Diabetic Retinopathy in Las Vegas
By: Oryana Otero What is Diabetic Retinopathy?
● It is a complication of diabetes that can lead to vision loss and
blindness
● Elevated sugar levels can damage the blood vessels in the retina
○ Leading to new blood vessel formation, blood vessel swelling,
leaking or disruption
● According to the CDC, it is one of the leading cause of blindness in
American adultsRisk Factors
● People with type 1 or type 2 DM (+
duration of diabetes)
● Race: Hispanics and African
Americans
● Pts with other medical conditions
such as high blood pressure and
high cholesterol
● Pregnancy
● Tobacco useSymptoms
● Blurry vision
● Poor night vision
● Floaters
● Imparied color vision
● Vision loss
● Dark or empty spots in your vision
● Patients may have few or no symptoms during the early stages of
diabetic retinopathyStages of Diabetic
Retinopathy
NPDR (Non-proliferative Diabetic
Retinopathy)
● The early stage of the disease
● Symptoms are mild or nonexistent
● Blood vessel walls may weaken, swell
and leak causing macular edema,
microaneurysms, or hemorrhages
● Sometimes deposits of fat may leak
into the retina, called hard exudates
● Patients can present with blurry
vision at this stageStages of Diabetic
Retinopathy
PDR (Proliferative Diabetic Retinopathy)
● Advanced stage of the disease
● Blood vessels can close off ->
chronic hypoxia -> resulting in new
abnormal blood vessel formation
(neovascularization)
● These new blood vessels can bleed
into the vitreous and can also lead to
scar tissue
● The scar tissue may cause the retina
to detach
● Vision loss can be both central and
peripheral in PDRHow to diagnose
● Screening is indicated 5 years after the diagnosis of type 1 DM and at the
time of diagnosis for those with type 2 DM
● Comprehensive dilated eye exam
● Fluorescein angiography
● Optical Coherence Tomography (OCT)
● The EyeArt AI Eye Screening System
○ In developmentComplications
● Diabetic Macular Edema (DME)
○ Damaged blood vessels in the retina leak fluid and blood -> causing
swelling in the macula
● Neovascular Glaucoma
○ New blood vessel formation can block fluid from draining out of the eye ->
and increase pressure in the eye
● Vitreous Hemorrhage
○ Bleeding into the vitreous and may lead to the presence of floaters (dark
spots)
● Retinal Detachment
○ The scar tissue from new blood vessel growth can cause the retina to
detach
● BlindnessTreatment
● Blood sugar control
● Anti-VEGF drugs (Vascular Endothelial Growth Factor inhibitors)
○ Injection in the eye that reduces swelling of the macula, and may help stop
growth of new blood vessels
● Laser treatment
○ Photocoagulation is a type of laser surgery in which it reduces the leakage
of blood and fluid into the eye, and shrink abnormal blood vessels
● Vitrectomy
○ Surgery that removes blood from the vitreous as well as scar tissueReferences
1. Boyd, Kierstan. “What is Diabetic Retinopathy?” American Academy of Ophthalmology, 18 Sept.
2020, www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy.
2. “Common Eye Disorders and Diseases.” Centers for Disease Control and Prevention, Centers for Disease Control and
Prevention, 3 June 2020, www.cdc.gov/visionhealth/basics/ced/index.html#a5.
3. “Diabetic Retinopathy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30
May 2018, www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611
4. “New England Retina Associates.” NERA, www.retinamd.com/diseases-and-treatments/retinal-conditions-anddiseases/diabetic-retinopathy/.
5. Silverstein, Steven M., and President. “The Role or Artificial Intelligence in Detecting Diabetic Retinopathy.”
CollaborativeEYE,collaborativeeye.com/articles/nov-dec-19/the-role-of-artificial-intelligence-indetecting-diabetic-retinopathy/
Oryana Otero
4th year UAG Student
Dr. Malitz
Diabetic Retinopathy
Diabetic retinopathy is the leading cause of blindness in American adults. It is a
condition where high blood sugar levels damage blood vessels located in the retina. The vessels
become damaged and can start to leak blood and fluid. As the disease progresses, it can lead to
vision changes and even blindness. Those at risk for diabetic retinopathy included both type 1
and type 2 diabetes mellitus. The longer the duration of diabetes, the higher the risk. Other risk
factors include race (African Americans and Hispanics), high blood pressure, high cholesterol,
pregnancy, and tobacco. Symptoms vary based on the severity of the disease, and can include
blurry vision, impaired color vision, floaters, poor night vision, and blindness. There are 2 main
stages of the disease, Non-Proliferative Diabetic Retinopathy (NPDR) and Proliferative Diabetic
Retinopathy (PDR). NPDR is considered the early stage as it is less severe with only few or no
symptoms at all. Since patients can remain asymptomatic at this stage, many of them are
unaware of the presence of the disease. At this point, the retinal blood vessels are beginning to
weaken, swell, and leak. This can lead to the formation of hard exudates (deposits of fat into
the retina), microaneurysms, hemorrhages, and macular edema. PDR is the more severe,
advanced stage. During this time vessels begin to close off leading to chronic hypoxia. This then
results in the formation of new blood vessels, also called neovascularization. Yet, these new
blood vessels are fragile and may leak blood and fluids into the vitreous of the eye as well as
lead to scar tissue. This scar tissue can cause the retina to detach. Patients at this stage may
report vision loss in both central and peripheral fields. Because of the severity of the disease, it
is important to diagnose early via screening. Screening is indicated 5 years after the diagnosis of
Type 1 Diabetes Mellitus and at the time of diagnosis for those with Type 2 Diabetes Mellitus.
There are several ways for a physician to diagnose Diabetic Retinopathy including a
comprehensive dilated eye exam, Fluorescein Angiography, Optical Coherence Tomography
(OCT), and even artificial intelligence technologies are promising. With these exams and
imaging available, the physician may look for abnormalities such as swelling, floaters, new
blood vessels, and more. Complications may arise from disease progression such as Diabetic
Macular Edema. The damaged blood vessels in the retina leak fluid and blood causing swelling
in the macula. Another complication is Neovascular Glaucoma, in which new blood vessel
formation in the front of the eye can block fluid from draining out and thus increasing the
pressure in the eye. As mentioned previously, scar tissue may form with PDR, which may cause
retinal detachment. Lastly, blindness is another severe complication of Diabetic Retinopathy.
Although there is no cure, treatment options are available to stop and delay progression of the
disease as well as reverse some of the vision loss. For patients with NPDR, the optimal
treatment is blood sugar control. In PDR, medications such as anti-VEGF drugs (vascular
endothelial growth factor inhibitors) and steroids may be given to reduce swelling of the
macula and inhibit the growth of new blood vessels. Photocoagulation, a type of laser surgery
can reduce the leakage of blood and fluid into the eye and even shrink the abnormal blood
vessels. Lastly, a vitrectomy is a surgery where blood is removed from the vitreous as well as the
scar tissue.