Diabetic retinopathy is retinopathy Retinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Frequently, retinopathy is an ocular manifestation of systemic disease.[citation needed] (damage to the retina The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical events that ultimately trigger nerve impulses. These) caused by complications of diabetes mellitus Diabetes mellitus —often simply referred to as diabetes—is a condition in which a person has a high blood sugar (glucose) level, either because the body doesn't produce enough insulin, or because body cells don't properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb, which can eventually lead to blindness Blindness is the condition of lacking visual perception due to physiological or neurological factors. It is an ocular manifestation of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more.^[1] Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there was proper and vigilant treatment and monitoring of the eyes.^[2]

Signs and symptoms

Diabetic retinopathy often has no early warning signs. Even macular edema Macular edema occurs when fluid and protein deposits collect on or under the macula of the eye, a yellow central area of the retina, causing it to thicken and swell. The swelling may distort a person's central vision, as the macula is near the center of the retina at the back of the eyeball. This area holds tightly packed cones that provide sharp,, which may cause vision loss more rapidly, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day.

As new blood vessels form at the back of the eye as a part of proliferative diabetic retinopathy (PDR), they can bleed (ocular hemorrhage) and blur vision. The first time this happens, it may not be very severe. In most cases, it will leave just a few specks of blood Blood is a specialized bodily fluid that delivers necessary substances to the body's cells – such as nutrients and oxygen – and transports waste products away from those same cells, or spots, floating in a person's visual field, though the spots often go away after a few hours.

These spots are often followed within a few days or weeks by a much greater leakage of blood, which blurs vision. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from the inside of the eye, and in some cases the blood will not clear. These types of large hemorrhages tend to happen more than once, often during sleep Sleep is a naturally recurring state of relatively suspended sensory and motor activity, characterized by total or partial unconsciousness and the inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than hibernation or coma. Sleep is a.

On funduscopic exam, a doctor will see cotton wool spots, flame hemorrhages (similar leisons are also caused by the alpha-toxin of Clostridium novyi), and dot-blot hemorrhages.

Elevation of blood-glucose levels can also cause edema (swelling) of the crystalline lens (hyperphacosorbitomyopicosis) as a result of sorbitol Sorbitol, also known as glucitol, is a sugar alcohol that the human body metabolises slowly. It is obtained by reduction of glucose, changing the aldehyde group to an additional hydroxyl group (sugar alcohol A sugar alcohol is a hydrogenated form of carbohydrate, whose carbonyl group (aldehyde or ketone, reducing sugar) has been reduced to a primary or secondary hydroxyl group (hence the alcohol). Sugar alcohols have the general formula H(HCHO)n+1H, whereas sugars have H(HCHO)nHCO. In commercial foodstuffs sugar alcohols are commonly used in place of) accumulating in the lens. This edema often causes temporary myopia Myopia , is a refractive defect of the eye in which collimated light produces image focus in front of the retina when accommodation is relaxed (nearsightedness). A common sign of hyperphacosorbitomyopicosis is blurring of distance vision while near vision remains adequate.^{[citation needed]}

Pathogenesis

Diabetic retinopathy is the result of microvascular retinal changes. Hyperglycemia Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood glucose level higher than 10 mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l (270-360 mg/dl). However, chronic levels exceeding 7-induced intramural pericyte death and thickening of the basement membrane The basement membrane is a thin sheet of fibers that underlies the epithelium, which lines the cavities and surfaces of organs, or the endothelium, which lines the interior surface of blood vessels lead to incompetence of the vascular walls. These damages change the formation of the blood-retinal barrier and also make the retinal blood vessels become more permeable.^[3]

The pericyte death is caused when "hyperglycemia persistently activates protein kinase C- (PKC-, encoded by Prkcd) and p38 mitogen-activated protein kinase (MAPK) to increase the expression of a previously unknown target of PKC- signaling, Src homology-2 domain–containing phosphatase-1 (SHP-1), a protein tyrosine phosphatase. This signaling cascade leads to PDGF receptor- dephosphorylation and a reduction in downstream signaling from this receptor, resulting in pericyte apoptosis…"^[4]

