allowing the doctor to examine the retina and optic nerve.

Optical coherence tomography (OCT). This method is similar to ultrasound but uses light waves instead of sound waves to capture images of tissues inside the body. OCT provides detailed images of tissues through which light can penetrate, such as the eyes.

A comprehensive eye examination with enhanced vision allows the doctor to check the retina for:

• Blood vessel changes
• Leaky blood vessels or warning signs of leaky blood vessels such as fatty deposits
• Macular edema
• Lens changes
• Nervous tissue injury

If DME or severe diabetic retinopathy is suspected, a fluorescein angiogram can be used to look for damaged or leaking blood vessels. In this test, a fluorescent dye is injected into the bloodstream, often into a vein in the arm. Pictures of retinal blood vessels are taken as the dye reaches the eye.

How can people with diabetes protect their eyesight?
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Vision loss due to diabetic retinopathy is sometimes irreversible; however, early detection and treatment can reduce the risk of blindness by 95 percent. Because diabetic retinopathy often has no early symptoms, people with diabetes should have a comprehensive eye examination with extended vision at least once a year. People with diabetic retinopathy may need more frequent eye exams. Women with diabetes who become pregnant should have a complete eye exam with pupil dilation as soon as possible. Additional examinations may be required during pregnancy.

Studies such as the Diabetes Control and Complications Study (DCCT) have shown that control of diabetes slows the onset and worsening of diabetic retinopathy. Participants in the DCCT study who maintained their blood glucose levels as close to normal as possible were significantly less likely to develop diabetic retinopathy and kidney and nerve disease than those who did not have optimal glucose control. Other studies have shown that controlling high blood pressure and cholesterol levels can reduce the risk of vision loss in people with diabetes.

Treatment of diabetic retinopathy focuses on the treatment of diabetic retinopathy and diabetic macular edema. Comprehensive extended eye exams are needed more frequently as diabetic retinopathy becomes more severe. People with more severe retinopathy require more frequent follow-up, which will be individually tailored by your ophthalmologist.

Treatment options

What are my treatment options?

Treatment options depend on the nature of the diabetic eye disease, but may include medication, laser, and sometimes surgery.

In the presence of early non-proliferative diabetic retinopathy, eye treatment may not be required if blood sugar levels are maintained at the proper level. If you have severe non-proliferative or proliferative diabetic retinopathy, laser treatments, surgery, or injectable drugs are available that can reverse, slow, or stop the progression of diabetic retinopathy.

Based on your vision diagnosis during the examination, our diabetic ophthalmologists will discuss the most appropriate treatment options with you.

How to treat proliferative diabetic retinopathy (PDR)?
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For decades, PDR has been treated with scattered laser surgery, sometimes called panretinal laser surgery or panretinal photocoagulation. Treatment involves performing 1,000 to 2,000 tiny laser burns in areas of the retina away from the macula. These laser burns are designed to shrink abnormal blood vessels. Although the treatment can be completed in one session, sometimes two or more sessions are required. While it may preserve central vision, diffuse laser surgery may result in some loss of lateral (peripheral), color and night vision. Scattered laser surgery works best before the new, fragile blood vessels begin to bleed. Recent studies have shown that anti-VEGF therapy is not only effective in treating DME, but also effective in slowing the progression of diabetic retinopathy, including PDR, so anti-VEGF is increasingly being used as first-line therapy for PDR.

When do patients with diabetic retinopathy need surgery?
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In some cases of proliferative diabetic retinopathy (PDR), new blood vessels can cause severe bleeding called vitreous haemorrhage. This bleeding can block vision and prevent your optometrist from performing laser treatment. In addition, neovascularization can lead to retinal detachment, putting the patient at risk of severe vision loss. In these cases, your retinal specialist may recommend surgery to remove the blood or repair a retinal detachment.

What is laser treatment for non-proliferative diabetic retinopathy?
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In non-proliferative diabetic retinopathy (NPDR), blood vessel leaks can cause diabetic macular edema (DME) and vision loss. The purpose of the DME laser in NPDR is to stop the leak and prevent further loss of vision. In some cases of severe NPDR, a peripheral laser is used to prevent the development of proliferative retinopathy.

