Diabetic Retinopathy
Diabetic people can have an eye disease which can be known as diabetic retinopathy. It is caused when high glucose levels damage tiny blood vessels in the retina which is a thin, light-sensitive layer of tissue of the eye. In this disease, blood vessels can further swell and leak fluid. Abnormal growth of new blood vessels is also found in the retina. If left untreated, all of these changes can be responsible for distorted vision and complete blindness in people. Diabetic retinopathy is characterized by hyperglycemia, microaneurysms, and pericyte loss leading to distorted vision through hemorrhage and tractional retinal detachment. It is one and the only key cause of blindness in industrialized countries. Glaucoma and detached retina are the major complications of this disease. Some other signs experienced by the patients suffering from diabetic retinopathy (DR) include
- Floaters
- Blurred vision
- Fluctuating vision
- Impaired color vision
- Dark or empty areas in your vision
Hyperglycemia is considered to play a significant role in the pathogenesis of this microvascular disease. Chronic low-grade inflammation has been detected in DR patients. Retinal neurodegeneration causes mitochondrial dysfunction which can lead to the progression of DR. Diabetic retinopathy can be categorized into two major types. Non-proliferative diabetic retinopathy (NPDR) is the primary stage of this disease and is usually symptomless. NPDR is associated with macular ischemia which occurs when the tiny blood vessels in the retina close off. In this disease, the macula, the central part of the retina, begins to swell and this condition is referred to as macular edema. This can further cause leaking fluid and blood into the retina. Proliferative diabetic retinopathy (PDR) is secondary and a more progressive stage of diabetic retinopathy also known as neovascularization. This disease leads to the formation of new, abnormal blood vessels in the retina which can often bleed into the vitreous. If there is heavy bleeding, it might cause complete blindness. Scar tissue is formed due to these new blood vessels leading to a retinal detachment. Although, there are retinal surgeries that can relieve symptoms of diabetic retinopathy such as photocoagulation, scatter laser treatment, and vitrectomy but controlling high blood sugar and managing early symptoms are the most effective and efficient ways to prevent it. Vascular endothelial growth factor (VEGF) appears to play an early role in the origination of diabetic retinopathy as it is found to be at an increased level in the vitreous and the retina of diabetic patients. Anti-VEGF drugs including the anti-VEGF aptamer (pegaptanib), ranibizumab, and the full-length antibody bevacizumab are injected into the eye in the form of intravitreal injections is currently the mainstay of therapy for DR treatment. These drugs have been also used to stop additional bleeding from PDR. Anti-VEGF therapy has some adverse effects associated with it such as injections on a monthly basis are needed to ensure efficacy, financial burden, and poor compliance of patients. Anti-inflammatory therapy such as intravitreal corticosteroids and non-steroid anti-inflammatory drugs have become progressively significant in the treatment of diabetic macular edema. Further investigation is required to facilitate the translation of recent research findings and for better optimization of current treatment therapies.
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