Small blood vessels The blood vessels are the part of the circulatory system that transport blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and the tissues; and the veins, which carry blood from – such as those in the eye – are especially vulnerable to poor blood sugar The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally, in mammals the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM (mmol/L, ie, millimoles/liter). It is tightly regulated as a part of metabolic homeostasis (blood glucose) control. An overaccumulation of glucose Glucose , a simple sugar (monosaccharide), is an important carbohydrate in biology. Cells use it as a source of energy and a metabolic intermediate. Glucose is one of the main products of photosynthesis and starts cellular respiration. Starch and cellulose are polymers derived from the dehydration of glucose. The name "glucose" comes and/or fructose Fructose is a simple monosaccharide found in many foods and is one of the three important dietary monosaccharides along with glucose and galactose. The organic fructose molecule was first discovered by Augustin-Pierre Dubrunfaut in 1847. Fructose is a white solid that dissolves in water – it is the most water-soluble of all the sugars. Honey, damages the tiny blood vessels in the retina. During the initial stage, called nonproliferative diabetic retinopathy (NPDR), most people do not notice any change in their vision.

Some people develop a condition called macular edema Macular edema occurs when fluid and protein deposits collect on or under the macula of the eye, a yellow central area of the retina, causing it to thicken and swell. The swelling may distort a person's central vision, as the macula is near the center of the retina at the back of the eyeball. This area holds tightly packed cones that provide sharp,. It occurs when the damaged blood vessels leak fluid and lipids Lipids are a broad group of naturally occurring molecules which includes fats, waxes, sterols, fat-soluble vitamins , monoglycerides, diglycerides, phospholipids, and others. The main biological functions of lipids include energy storage, as structural components of cell membranes, and as important signaling molecules onto the macula The macula or macula lutea is an oval-shaped highly pigmented yellow spot near the center of the retina of the human eye. It has a diameter of around 5 mm and is often histologically defined as having two or more layers of ganglion cells. Near its center is the fovea, a small pit that contains the largest concentration of cone cells in the eye and, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.

Proliferative diabetic retinopathy (PDR)

As the disease progresses, severe nonproliferative diabetic retinopathy enters an advanced, or proliferative, stage when blood vessels proliferate (ie grow). The lack of oxygen Oxygen (pronounced /ˈɒksɨdʒɨn/, OK-si-jin, from the Greek roots ὀξύς (acid, literally "sharp", from the taste of acids) and -γενής (-genēs) (producer, literally begetter), is the element with atomic number 8 and represented by the symbol O. It is a member of the chalcogen group on the periodic table, and is a highly in the retina causes fragile, new, blood vessels to grow along the retina and in the clear, gel-like vitreous humour The vitreous humour or vitreous humor (US spelling) is the clear gel that fills the space between the lens and the retina of the eyeball of humans and other vertebrates. It is often referred to as the vitreous body or simply "the vitreous" that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina. Fibrovascular proliferation can also cause tractional retinal detachment Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a medical emergency. The new blood vessels can also grow into the angle of the anterior chamber of the eye and cause neovascular glaucoma.

Nonproliferative diabetic retinopathy shows up as cotton wool spots, or microvascular abnormalities or as superficial retinal hemorrhages. Even so, the advanced proliferative diabetic retinopathy (PDR) can remain asymptomatic In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical infections. The term clinically silent is also for a very long time, and so should be monitored closely with regular checkups.

