Tufts OCW material is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Diabetic retinopathy (DR) is caused by changes in the retinal vasculature induced by frequent or prolonged episodes of hyperglycemia. In the proliferative stage of DR, circulatory problems can cause areas of the retina to become oxygen deprived or ischemic.
In addition to developing active neovascularization, significant fibrosis can occur with either NVD or NVE.
DR is known to have a significant effect on overall health-related quality of life (HRQoL) and vision-specific function. Control of various systemic factors, such as blood pressure, lipid levels, blood sugar levels and renal function, is recommended for managing patients with DR. Patients with untreated proliferative DR are at a significant risk for the development of severe visual loss secondary to vitreous hemorrhage or tractional retinal detachment. While retinal laser and vitrecomy surgery have been the mainstay of treatment for DR for the past 20 years, other treatments for this condition are emerging.
Sanjay Sharma, MD, is director of the Cost-Effective Ocular Health Policy Unit, deputy head of the department of ophthalmology, associate professor, department of ophthalmology, and assistant professor, department of epidemiology, Queen’s University, Kingston, Ontario.


This impairs breathing, thereby reducing the amount of O2 in the capillaries that supply the lungs. In its early phases, there is thickening of retinal capillary endothelial cell basement membranes and the loss of pericytes that support the retinal capillaries.1 These changes ultimately lead to focal areas of weakness in the vessel walls through which red blood cells, lipids and proteins can leak. The presence of nonproliferative retinopathy is characterized by retinal hemorrhages, exudates and microaneurysms.
As the circulatory system attempts to maintain adequate oxygen levels within the retina, angiogenic factors are released that predispose to the formation of retinal neovascularization.3 Clinically, this stage of retinopathy is characterized by the presence of new blood vessels on the surface of the optic nerve head (neovascularization of the disc [NVD]) or retina itself (neovascularization elsewhere [NVE]). This component of neovascularization can cause retinal traction to the point of retinal tear or detachment. Hyperlipidemia can contribute to the progression of DR as accumulation of retinal exudates can lead to vision loss from a foveal lipid plaque.
With worsening disease, focal ischemia of the retina may occur and cause the formation of cotton-wool spots. New retinal blood vessels are fragile and may bleed into the retina or the vitreous, the jelly portion of the eye. The angiogenic factors that are released in response to retinal ischemia can also migrate anteriorly towards the front of the eye and stimulate the creation of anterior segment neovacularization. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders.


Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Pars plana vitrectomy with internal limiting membranectomy for refractory diabetic macular edema without a taut posterior hyaloid. In addition to the spots and hemorrhages, extensive neovascularization is noted both in the retina and on the optic disc. These lesions are typically whitish in nature and represent focal damming of axoplasmic flow of intracellular organelles.2 Common causes of visual loss in patients with nonproliferative retinopathy are macular edema and macular ischemia. Patients with this stage of retinopathy may complain of decreased vision or the presence of floaters. This condition may be present with visible vessels growing on the surface of the iris or with high intraocular pressures, if the vessels grow into trabecular meshwork. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment risk of complications in patients with type 2 diabetes (UKPDS 33).



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