Retinopathy

Retinopathy of prematurity (ROP) is an eye disease that occurs in some premature babies. In premature infants, the normal growth of the retinal vessels stops, and abnormal new vessels begin to grow. There seems to be a barrier to the normal growth of vessels, a line beyond which the precursors of the vessels cannot pass. The retina anterior to this line does not have an adequate oxygen supply, and probably exudes chemical signals that stimulate new vessel growth. As more new vessels grow in response to the chemical signals, they form arterio-venous shunts at the location of the barrier on the surface of the retina. This shunt gradually enlarges, becoming thicker and more elevated. The new vessels are accompanied by fibroblasts, which produce fibrous scar tissue. Eventually, a ring of scar tissue extending for 360 degrees inside the eye is formed. This tissue is attached to the retina and to the vitreous gel. When this scar tissue contracts, it pulls on the retina and produces a traction retinal detachment. If the retina becomes completely detached, the infant is diagnosed to be blind. Subtle changes of ROP in the retina of premature infants is a common occurrence but only approximately 1 out of 10 infants with early changes will progress to more severe retinal disease.

Pupil, white spots (leukocoria). Cataract (visible as clouding or whiteness in pupil). Repetitive jerking of eyes (nystagmus). Strabismus Lazy eye (amblyopia). Near sighted (myopia). Subtle retinal changes of ROP cannot be seen by the parents and are visible only by ophthalmoscopic examination. The ophthalmologist gets a stereoscopic wide-angle view of the retina. A lid speculum is used to hold the eyelids open, and a probe may be used to position the eye during the exam. A drop of topical anesthetic is applied to each eye prior to the exam in order to reduce the discomfort as much as possible. Subsequent examinations are usually done every two weeks until the retinal vessels are matured to the edge of the retina. In patients with actively progressing ROP, examinations may need to be done every week. Once the retinal vessels are matured to the ora serrata, the risk for visual problems from ROP is extremely low, and further retinal examinations are usually not indicated

The development and progression of retinopathy may be prevented through tight blood glucose control and treatment of elevated blood pressure or lipid levels. In both types of diabetes, elevated diastolic blood pressure is a risk factor for the development of macular edema, and elevated systolic blood pressure is a risk factor for loss of vision. People with elevated serum cholesterol, low-density lipoprotein (LDL) cholesterol or triglyceride levels are more likely to have or develop retinal hard exudate, which can be associated with risk for loss of vision independent of the extent of macular edema. Retinopathy can become worse during pregnancy, independent of higher levels of glycated hemoglobin. Women with type I diabetes should have an ophthalmic assessment before conception in a planned pregnancy and in the first trimester of pregnancy and be followed up as needed during pregnancy

The exact mechanism leading to ROP is not fully understood, but contributing factors (besides prematurity and illness) include: Too much oxygen (hyperoxia). Too little oxygen (hypoxia). Respiratory distress and its derangements in blood gasses. Infection. Congenital heart disease. Medications. Variations in light and temperature

Changes in vision may happen at the time when diabetes is first diagnosed or at any time when blood sugar control is poor. Fluctuating blood sugars cause the lens to swell and shrink, and result in fluctuating vision. Many times, people who have "borderline" diabetes finally decide to take their diabetes seriously when their vision becomes blurred. Due to low sugar levels in diabetes patients, vision becomes blurred and cannot be corrected by their prescription lenses. Either of these scenarios can be frightening to people who have heard of the severe eye damage that goes along with diabetes. Blurred vision in both eyes when insulin or other treatment begins is almost never caused by damage to the eye. Rather, it results from the speed at which the swelling, due to high blood sugars in the previous weeks and months, dissipates from the lens. Vision is usually out of sync for 3 to 4 weeks, sometimes with an accompanying headache.

Avoid sugar and concentrate on diet rich in vegetables and fruits. Also drink plenty of water.

A regular deep therapy massage is effective in regulating the system.

Damage to the eye is the most feared complication of diabetes. We should adopt every possible measure to protect to minimize that damage.