Risk factors

All people with diabetes mellitus are at risk – those with Type I diabetes (juvenile onset) and those with Type II diabetes (adult onset). The longer a person has diabetes, the higher the risk of developing some ocular problem. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy.^[5] After 20 years of diabetes, nearly all patients with type 1 diabetes and >60% of patients with type 2 diabetes have some degree of retinopathy.^[6]

Prior studies had also assumed a clear glycemic threshold between people at high and low risk of diabetic retinopathy.^[7][8] However, it has been shown that the widely accepted WHO and American Diabetes Association diagnostic cutoff for diabetes of a fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl) does not accurately identify diabetic retinopathy among patients.^[9] The cohort study A cohort study or panel study is a form of longitudinal study used in medicine, social science and ecology. It is one type of study design and should be compared with a cross-sectional study included a multi-ethnic, cross-sectional Cross-sectional data or cross section in statistics and econometrics is a type of one-dimensional data set. Cross-sectional data refers to data collected by observing many subjects (such as individuals, firms or countries/regions) at the same point of time, or without regard to differences in time. Analysis of cross-sectional data usually consists adult population sample in the US, as well as two cross-sectional adult populations in Australia. For the US-based component of the study, the sensitivity Sensitivity and specificity are statistical measures of the performance of a binary classification test. The sensitivity measures the proportion of actual positives which are correctly identified as such (e.g. the percentage of sick people who are identified as having the condition); and the specificity measures the proportion of negatives which was 34.7% and specificity Sensitivity and specificity are statistical measures of the performance of a binary classification test. Sensitivity measures the proportion of actual positives which are correctly identified as such (e.g. the percentage of sick people who are identified as having the condition). Specificity measures the proportion of negatives which are correctly was 86.6%. For patients at similar risk to those in this study (15.8% had diabetic retinopathy), this leads to a positive predictive value The positive predictive value, or precision rate, or post-test probability of disease, is the proportion of patients with positive test results who are correctly diagnosed. It is the most important measure of a diagnostic method as it reflects the probability that a positive test reflects the underlying condition being tested for. Its value does of 32.7% and negative predictive value of 87.6%.

Published rates vary between trials, the proposed explanation being differences in study methods and reporting of prevalence In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how common a condition is within a population over a rather than incidence Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator values.^[10]

During pregnancy Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the womb of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies. Childbirth usually occurs about 38 weeks after conception; i.e., approximately 40 weeks, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations An eye examination is a battery of tests performed by an ophthalmologist, optometrist, or orthoptist assessing vision and ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes. All people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye each trimester to protect their vision.^{[citation needed]}

People with Down's syndrome Down syndrome, Down's syndrome, or trisomy 21 is a chromosomal disorder caused by the presence of all or part of an extra 21st chromosome. It is named after John Langdon Down, the British doctor who described the syndrome in 1866. The disorder was identified as a chromosome 21 trisomy by Jérôme Lejeune in 1959. The condition is characterized by, who have three copies of chromosome 21, almost never acquire diabetic retinopathy. This protection appears to be due to the elevated levels of endostatin,^[11] an anti-angiogenic protein, derived from collagen XVIII. The collagen XVIII gene is located on chromosome 21.

Diagnosis

Diabetic retinopathy is detected during an eye examination An eye examination is a battery of tests performed by an ophthalmologist, optometrist, or orthoptist assessing vision and ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes. All people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye that includes:

