Types of Diabetic Retinopathy


Despite having similar symptoms and causes, there are three primary forms of retinopathy. They are not different types, but rather stages. This means the type you have is subject to the progression of the condition and this may change over time.

Background Retinopathy

The first of these is background retinopathy. This begins initially by acute swelling in the walls of the blood vessels. Spots known as micro aneurysms form on the retina and appear on the wall as small red coloured dots. There are also small yellow patches, which may form. This is a result of exuding protein from the blood stream onto the retina. Other marks on the retina at this stage could potentially be a haemorrhage, which appears in a similar form. At this stage of retinopathy, it will not directly affect your vision, however, constant checks from an ophthalmologist are advised to keep the condition well monitored.

Non Proliferative Retinopathy

In the early stages, it is important to look out for non proliferative retinopathy. It is diagnosed in the stages; mild, moderate and severe and is very similar to background retinopathy. From the outset, this is due to swelling in the blood vessels in the retina and it may block them as the disease progresses. However, as more and more vessels are affected, it begins to reduce the blood flow to the retina and develops into a more severe non proliferative retinopathy. The bulging areas from the swelling may cause some of the blood vessels to close completely. Some of the larger retinal veins may start to become irregular as they dilate. Sometimes this can spread to the centre of the retina, to the macula, causing macula oedema.

Maculopathy

Maculopathy, which leads to the sight threatening condition macula oedema, is when the blood vessels become more delicate and begin to leak. In the early stages, fluid from this can leak into the macula, which operates our immediate, straight-ahead vision, resulting in swelling and blurred vision. The macula is an extremely sensitive area of the retina and macula oedema is one of the most common causes of visual impairment that you can develop through diabetes.

During the maculopathy stage, the haemorrhages, swellings and leakages of protein as seen in the background retinopathy stage all begin to affect the macula. Specifically, this affects our ability to see finer details, for example, fine print in books.

These leakages can be cured by laser eye treatment, but often, several years later, more is needed to ensure they are properly treated. The leaks are known as clinically significant macula oedema and it takes four to six weeks for the treatment to take any sort of effect. As the condition develops, if left untreated it could become very severe. Should severe maculopathy occur, it will be very difficult to treat. Your eye doctor will do everything they can to salvage your eyesight and prevent diabetic retinopathy from reaching the most aggressive stages.

Proliferative Retinopathy

Eventually after the initial stages of diabetic retinopathy, proliferative retinopathy is acquired. Firstly however, it is important to note than maculopathy affects around half the patients already suffering from proliferative retinopathy.

Proliferative retinopathy begins by the blood vessels within the retina becoming blocked. As a result of the insufficient blood flow to the retina, new, abnormally sized blood vessels begin to grow. Because these new blood vessels are very delicate and fragile, as they grow they are easily broken and can leak or bleed. The vessels are so easily broken that even sudden head movements such as sneezing, or rapid eye movement during sleep can cause them to break. They leak into the vitreous, causing a vitreous haemorrhage. The vitreous is a jelly like substance, which fills the centre of the eye to support its structure and give it its shape. As these vessels grow, they stimulate the growth of further abnormal tissue and as they break, they will eventually cause scar tissue to form. As a result of this, eventually the retina will detach itself altogether from the back of the eye.

From the start, abscesses and abnormal growths do not pose immediate threat to your vision. Nonetheless, if the new blood vessels forming in your eye should begin to interfere with the regular flow of blood and fluids into your eye, it will begin to put pressure on the eyeball. This will eventually result in damage to the optic nerve (this is the component of the eye which carries images and signals to the brain to make sense of what we are seeing).

No symptoms are obvious as the condition commences and vision remains unaffected. However, all of the complications could ultimately lead to impaired vision and blindness if left untreated for too long. The vision loss could occur gradually or suddenly. Additionally, chances of contracting a type of glaucoma, a condition which puts pressure upon the eye, is increased with proliferative retinopathy, which is quite complicated to treat. Experts are as of yet unable to pin down a definite cause of proliferative retinopathy, but it is widely believed that it is simply the body’s way of responding to already damaged blood vessels from diabetes.

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