Diabetic Retinopathy

Limiting the disability of diabetes mellitus has been greatly advanced with laser control of retinal disease. The onset of retinopathy is the appearance of microaneurysms indicative of diabetic angiopathy. Microaneurysms represent the beginning of a progression from background to proliferative reti-nopathy with neovascularization. Advanced retinopathy is caused by continuing capillary failure with leakage, hemorrhage, and closure, producing zones of retinal ischemia. The resulting compensatory capillary proliferation in the isch-emic parts of the retina is prone to leak and rupture, causing gross hemorrhage. A reabsorbing hemorrhage in the vitreous can exert a pull on the retina resulting in retinal detachment with onset of blindness. Capillary hemorrhage can be detected by inspection or imaging modalities. Treatment by laser application decreases angiogenesis and further hemor-rhagic risks. Vitreous hemorrhage can be removed, restoring vision and eliminating the risk of retinal detachment.

All type 1 diabetic patients should begin to have periodic dilated retinal examinations about 5 years after diagnosis. Because of the long asymptomatic latent period of type 2 diabetes, these formal eye evaluations should begin at the onset of type 2 diabetic management. In patients maintaining near normal HbA1c of 7% or less, some authorities believe that formal dilated eye examinations can be deferred longer than 12 months.

Measures to prevent diabetic retinopathy include maintenance of glycemic control with avoidance of the stress of hypoglycemic reactions and control of blood pressure (BP). Aspirin therapy does not exacerbate or predispose to bleeding. However, intensive physical activity (exercise, sexual intercourse) can promote ocular bleeding.

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