• Visual acuity test: This test uses an eye chart to measure how well a person sees at various distances (i.e., visual acuity Visual acuity is acuteness or clearness of vision, especially form vision, which is dependent on the sharpness of the retinal focus within the eye and the sensitivity of the interpretative faculty of the brain).
• Pupil dilation: The eye care professional places drops into the eye to widen the pupil The pupil is a hole located in the center of the iris of the eye that allows light to enter the retina. It appears black because most of the light entering the pupil is absorbed by the tissues inside the eye. In humans the pupil is round, but other species, such as some cats, have slit pupils. In optical terms, the anatomical pupil is the eye's. This allows him or her to see more of the retina and look for signs A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient of diabetic retinopathy. After the examination, close-up vision may remain blurred for several hours.
• Ophthalmoscopy: This is an examination of the retina in which the eye care professional: (1) looks through a device with a special magnifying lens that provides a narrow view of the retina, or (2) wearing a headset with a bright light, looks through a special magnifying glass and gains a wide view of the retina. Note that hand-held ophthalmoscopy is insufficient to rule out significant and treatable diabetic retinopathy.
• Optical coherence tomography Optical coherence tomography is an optical signal acquisition and processing method allowing extremely high-quality, micrometre-resolution, three-dimensional images from within optical scattering media (e.g., biological tissue) to be obtained. In distinction with other optical methods, OCT, an interferometric technique, is able to penetrate (OCT): This is an optical imaging modality based upon interference, and analogous to ultrasound. It produces cross-sectional images of the retina (B-scans) which can be used to measure the thickness of the retina and to resolve its major layers, allowing the observation of swelling and or leakage.
• Digital Retinal Screening Programs: Systematic programs for the early detection of eye disease including diabetic retinopathy are becoming more common, such as in the UK, where all people with diabetes mellitus Diabetes mellitus —often simply referred to as diabetes—is a condition in which a person has a high blood sugar (glucose) level, either because the body doesn't produce enough insulin, or because body cells don't properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb are offered retinal screening at least annually. This involves digital image capture and transmission of the images to a digital reading center for evaluation and treatment referral. See Vanderbilt Ophthalmic Imaging Center [1] and the English National Screening Programme for Diabetic Retinopathy [2]
• Slit Lamp Biomicroscopy Retinal Screening Programs: Systematic programs for the early detection of diabetic retinopathy using slit-lamp biomicroscopy. These exist either as a standalone scheme or as part of the Digital program (above) where the digital photograph was considered to lack enough clarity for detection and/or diagnosis of any retinal abnormality.

The eye care professional will look at the retina for early signs of the disease, such as: (1) leaking blood vessels, (2) retinal swelling, such as macular edema, (3) pale, fatty deposits on the retina (exudates) – signs of leaking blood vessels, (4) damaged nerve A peripheral nerve, or simply nerve is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system. In the central nervous system, the analogous structures are known as tracts tissue (neuropathy Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness), and (5) any changes in the blood vessels.

Should the doctor suspect macular edema Macular edema occurs when fluid and protein deposits collect on or under the macula of the eye, a yellow central area of the retina, causing it to thicken and swell. The swelling may distort a person's central vision, as the macula is near the center of the retina at the back of the eyeball. This area holds tightly packed cones that provide sharp,, he or she may perform a test called fluorescein angiography Fluorescein angiography, or fluorescent angiography, is a technique for examining the circulation of the retina using the dye tracing method. It involves injection of sodium fluorescein into the systemic circulation, and then an angiogram is obtained by photographing the fluorescence emitted after illumination of the retina with blue light at a. In this test, a special dye A dye can generally be described as a colored substance that has an affinity to the substrate to which it is being applied. The dye is generally applied in an aqueous solution, and may require a mordant to improve the fastness of the dye on the fiber is injected into the arm In anatomy, an arm is one of the upper limbs of an animal. The term arm can also be used for analogous structures, such as one of the paired upper limbs of a four-legged animal, or the arms of cephalopods. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows the doctor to find the leaking blood vessels.

Management

There are three major treatments for diabetic retinopathy, which are very effective^{[citation needed]} in reducing vision loss from this disease. In fact, even people with advanced retinopathy have a 90 percent chance of keeping their vision when they get treatment before the retina is severely damaged.^{[citation needed]} These three treatments are laser surgery, injection of triamcinolone Triamcinolone is a synthetic corticosteroid given orally, by injection, inhalation, or as a topical ointment or cream into the eye, and vitrectomy Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye. Anterior vitrectomy entails removing small portions of the vitreous from the front structures of the eye - often because these are tangled in an intraocular lens or other structures. Pars plana vitrectomy is a general term for a group of operations accomplished in.

Although these treatments are very successful (in slowing or stopping further vision loss), they do not cure diabetic retinopathy. Caution should be exercised in treatment with laser surgery since it causes a loss of retinal tissue. It is often more prudent to inject triamcinolone. In some patients it results in a marked increase of vision, especially if there is an edema of the macula Macular edema occurs when fluid and protein deposits collect on or under the macula of the eye, a yellow central area of the retina, causing it to thicken and swell. The swelling may distort a person's central vision, as the macula is near the center of the retina at the back of the eyeball. This area holds tightly packed cones that provide sharp,.

