“Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults”, states the National Eye Institute. (2015) But why? As with any disease or disorder of the eye, diabetic retinopathy has the potential for loss of vision and even complete blindness (National Eye Institute, 2015), so what makes this one such an issue? Below we’ll discuss the pathophysiology and etiology of the disease, some risk factors and complications, diagnosis, treatments, and nursing care.
Pathophysiology and Etiology
Diabetic retinopathy is caused by excessive blood glucose in uncontrolled diabetics. There are three stages of the disease. In background retinopathy, the earliest stage, the
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If the leakage of blood from the capillaries causes edema, the person may have some loss of color vision or visual acuity, but most experience no symptoms until the proliferative stage when they begin losing vision entirely. Due to these mostly minor symptoms, many people do not seek treatment until they have already lost some vision, at which point it is not possible to restore. (Williams & Hopper, 2015)
Risk Factors
The main risk factor for diabetic retinopathy is, of course, diabetes. Anyone with diabetes can develop diabetic retinopathy, but some conditions can increase this risk further. This includes: the duration of your diabetes, as the longer you have the disease the higher your risk of complications related to it; poor control of blood sugar levels, as regularly high sugar levels increase ketones in the blood, leading to damage of small blood vessels; high blood pressure, which contributes to the microaneurysms and rupture of fragile eye blood vessels; high cholesterol, which can block arteries and increase blood pressure; pregnancy, which can increase blood pressure; tobacco use, which causes vasoconstriction; and being Black, Hispanic, or Native American. (Mayo Clinic,
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Early treatment can prevent any further loss of vision, though it cannot reverse damage already done. (Williams & Hopper, 2015) Another complication is the increased risk of glaucoma; as abnormal growth of blood vessels can block the normal flow of fluids through the eye, causing pressure to build up. (Mayo Clinic,
Diabetes is a lifelong disease that can affect both children and adults. This disease is the sixth leading cause of death in the United States. It claims about 178,000 lives each year. Type one diabetes, also known as insulin dependent diabetes mellitus, usually occurs in people less than thirty years of age, but it also may appear at any age. Diabetes is a very serious disease with many life threatening consequences, but if it is taken care of properly, diabetics can live a normal life.
Loss of vision in one or both eyes
Well how can you get it? Well it’s caused by damaged blood vessels in the tissue that the retina which is located at the back of the eye. When blood sugar levels are too high for extended periods of time, it can damage capillaries which are tiny blood vessels that supply blood to the retina. Over time these blood vessels begin to leak fluids and fats, causing edema. Then the vessels can close off which is called ischemia. These types of signs are non-proliferative diabetic retinopathy (“Diabetic Retinopathy Treatment,”2016).
The pathophysiology of diabetes mellitus in is related to the insulin hormone. Insulin is secreted by cells in the pancreas and is responsible for regulating the level of glucose in the bloodstream. It also aids the body in breaking down the glucose to be used as energy. When someone suffers from diabetes, however, the body does not break down the glucose in the blood as a result of abnormal insulin metabolism. When there are elevated levels of glucose in the blood, it is known as hyperglycemia. If the levels continue to remain high over an extended period of time, damage can be done to the kidneys, cardiovascular systems; you can get eye disorders, or even cause nerve damage. When the glucose levels are low in one’s body, it is called hypoglycemia. A person begins to feel very jittery, and possibly dizzy. If that occurs over a period of time, the person can possibly faint. Diabetes mellitus occurs in three different forms - type 1, type 2, and gestational.
Glaucoma, one of the leading causes of blindness, is estimated to affect 1 of every 50 adults. Although glaucoma can occur at any age, the risk of developing the disease increases dramatically after the age of 35. Glaucoma is also more likely to develop in patients who are severely nearsighted, have a family history of the condition, diabetics and Black or African American. This disease often goes unnoticed until permanent vision loss has occurred. Visual damage from glaucoma can be prevented by early diagnosis and careful treatment. Glaucoma is related to elevated fluid pressure of the eye which is causing loss of side vision. It is a series of diseases which damage the optic nerve. Damage to the optic nerve and retina causes blind spots in the field of vision. When the entire nerve is destroyed, blindness will occur. Glaucoma is usually caused by an increase in the fluid pressure in the eye. The front part of the eye contains a clear, nourishing fluid called aqueous which constantly circulates through the eye. Normally, this fluid leaves the eye through a drainage system and returns to the blood stream. Glaucoma occurs from an overproduction of fluid or when the drainage system becomes blocked, causing fluid pressure to increase. The high pressure causes damage to the optic nerve, resulting in permanent vision loss. The exact reason the fluid system in the eye stops functioning properly is not completely understood
The ADA supports the decision made by the International Expert Committee for using the HbA1c threshold of ≥ 6.5% as a diagnosis of diabetes (ADA, 2013; International Expert Committee, 2009). The cut point of 6.5% is associated with an inflection point for the prevalence of retinopathy, just as are the diagnostic thresholds for fasting plasma glucose (FPG) and 2-hour plasma glucose (2-h PG) (ADA, 2013; Bao et al., 2010; International Expert Committee, 2009). Before the report form the International Expert Committee was released diabetes was diagnosed using FPG ≥ 126 mg/dl (Carson, Reynolds, Fonseca, & Munter, 2010).
