Retinopathy - forms, symptoms and treatment

Retinopathy - forms, symptoms and treatment

Retinopathy is a dysfunction of the RETINA in which new BLOOD vessels grow across the retina’s surface. This growth causes the death of photoreceptors, the specialized cells (rods and cones) in the retina that receive lightwaves and convert them to NERVE impulses for transmission to the BRAIN. The blood vessels are also delicate and prone to bleeding, which further damages the surface of the retina.

The most common forms of retinopathy are the following:

  • Retinopathy of DIABETES results from chronically elevated blood GLUCOSE levels. Retinopathy of diabetes takes one of two forms: proliferative, in which the new blood vessels that grow across the retina are unstable and bleed, or nonproliferative, in which existing blood vessels deteriorate and form aneurysms that rupture and bleed. Retinopathy of diabetes typically develops over decades, is more common in people who require INSULIN THERAPY, and is the most common cause of blindness in people under age 60.
  • Retinopathy of prematurity occurs in some infants born earlier than 32 weeks of gestational age in whom the retinal blood vessels, which develop late in gestation, have not yet formed. In most infants, the blood vessels resume growth and establish normal retinal vasculature with no damage to vision. In some premature infants who have retinopathy, inadequate blood supply to the retina or abnormal vessel development can cause RETINAL DETACHMENT with resulting VISION IMPAIRMENT.
  • Hypertensive retinopathy develops as a consequence of untreated or poorly managed HYPERTENSION (high BLOOD PRESSURE). Blood vessels in the retina, like blood vessels throughout the body, become stiff and inflexible as a result of the continuous pressure. This brittleness makes them susceptible to rupture, which floods the retina with blood.
  • Central serous retinopathy, in which fluid accumulates between the retina and the choroid, causes the retina to swell and lift up from the choroid.

Symptoms of Retinopathy and Diagnostic Path

Most often, retinopathy does not cause symptoms until eye damage becomes significant. When symptoms are present, they may include

  • blurred or distorted vision
  • diminished near vision for reading and other close focus
  • FLASHES and FLOATERS
  • sudden loss of vision

OPHTHALMOSCOPY typically reveals discolored areas of the retina that indicate diminished blood supply (pale) or bleeding (dark). The ophthalmologist may also be able to see frank bleeding or irregularities in the surface of the retina that indicate accumulated fluid. When the cause of the retinopathy is hypertension, there may also be PAPILLEDEMA (swelling of the OPTIC NERVE). Ophthalmoscopy in combination with health history generally provides the information the ophthalmologist needs to make the diagnosis.

Retinopathy Treatment Options and Outlook

Often retinopathy improves on its own, especially retinopathy of prematurity and central serous retinopathy. Retinopathy of diabetes or hypertension typically improves with tighter control of the underlying condition. When retinopathy improves, vision may return to its previous state or damage to vision may be minimal. Retinopathy that progresses leads to vision impairment, including total loss of vision. Central serous retinopathy tends to recur. Proliferative and nonproliferative retinopathy often require laser treatment.

Risk Factors and Preventive Measures

The key risk factors for most retinopathy are the underlying health conditions associated with the retinopathy. Preventive measures emphasize control of the underlying condition—maintaining stable blood glucose levels in retinopathy of diabetes, and healthy blood pressure in retinopathy of hypertension. Consistent PRENATAL CARE and attention to maternal health (notably SMOKING CESSATION) help reduce the risk for PREMATURE BIRTH. Regular ophthalmic examinations can detect retinopathy in its early stages, allowing therapeutic interventions to minimize damage to the eye.

See also ISCHEMIC OPTIC NEUROPATHY; RETINITIS PIGMENTOSA; TOXIC OPTIC NEUROPATHY.

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