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Diabetic Retinopathy

Concerns regarding Diabetic Retinopathy and Lasik, PRK, LASEK, Epi-Lasik, etc.

Image of man and child illustrated with and without diabetic retinopathy.  
Vision with diabetic retinopathy can be severely disrupted as the retina is affected. Diabetic retinopathy as a contraindication for Lasik and similar refractive surgery.  

In most cases, refractive surgery of all kinds should be avoided in a patient with diabetic retinopathy. conventional or custom wavefront Lasik, Epi-Lasik, and Bladeless Lasik require a microkeratome that increases IOP when affixed to the eye with suction. PRK and LASEK do not require this dramatic rise in IOP and may (emphasis on "may") be appropriate in some cases. Any patient with diabetic retinopathy should be fully evaluated by a retina specialist before considering refractive surgery.

Diabetic retinopathy damages the tiny blood vessels that supply the retina (the light-sensitive nerve tissue at the back of the eye that transmits visual images to the brain). In the early stages of this disease-called non-proliferative or "background" retinopathy, the retinal vessels weaken and develop bulges (microaneurysms) that may leak blood (hemorrhages) or fluid (exudates) into the surrounding tissue. Vision is rarely affected during this stage of retinopathy.

If proliferative retinopathy is left untreated, about half of those who have it will become blind within five years, compared to just 5% of those who receive treatment. Yet only half of all diabetic patients in the U.S. have a yearly eye examination by an ophthalmologist , even though regular eye exams offer the best chance of catching retinopathy at its treatable stage.

Proliferative retinopathy, a later stage of the disease, involves the growth of fragile new blood vessels on the retina and into the vitreous -- a jelly-like substance inside the eyeball. These vessels can rupture and release blood into the vitreous, which causes blurred vision or temporary blindness. The scar tissue that may subsequently develop can pull on the retina and cause retinal detachment, which may lead to permanent vision loss. Macular edema - swelling due to fluid accumulating around the macular, the part of the retina most crucial for fine vision - may also occur.

Much later on, however, fragile new blood vessels may begin to grow on the retina and into the vitreous (the jelly-like substance inside the back of the eye). These abnormal vessels are prone to rupture and bleed into the vitreous, causing blurred vision or temporary blindness. As a result, the formation of scar tissue can eventually pull the retina away from the back of the eye (retinal detachment), and lead to permanent vision loss. In addition, at any stage of retinopathy, severe blurring of vision may occur if fluid accumulates around the macula-the most sensitive portion of the retina that is crucial for seeing fine detail-a condition called macular edema.

Lowering blood glucose levels can significantly reduce the risk of developing retinopathy or slow its progression, even in people who have had diabetes for a number of years, according to a recent study.

This study involved 834 people who were over 30 when they developed diabetes and who were, on average, 65 at the start of the study. A glycohemoglobin test was performed at the start of the study and at a four-year follow-up. Eye exams were conducted at both these points in the study and then again at a ten-year follow-up. In non-insulin treated participants, those with the highest levels of glycohemoglobin at the start of the study had a nearly three-fold greater chance of having developed retinopathy after ten years than those with the lowest levels. Among those who already showed evidence of retinopathy at the start of the study, elevated glycohemoglobin resulted in a 4 times greater risk of retinopathy progression and a 14 times greater risk of proliferative retinopathy. In people taking insulin, those with the highest glycohemoglobin levels had a 90% increased risk of developing retinopathy than those with the lowest levels; patients with the highest levels also had twice the risk of retinopathy progression and triple the risk of proliferative retinopathy.

The researchers concluded that reduction in hyperglycemia at any time in the course of diabetes will result in a significant decrease in the long-term incidence and progression of retinopathy and in the development of visual loss.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

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Recent Diabetic Retinopathy Medical Journal Articles...

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(Diabetic Retinopathy[Title])

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