Diabetic
retinopathy is one of the leading causes of blindness.
Retinopathy is classified as to non- proliferative
and proliferative retinopathy. Non-proliferative background
diabetic retinopathy has microaneurysms, dilated veins
and hemorrhages. Proliferative retinopathy has cotton-wool
spots, neovascularization vitreous hemorrhage and
retinal detachment. Macular edema is present in both
forms and is the most frequent cause of visual loss
among patients with background diabetic retinopathy.
Blindness is 25 times more common in diabetics than
in the general population. Anyone with diabetes over
age 30 should be examined by an ophthalmologist at
the time of initial diagnosis and at least yearly
thereafter. This can become particularly aggressive
during pregnancy and pregnant women should be examined
by an ophthalmologist in the first trimester. In patients
with high-risk proliferative disease and for patients
with clinically significant macular edema, those who
are treated appropriately are more likely to have
better visual outcomes than those who are not. This
reduces the rate of severe visual loss by over 50%.
A dilated exam is necessary to correctly classify
the presence and severity of retinopathy. In the Diabetic
Trial strict control of diabetes with multidose insulin
decreased the development of retinopathy by 75%. It
reduced the risk of background retinopathy developing
to proliferative retinopathy requiring laser treatment
by 50%.
Mark F. Johnson, M.D.
J. Lawrence Sippe, M.D.
Department of Ophthalmology
