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[IP] Re: eye problems - long

Hello everyone.  Here is some information regarding the eye problems from a 
student of ophthalmic medical technology.  But 1st, and most important, every 
person is different and their eyes respond differently.  If you are not 
comfortable with the care you ophthalmologist provides - go elsewhere.  But 
give the doc time to address any questions - if he/she doesn't know there is 
a problem (in communication), it is really tough to fix it.

The are 2 stages to diabetic retinopathy:  non-proliferative and 
proliferative.  Non-proliferative is further broken down into 2 stages:  
background and preproliferative retinopathy.
    In background diabetic retinopathy (BDR) the capillaries in the eye (the 
smallest blood vessels) become weak and develop small outpouchings of the 
vessels (microaneurysms).  The larger blood vessels start to become larger 
and the path they take becomes twisted.  Some of these microaneurysms burst 
producing various types of hemorrhages (flame shaped, dot and blot hemes).  
As the vessels further break down, blood plasma may leak out into the retinal 
layers.  The extra fluid causes the retina to swell, or become edematous.  If 
this happens in the place of best central vision, the macula, it is know as 
macular edema.  Lipid deposits may accumulate at the locations and appear as 
a yellowish depost know as exudate.
    As the smaller vessels close off, small areas of the retina start to 
appear as fluffy white patches (cotton wool spots).  The presence of cotton 
wool spots signifies the progression form BDR to preproliferative 
retinopathy.  If a fluorescein angiogram is done and the is macular edema, it 
may appear with a characteristic flower shaped appearance - petaloid.
    The treatment at this stage depends on where the leaks are.  If they are 
with about 1/2 mm of the center of the macula, a focal laser may be done 
which target the specific capillaries that are leaking , sealing those 
vessels and hopefully allowing the reabsorption of the fluids.  Usually, if 
the leakage and edema are more peripheral, the treatment is to monitor and 
control blood sugar levels.
    As the capillaries die off to to occlusion, large leaks, whatever, they 
don't "go quietly into the night" but rather the stressed tissue sends a 
chemical signal to call for help.  Help is in the form of new blood vessel 
growth - neovascularization.  These new blood vessels mark the transition 
into proliferative diabetic retinopathy (PDR).  Sounds good doesn't it?  The 
eye needs blood flow, a signal is sent to make new vessels grow and bring 
blood to the starving areas.  Unfortunately, the new vessels are very leaky 
causing more hemes and edema.  These vessels may grow onto the colored part 
of the eye (iris) blocking the fluid outflow paths (neovascular glaucoma), so 
the doc will keep a careful look of for rubeosis, or neovascularization of 
the iris.  These vessles also tend to grow onto the posterior vitreous, a 
jelly like substance in the back of the eye.  As the vitreous ages, it tends 
to pull away from the retina causing a posterior vitreous detachment (PVD).  
By itself, not so bad, but if a new blood vessel is there, it will probably 
break causing a vitreous heme.  The treatment in this case 
(neovascularization) is panretinal photocoagulation (PRP) where the entire 
(?) periphery of the retina is blasted with the laser.  Specific vessles are 
not targeted, but it is more of a shotgun approach.  The idea is 2 fold.  1, 
tack the vitreous down to the retina via retinal scars and 2 kill the tissues 
sending the chemical signal causing new vessel growth.

Sorry for the length of the post, but I hope it helps clear up some of the 
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