Age related macular degeneration (AMD) is the leading cause of blindness in people over the age of 50. Every ten years after the age of 50 the prevalence of this disease increases exponentially. Many different factors contribute to the development of AMD including genetic, environment, and metabolic functions. Aside from smoking, abnormal blood pressure, and an unhealthy diet low in fruits and vegetables, many more studies are concluding that similar inflammatory and oxidative processes seen in other age related diseases are also playing a key role in the development of AMD. This disease affects the central areas of the retina and choroid. In return central vision is impaired while peripheral vision is usually not lost. AMD is seen in two different forms, the earlier nonneovascular (dry) type and the more advanced neovascular (wet) type. Each form has its own specific pathology and unique characteristics that set them apart. Fatty, protein deposits called drusens may be the key risk factor in understanding dry AMD pathology, progression, and treatment. Once the more advanced wet AMD is diagnosed, pathology and treatment are targeted around the formation and destruction of abnormal blood vessels, characteristic of the wet AMD eye. The increasing prevalence of AMD has influenced more investigation into what factors can be modulated to prevent the onset or to stop the progression of AMD. Early diagnosis is very important because this is when an eye doctor can spot the early signs of the disease through ultrasound or angiography. This text will discuss the pathology of drusens and the role of inflammation and oxidation in the aged eye. By better understanding these processes more effective treatment approaches and preventive...
After laser surgery and eye drops don’t do the job making a drainage flap in the eye and inserting a drainage valve is next. Trabeculectomy is the filtering microsurgery involving the creation of a drainage flap. This flap will then allow fluid to “percolate” and later drain into the vascular system. All procedures aim to reduce the pressure inside the eye. Surgery may help lower pressure when medication is not sufficient, however it cannot reverse vision loss.
Retinitis pigmentosa is a genetic disorder that causes blindness in the people that are affected by it. I chose retinitis pigmentosa because my grandmother has this genetic disorder. The disorder is very costly on those who have it. The disorder has robbed my grandmother of the life she wanted. She is no longer able to do the things she once was. She is legally blind, cannot drive, and has trouble getting around crowded areas. Retinitis pigmentosa was discovered by Doctor Donders in 1857. Retinitis pigmentosa is a very serious disorder in how it occurs, its signs and symptoms, its prevalence, and how its treated.
Diabetes is a disease in which a person’s body in unable to make or utilize insulin properly which affects blood sugar levels. Insulin is a hormone that is produced in the pancreas, which helps to regulate glucose (sugar) levels, break down carbohydrates and fats, and is essential to produce the body’s energy. The CDC (2013) offers reliable insight, summarized here, into the different types of diabetes, some causes, and health complications that may arise from the disease.
Is a multisystem disease related to abnormal insulin production, impaired insulin utilization, or both. Diabetes Mellitus is a serious health problem throughout the world. It is the 5th leading cause of death in the U.S. It is the leading cause of heart disease, stroke, adult blindness, and nontraumatic lower limb amputations.
Many signs include a "white pupil," also known as leukocoria. Retinoblastoma can occur in either one or two eyes (Paul T. Finger, Pg. 1). This abnormal white pupillary reflex is sometimes referred to as a cat's eye reflex. Another sign of retinoblastoma is a crossed eye (Ambramson, Ch3). Leukocoria doesn't always end up as being retinoblastoma, it can even result in: congenital cataract, Toxocara canis, Coat's disease, and persistent hypertrophic primary vitreous (PHPV) (Finger, Pg.2). Retinoblastoma occurs when there's a mutation or deletion of the q14 band of chromosome 13 (Finger, Pg. 1). Symptoms can be painful if not treated quickly. Some include a red, painful eye, swelling of the surrounding eye, poor vision, dilated pupil, even extra fingers or toes, and retardation (Ambramson, Ch3).
When the blood glucose is higher than the normal levels, this is known as diabetes disease. The body turns the food we eat into glucose or sugar and use it for energy. The insulin is a hormone created by the pancreas to help the glucose get into the cells. The sugar builds up in the blood because either the body doesn’t make enough insulin or can’t well use its own insulin (CDC, 2015). In the United States diabetes is known as the seventh leading cause of death. There are different types of diabetes. However, there are two main types of diabetes and these are; Diabetes type 1 and Diabetes type 2 (CDC, 2015).
Robert, a 65 year-old male, has trouble reading fine detail, especially out of his central vision. He complains that his vision is blurred and that it is harder to see while operating a motor vehicle. In addition, sometimes objects appear wavy or crooked, which impairs his vision. His worst symptoms were that he occasionally lost the ability to distinguish between the features of familiar faces and he had a localized blind spot. Robert is not alone; many people suffer from symptoms related to loss and distortion of the visual field. He suffers from macular degeneration, the leading cause of decreased vision loss in the United States, especially for people over the age of 50 (Philippi, 2000).