Avoiding tobacco use and correction of associated hypertension are important therapeutic measures in the management of diabetic retinopathy.^[12]

The best way of addressing diabetic retinopathy is to monitor it vigilantly and achieve euglycemia.^{[citation needed]}

By 2008 there were other drugs (e.g. kinase inhibitors and anti-VEGF) available.^[13]

Laser photocoagulation

Laser photocoagulation can be used in two scenarios for the treatment of diabetic retinopathy.^{[clarification needed]} It is widely used for early stages of proliferative retinopathy.

Panretinal photocoagulation

Panretinal photocoagulation, or PRP (also called scatter laser treatment), is used to treat proliferative diabetic retinopathy (PDR). The goal is to create 1,000 - 2,000 burns in the retina with the hope of reducing the retina's oxygen demand, and hence the possibility of ischemia.

In treating advanced diabetic retinopathy, the burns are used to destroy the abnormal blood vessels that form in the retina. This has been shown to reduce the risk of severe vision loss for eyes at risk by 50%.<^[1]

Before using the laser, the ophthalmologist dilates the pupil and applies anesthetic drops to numb the eye. In some cases, the doctor also may numb the area behind the eye to prevent any discomfort. The patient sits facing the laser machine while the doctor holds a special lens to the eye. The physician can use a single spot laser or a pattern scan laser for two dimensional patterns such as squares, rings and arcs. During the procedure, the patient may see flashes of light. These flashes may eventually create an uncomfortable stinging sensation for the patient. After the laser treatment, patients should be advised not to drive for a few hours while the pupils are still dilated. Vision may remain a little blurry for the rest of the day, though there should not be much pain in the eye.

Patients may lose some of their peripheral vision after this surgery, but the procedure saves the rest of the patient's sight. Laser surgery may also slightly reduce colour and night vision.

A person with proliferative retinopathy will always be at risk for new bleeding, as well as glaucoma, a complication from the new blood vessels. This means that multiple treatments may be required to protect vision.

Intravitreal Triamcinolone acetonide

Triamcinolone is a long acting steroid preparation. When injected in the vitreous cavity, it decreases the macular edema (thickening of the retina at the macula) caused due to diabetic maculopathy, and results in an increase in visual acuity. The effect of triamcinolone is transient, lasting up to three months, which necessitates repeated injections for maintaining the beneficial effect. Complications of intravitreal injection of triamcinolone include cataract, steroid-induced glaucoma and endophthalmitis.

Vitrectomy

Instead of laser surgery, some people require a vitrectomy to restore vision. A vitrectomy is performed when there is a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a saline solution.

Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than someone who waits to have the operation. Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.

Vitrectomy is often done under local anesthesia. The doctor makes a tiny incision in the sclera, or white of the eye. Next, a small instrument is placed into the eye to remove the vitreous and insert the saline solution into the eye.

Patients may be able to return home soon after the vitrectomy, or may be asked to stay in the hospital overnight. After the operation, the eye will be red and sensitive, and patients usually need to wear an eyepatch for a few days or weeks to protect the eye. Medicated eye drops are also prescribed to protect against infection.

Experimental treatments

C-peptide

Though not yet commercially available, c-peptide has shown promising results in treatment of diabetic complications incidental to vascular degeneration. Once thought to be a useless byproduct of insulin production, it helps to ameliorate and reverse many symptoms of diabetes.^[14]

Pine bark extract

A pine bark extract of oligomeric proanthocyanidins has been shown to improve microcirculation, retinal edema and visual acuity in the early stages of diabetic retinopathy.^[15]

