Retinopathies Health Article

Definition

Retinopathy is a noninflammatory disease of the retina. There are many causes and types of retinopathy.

Description

The retina is the thin membrane that lines the back of the eye and contains light-sensitive cells (photoreceptors). Light enters the eye and is focused onto the retina. The photoreceptors send a message to the brain via the optic

nerve. The brain then "interprets" the electrical message sent to it, resulting in vision. The macula is a specific area of the retina responsible for central vision. The fovea is about 1.5 mm in size and located in the macula. The fovea is responsible for sharp vision. When looking at something, the fovea should be directed at the object.

Retinopathy, or damage to the retina, has various causes. A hardening or thickening of the retinal arteries is called arteriosclerotic retinopathy. High blood pressure in the arteries of the body can damage the retinal arteries and is called hypertensive retinopathy. The spreading of a syphilis infection to the retinal blood vessels cases syphilitic retinopathy, and diabetes damages the retinal vessels resulting in a condition called diabetic retinopathy. Sickle cell anemia also affects the blood vessels in the eyes. Exposure to the sun (or looking at the sun during an eclipse) can cause damage (solar retinopathy), as well as certain drugs (for example, chloroquine, thioridazine, and large doses of tamoxifen). The arteries and veins can become blocked, thus resulting in a retinal artery or vein occlusion. These are just some of the causes of the various retinopathies.

Retinopathies are divided into two broad categories, simple or nonproliferative retinopathies and proliferative retinopathies. The simple retinopathies include the defects identified by bulging of the vessel walls, by bleeding into the eye, by small clumps of dead retinal cells called cotton wool exudates, and by closed vessels. This form of retinopathy is considered mild. The proliferative, or severe, forms of retinopathies include the defects identified by newly grown blood vessels, by scar tissue formed within the eye, by closed-off blood vessels that are badly damaged, and by the retina breaking away from its mesh of blood vessels that nourish it (retinal detachment).

While each disease has its own specific effect on the retina, a general scenario for many of the retinopathies is as follows (note: not all retinopathies necessarily affect the blood vessels). Blood flow to the retina is disrupted, either by blockage or breakdown of the various vessels. This can lead to bleeding (hemorrhage) and fluids, cells, and proteins leaking into the area (exudates). There can be a lack of oxygen to surrounding tissues (hypoxia) or decreased blood flow (ischemia). Chemicals produced by the body then can cause new blood vessels to grow (neovascularization), however, these new vessels generally leak and cause more problems. Neovascularization can even grow on the colored part of the eye (iris). The retina can swell and vision will be affected.

Diabetic retinopathy is the leading cause of blindness in people ages 20 to 74. Diabetic retinopathy will occur in 90% of persons with type 1 diabetes (insulin-dependent, or insulin requiring) and 65% of persons with type II diabetes (non-insulin-dependent, or not requiring insulin) by about 10 years after the beginning of diabetes. In the United States, new cases of blindness are most often caused by diabetic retinopathy. Among these new cases of blindness, 12% are people between the ages of 20 to 44 years, and 19% are people between the ages of 45 to 64 years.

Causes and symptoms

There are many causes of retinopathy. Some of the more common ones are listed below.

Diabetic retinopathy

Diabetes is a complex disorder characterized by an inability of the body to properly regulate the levels of sugar and insulin (a hormone made by the pancreas) in the blood. As diabetes progresses, the blood vessels that feed the retina become damaged in different ways. The damaged vessels can have bulges in their walls (aneurysms), they can leak blood into the surrounding jelly-like material (vitreous) that fills the inside of the eyeball, they can become completely closed, or new vessels can begin to grow where there would not normally be blood vessels. However, although these new blood vessels are growing in the eye, they cannot nourish the retina and they bleed easily, releasing blood into the inner region of the eyeball, which can cause dark spots and cloudy vision.

Diabetic retinopathy begins prior to any outward signs of disease being noticed. Once symptoms are noticed, they include poorer than normal vision, fluctuating or distorted vision, cloudy vision, dark spots, episodes of temporary blindness, or permanent blindness.