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Retinopathy

Eyes, Diabetes, Age related illnesses | February 12, 2020 | Author: Naturopath

Eyes, age related, diabetes

Retinopathy

Retinopathy is disease of the retina which impairs vision and can sometimes result in blindness. Disorders of the retina include retinal detachment, retinal vein occlusion, retinal telangiectasia and retinal microaneurysms. Some of the disorders can be due to complications involving diabetes, high blood pressure and cardiovascular disease (arteriosclerosis).

What is the retina?

The retina is part of the eye involved in vision. It is a thin layer of tissue lining the back of the eye and located near the optic nerve. The role of the retina is to receive focused light and convert this light into neural signals.These signals are then sent to the brain to be interpreted.

Detecting retinopathy

What is the retina?Eye examination, called ophthalmoscopy or funduscopy, examines the fundus of the eye (the interior surface of the eye opposite the lens which includes the retina, optic disc, macula, fovea, and posterior pole. Funduscopy checks for haemorrhages, exudates, cotton wool spots, blood vessel abnormalities and pigmentation.

Interestingly the fundus of the eye is the only part of the body in which the smallest blood vessels of the body (microcirculation) can be observed directly.

Disorders of Retinopathy

Retinal detachment

Retinal detachment is a serious eye problem. This is where the retina is pulled away from its normal position at the back of the eye. This can happen due to aging or injury. Symptoms include seeing floaters and flashes of light in one eye or both eyes and shadowing over the field of vision. Retinal detachment required immediate medical attention. Protective eye wear whilst doing certain physical activity can help avoid injury. Regular eye examinations will help detect any abnormalities.

Retinal vein occlusion

Retinal vein occlusion can occur as a sudden loss of vision acuity, or it may be symptomless. It characteristically appears as flame shaped haemorrhages in the affected vein on examination (funduscopy). Important systemic risk factors for retinal vein occlusion include arterial hypertension, diabetes mellitus, aging, elevated intraocular pressure, hyperhomocystinaemia and glaucoma. Medical treatment needs to occur as soon as possible.

Retinal telangiectasia

Retinal telangiectasia are a result of damaged fibers that can no longer support underlying vessels, causing vessel dilation in the retinal periphery or the macula. The cause is unknown. This condition usually occurs in males less than 20 years of age with vision being greatly affected in advanced cases. Leber’s is a milder form of the same condition and will present later in life. It is characterised by a localized cluster of dilated capillaries, aneurisms and telangiectasia (spider veins). In some cases it is found in older people and associated with macular dysfunction. 

Diabetes

In diabetic patients – microvascular changes, inflammation and retinal neurodegeneration are thought to contribute to diabetic retinal damage. In studies of older people with diabetes, there has been an association with retinopathy and coronary heart disease, stroke and LDL cholesterol. Hyperglycaemia leads to oxidative stress and results in damage.

Retinal macro - aneurysms

Retinal macroaneurysms refers to isolated aneurysmal dilatation of a major arterial or arteriolar branch that is often associated with leakage of exudate and multiple retinal haemorrhages.

Cause of retinopathy

Diabetes

In diabetic patients – microvascular changes, inflammation and retinal neurodegeneration are thought to contribute to diabetic retinal damage. In studies of older people with diabetes, there has been an association with retinopathy and coronary heart disease, stroke and LDL cholesterol. Hyperglycaemia leads to oxidative stress and results in damage.

Hypertension

High blood pressure is the most common cause of retinopathy in people without diabetes.

Cause of retinopathyOver time high blood pressure causes blood vessel walls to thicken and narrow which restricts blood flow to the retina. This affects its function and puts pressure on the optic nerve. The end result is restricted vision, pressure on blood vessels causing them to rupture, eye swelling, headaches and double vision.
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Atherosclerosis

Carotid atherosclerotic vessel disease which causes a blockage of more than 90% may result in retinopathy.

Systemic vasculitis

There are a number of systemic connective tissue diseases which may manifest in the eye as retinopathy. Systemic lupus erythematosus (SLE) manifests as intraretinal haemorrhage and cotton wool spots. Behcet's disease characteristically presents with white patches of retinitis associated with cotton wool spots and retinal haemorrhages, venous occlusion and inflammation.

Blood dyscrasias

Dyscarsias are unspecified disorder of the blood resulting from the presence of abnormal material in the blood and are associated with diseases affecting blood cells or platelets. Extreme anaemias of any sort are known to cause retinopathy. 

Systemic infections

Various systemic infection can also be responsible for retinopathy. These might include AIDs, cytomegalovirus, toxoplasmosis, tuberculosis and syphilis. Treating the cause will often result in resolution of the condition.

Radiation therapy

Retinopathy due to radiation therapy is known to occur up to 10 years after cranial or maxillary radiation. Damage from direct radiation may induce retinal vascular endothelial damage resulting in leakage (haemorrhage) and ischaemia (restricted blood supply).

Diagnosis of causes

In cases of retinopathy investigation through a thorough medical history and physical examination is necessary to establish probable cause. Checks for diabetes, hypertension, cardiovascular disease, anaemias, connective tissue disease, past radiation therapy, malignancies and AIDS for example.

How to avoid retinopathy

  • Maintain healthy cholesterol levels
    Click Here for further reading
  • Avoid high blood pressure by maintaining normal weight and performing regular exercise
  • Follow a regular, healthy eaten pattern
  • Avoid high sugar foods and highly processed food
  • Check and resolve anaemias (iron, B12, folic acid for example)
  • If diabetic or insulin resistant, supplementing with nutraceuticals may help reduce the advancement of retinopathy. Avoid prolonged hyperglycaemia - too much sugar for too long periods of time – monitor blood sugar levels regularly and follow diabetic protocols to reduce if levels are high.
    Click Here for further reading
  • Quit smoking
  • Include in the diet a broad variety of fresh fruits, berries, vegetables, green tea and cacao.
  • Supplement with – lutein, zeaxanthin, quercetin, rutin, green tea, anthocyanins, resveratrol and curcumin. These supplements have been found to support a healthy eye.
    Click Here for further reading

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References

The Retina Neuroscience. 2nd edition. The Retina. https://www.ncbi.nlm.nih.gov/books/NBK10885/

Ocular and systemic causes of retinopathy in patients without diabetes mellitus https://www.ncbi.nlm.nih.gov/pmc/articles/PMC381138/

Pathophysiology of Diabetic Retinopathy: The Old and the New https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202564/

Diabetic Retinopathy: Pathophysiology and Treatments https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032159/

https://pubmed.ncbi.nlm.nih.gov/30987058-nutraceuticals-for-the-treatment-of-diabetic-retinopathy/

https://www.sciencedirect.com/topics/medicine-and-dentistry/retinal-telangiectasia

https://www.sciencedirect.com/topics/medicine-and-dentistry/coats-disease

https://www.healthline.com/health/hypertensive-retinopathy

The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the Cardiovascular Health Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770969/

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