See also

• Diabetic diet

References

1. ^ ^{a b} Kertes PJ, Johnson TM, ed (2007). Evidence Based Eye Care. Philadelphia, PA: Lippincott Williams & Wilkins. ISBN 0-7817-6964-7. ^{[page needed]}
2. ^ Tapp RJ, Shaw JE, Harper CA, et al. (June 2003). "The prevalence of and factors associated with diabetic retinopathy in the Australian population". Diabetes Care 26 (6): 1731–7. doi:10.2337/diacare.26.6.1731. PMID 12766102.
3. ^ Pardianto G et al. (2005). "Understanding diabetic retinopathy". Mimbar Ilmiah Oftalmologi Indonesia 2: 65–6.
4. ^ Geraldes, Pedro; Hiraoka-Yamamoto, Junko; Matsumoto, Motonobu; Clermont, Allen; Leitges, Michael; Marette, Andre; Aiello, Lloyd P; Kern, Timothy S et al. (2009). "Activation of PKC-δ and SHP-1 by hyperglycemia causes vascular cell apoptosis and diabetic retinopathy". Nature Medicine 15 (11): 1298–306. doi:10.1038/nm.2052. PMID 19881493.
5. ^ "Causes and Risk Factors". Diabetic Retinopathy. United States National Library of Medicine. 15 September 2009. http://nihseniorhealth.gov/diabeticretinopathy/causesandriskfactors/02.html.
6. ^ "Diabetic Retinopathy". Diabetes Care 25: 90S. 2002. doi:10.2337/diacare.25.2007.S90.
7. ^ Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (January 2003). "Report of the expert committee on the diagnosis and classification of diabetes mellitus". Diabetes Care 26 (Suppl 1): S5–20. doi:10.2337/diacare.26.2007.S5. PMID 12502614.
8. ^ "Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus". Diabetes Care 20 (7): 1183–97. July 1997. PMID 9203460.
9. ^ Wong TY, Liew G, Tapp RJ, et al. (March 2008). "Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies". Lancet 371 (9614): 736–43. doi:10.1016/S0140-6736(08)60343-8. PMID 18313502.
10. ^ Williams R, Airey M, Baxter H, Forrester J, Kennedy-Martin T, Girach A (October 2004). "Epidemiology of diabetic retinopathy and macular oedema: a systematic review". Eye 18 (10): 963–83. doi:10.1038/sj.eye.6701476. PMID 15232600.
11. ^ Ryeom, Sandra; Folkman, Judah (2009). "Role of Endogenous Angiogenesis Inhibitors in Down Syndrome". Journal of Craniofacial Surgery 20 (Suppl 1): 595–6. doi:10.1097/SCS.0b013e3181927f47. PMID 19795527.
12. ^ Masharani, Umesh (2006). "Diabetes Ocular complications". Chronic Complications of Diabetes. Armenian Medical Network. http://www.health.am/db/diabetes-ocular-complications/.
13. ^ Fraser-Bell S, Kaines A, Hykin PG (May 2008). "Update on treatments for diabetic macular edema". Current Opinion in Ophthalmology 19 (3): 185–9. doi:10.1097/ICU.0b013e3282fb7c45. PMID 18408491.
14. ^ Wahren J, Ekberg K, Jörnvall H (March 2007). "C-peptide is a bioactive peptide". Diabetologia 50 (3): 503–9. doi:10.1007/s00125-006-0559-y. PMID 17235526.
15. ^ EurekAlert (December 2, 2009). "Study shows pine bark improves circulation, swelling and visual acuity in early diabetic retinopathy". Press release. http://www.eurekalert.org/pub_releases/2009-12/mg-ssp113009.php. Retrieved 2010-02-16.

• The original text of this document was taken from the public domain resource document "Facts About Diabetic Retinopathy", at http://www.nei.nih.gov/health/diabetic/retinopathy.asp See the copyright statement at http://www.nei.nih.gov/order/index.htm, which says "Our publications are not copyrighted and may be reproduced without permission. However, we do ask that credit be given to the National Eye Institute, National Institutes of Health."

External links

• Diabetic Retinopathy Resource Guide from the National Eye Institute (NEI).
• National Diabetes Information Clearinghouse
• English National Screening Programme for Diabetic Retinopathy

Categories: Diabetes | Blindness | Disorders of choroid and retina

See Also:

• Retinopathy: Encyclopedia
• Hypertensive Retinopathy: Encyclopedia
• Birdshot Chorioretinopathy: Encyclopedia
• Retinopathy of Prematurity: Encyclopedia
• Central Serous Retinopathy: Encyclopedia

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