By: Marc Wentz, Regina Carson, Jonathan Nissen, Cydney Williams Diabetic Retinopathy By: Marc Wentz, Regina Carson, Jonathan Nissen, Cydney Williams

Diabetic Retinopathy Facts What is diabetic retinopathy? Diabetic retinopathy is a complication of diabetes that occurs when the disease damages tiny blood vessels inside the retina. Elevated levels of blood glucose harm these blood vessels, usually causing blindness in both eyes.

Symptoms and Functional Implications Stage one, mild non-proliferative retinopathy. Swelling in the retina’s blood vessels. Stage two, moderate non-proliferative retinopathy. Some blood vessels that nourish the retina are blocked. Stage three, severe non-proliferative retinopathy. Many more blood vessels are blocked and deprive the retina of blood supply. This sends signals to the body to grow new blood vessels for nourishment. Stage four, proliferative retinopathy. Signals sent by the retina for nourishment trigger growth of new blood vessels but they are fragile and abnormal as they grow along the retina and surface of the vitreous gel inside the eye. These blood vessels have a thin wall and may leak, causing severe or total vision loss. Swelling, fluctuating vision, eye floaters and spots, blurry or distorted vision, eye pain and cataracts.

Diabetic Retinopathy Treatments The best treatment is prevention. Controlling blood sugar and regular ophthalmology visits significantly reduce the risk of long-term vision loss. Those with type 1 diabetes should be examined within five years of diagnosis. Those with type 2 diabetes should be examined at the time they are diagnosed and then once a year after.

Treatments for Vision Loss Due to Diabetic Retinopathy Injections of anti-VEGF Injections of anti-VEGF medication can stop the growth of new blood vessels and subsequent bleeding. VEGF builds new blood vessels and causes regression of fragile and abnormal blood vessels. This is important because fragile and abnormal blood vessels may leak fluid or bleed, which will swell retinal tissue and affect vision.

Other Treatments for Vision Loss Laser Surgery The laser is focused on all parts of the retina except the macula. The treatment shrinks abnormal new vessels and prevents future growth. The procedure will also decrease the chance of vitreous bleeding or retinal distortion. Of note is the fact that laser surgery does not cure diabetic retinopathy or prevent further vision loss.

Other Treatments (con’t) Vitrectomy A microsurgical procedure that replaces the blood-filled vitreous with a clear solution. The procedure also prevents further bleeding by removing the abnormal vessels. If the retina is detached, it can be repaired during the procedure.

Case Study Don is an 18 year old male with Proliferative Diabetic Retinopathy (PDR). The onset of Don’s PDR was early in life, approximately eight years after being diagnosed with Type 1 diabetes. The medical report states that controlling Don’s diabetes with the use of insulin was a struggle due to his lack of motivation for self-maintenance and constant defiance of prescribed treatment. In addition to this, Don’s parents chose to remain uneducated about his condition and never pushed him to maintain or keep up with his treatment of the disease. Several months ago, Don began complaining of blurred vision and spots floating in and around his visual field. Visual tests revealed impaired acuities at near and at distance. In addition, confrontational visual field testing showed a slight reduction in peripheral vision at about 1 o’clock temporally on both sides. Finally, an initial examination of Don’s retinas with a direct ophthalmoscope showed hemorrhaging blood vessels in both eyes. Due to the advanced progression of Don’s condition, the doctor recommended laser photocoagulation to seal off the leaking blood vessels and stabilize the vision loss. Within weeks, Don received the procedure and though it went as planned, Don was informed that the photocoagulation was just the first step in treating his PDR. Don was fitted with glasses to correct his acuities and regular visits to the eye doctor help Don monitor the progression of the disease. Since his surgical intervention, Don meets regularly with a number of individuals to help manage his diabetes, which is paramount in preventing further vision loss and damage to his eyes. With the assistance of his ophthalmologist, low vision specialist, primary care physician, and social support groups, Don is managing his health and taking a proactive approach to preventing further health concerns. At this time, Don does not utilize any low vision devices to assist him with activities of daily living and is able to maintain a good quality of life while living with PDR.

A Parent’s Guide to Diabetic Retinopathy Objective Provide a brochure of helpful information about Diabetic Retinopathy to parents of children living with diabetes.

Parents Guide Cont. Topics What is Diabetic Retinopathy Who is at rick What are some symptoms What is the treatment Discussing Diabetic Retinopathy with Children Empowering children living with Diabetic Retinopathy

Parents Guide Cont. What is Diabetic Retinopathy Common diabetic complication of the eye caused by changed in the blood vessels of the retina Who is at risk All people with diabetes – Both type 1 and Type 2 Longer a person lives with diabetes the greater the risk of developing diabetic retinopathy

Parents Guide Cont. What are some symptoms Blurred vision Sudden loss of vision in one eye Seeing rings around lights What are some treatments Mild cases, no treatment Eye exams are critical for monitoring progression Treatments for severe cases

Parents Guide Cont. Discussing Diabetic Retinopathy with children Be positive Honest Informative age level information Empowering children living with Diabetic Retinopathy Focus on the day-to-day Diet Exercise Life skills

More resources for DR American Society of Retina Specialists http://www.asrs.org/patients/retinal-diseases/3/diabetic-retinopathy -This site explains symptoms, treatment options, prevention, risk factors and what to expect when learning about Diabetic Retinopathy. *American Diabetes Association http://www.diabetes.org/living-with-diabetes/complications/eye-complications/ -This site is full of information all about diabetes, including eye complications. *National Eye Institute http://www.nei.nih.gov/health/diabetic/retinopathy.asp -Complete explanation of Diabetic Retinopathy with pictures, diagrams and tons of valuable information.

Helpful Information for Parents Diabetic Retinopathy Brochure for Parents

A few more facts… These are the same two scenes. The one on the left is someone’s view who has normal vision. The one on the right is the view from someone with Diabetic Retinopathy.

How should the eye look?

Conclusion Diabetic retinopathy is a leading cause of new onset blindness in adults in the United States. Effective treatments are available to preserve vision for those who may be at risk of losing it. The best time for treatment is before any vision has been lost.

Additional References http://nihseniorhealth.gov/diabeticretinopathy/whatisdiabeticretinopathy/0 1.html http://www.allaboutvision.com/conditions/diabetic.htm http://www.joslin.org/info/Diabetic_Retinopathy_What_You_Need_to_K now.html