How about laser treatment for proliferative diabetic retinopathy?
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If the number of new vessels is high, laser treatment can often prevent vision loss. A type of laser treatment that is performed on a large number of vessels is called panretinal photocoagulation. This type of laser treatment is usually done in two or more separate sessions. The idea is to use a laser to destroy all the dead areas of the retina where the blood vessels have been blocked. When these areas are treated with a laser, the retina stops producing new blood vessels, and the ones that do tend to shrink or disappear.

Panretinal photocoagulation may have side effects and usually does not improve vision; it is a means of maintaining stable vision to prevent further loss of vision. After laser treatment, patients may still have reduced vision or may continue to lose vision. But if a laser is indicated, there is a chance that laser treatment will prevent serious vision loss.

Panretinal photocoagulation is performed at the periphery of the retina rather than in the center, and peripheral vision may be reduced. These peripheral areas are treated to preserve central vision as much as possible and preserve the eye itself. Night vision may also be reduced. After the laser, blurred vision often occurs. This blurring usually disappears, but in a small number of patients some blurring may remain permanently.

How is DME treated?
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DME can be treated with several therapies, which can be used alone or in combination.

Anti-VEGF injection therapy. Anti-VEGF drugs are injected into the vitreous gel to block a protein called vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessel growth and fluid leakage. Blocking VEGF can reverse the abnormal growth of blood vessels and reduce the amount of fluid in the retina. Available anti-VEGF drugs include Avastin (bevacizumab), Lucentis (ranibizumab), and Eylea (aflibercept). Lucentis and Eylea are approved by the US Food and Drug Administration (FDA) for the treatment of DME. Avastin has been approved by the US Food and Drug Administration (FDA) for the treatment of cancer, but is commonly used to treat a variety of eye conditions, including DME and severe diabetic retinopathy.

Avastin, Lucentis and Eilea vary in cost and how often they need to be administered, and treatment will be individual for each patient.

Focal/lattice laser macular surgery. In focal/lattice laser macula surgery, small laser burns are applied to leaking blood vessels in areas of swelling near the center of the macula. Laser burns in DME slow fluid leakage, reducing retinal edema. The procedure is usually completed in one session, but some people may need more than one session. The focus/reticulum laser can be used with or without anti-VEGF injections.

Corticosteroids. Corticosteroids, injected or implanted in the eye, may be used alone or in combination with other drugs or laser surgery to treat DME. The Ozurdex (dexamethasone) implant is for short term use, while the Iluvien (fluocinolone acetonide) implant lasts longer. Both release a sustained dose of corticosteroids to suppress DME. The use of corticosteroids in the eyes increases the risk of cataracts and glaucoma. Patients with DME taking corticosteroids should be monitored for increased intraocular pressure and glaucoma.

What is a vitrectomy?
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Vitrectomy is the surgical removal of the vitreous in the center of the eye. The procedure is used to treat severe bleeding into the vitreous body and is performed under local or general anesthesia. Ports (temporary waterproof openings) are placed in the eye to allow the surgeon to insert and remove instruments, such as a tiny light source or a small vacuum cutter called a vitrector. A clear saline solution is gently pumped into the eye through one of the ports to maintain intraocular pressure during surgery and to replace the removed vitreous or blood in diabetic retinopathy. The same instruments used during a vitrectomy can also be used for laser treatment, removal of scar tissue, or repair of a detached retina.

Vitrectomy is usually performed on an outpatient basis. After surgery, the eye is treated with eye drops while the surgeon monitors the healing of the eye.

Take the first step

If you have diabetes, the first step is a thorough comprehensive eye examination by one of our diabetic ophthalmologists. Our doctors use very specialized technology – as well as years of training and experience – to examine your eyes and check for diseases. During the examination, your doctor will personally discuss with you the health of your eyes, how your condition is affecting your vision, and what treatment options are available. Conclusion: trust the experts. Insist on eye consultants from Pennsylvania.

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