1.Overstay more than package days, 2. Any other Specialty Consultations, 3. Special Equipment, 4. Additional Procedure/Surgery. 5. Blood Components.
What is Diabetic Retinopathy?
Diabetic retinopathy is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). Diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness. The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication.
Spots or dark strings floating in your vision (floaters)
Impaired color vision
Dark or empty areas in your vision
Diabetic retinopathy usually affects both eyes.
Duration of diabetes — the longer you have diabetes, the greater your risk of developing diabetic retinopathy
Poor control of your blood sugar level
High blood pressure
Being African-American, Hispanic or Native American
There are two types of diabetic retinopathy:
Early diabetic retinopathy- In this more common form called no proliferative diabetic retinopathy (NPDR) new blood vessels aren't growing (proliferating).When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges (microaneurysms) protrude from the vessel walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter, as well. NPDR can progress from mild to severe, as more blood vessels become blocked.
Advanced diabetic retinopathy-Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type,damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina, and can leak into the clear, jelly-like substance that fills the center of your eye (vitreous). Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure may build up in the eyeball. This can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma.
Complications can lead to serious vision problems:
Vitreous hemorrhage -The new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision. Vitreous hemorrhage by itself usually doesn't cause permanent vision loss.
Retinal detachment-The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss.
Glaucoma- New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).
Blindness-Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.
During the exam, your eye doctor will look for:
Abnormal blood vessels
Swelling, blood or fatty deposits in the retina
Growth of new blood vessels and scar tissue
Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)
Abnormalities in your optic nerve
Doctor will test your vision, measure your eye pressure to test for glaucoma and look for evidence of cataracts.
With your eyes dilated, your doctor takes pictures of the inside of your eyes. Then your doctor will inject a special dye into your arm vein and take more pictures as the dye circulates through your eyes' blood vessels. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid.
Optical coherence tomography
Your eye doctor may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue.
Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping progression of the condition.
Early diabetic retinopathy
If you have mild or moderate no proliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment. Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.
Advanced diabetic retinopathy
If you have proliferative diabetic retinopathy or macular edema, you'll need prompt surgical treatment. Depending on the specific problems with your retina, options may include:
Photocoagulation. This laser treatment, also known as focal laser treatment, can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns. Focal laser treatment is usually done in your doctor's office or eye clinic in a single session. If you had blurred vision from macular edema before surgery, the treatment might not return your vision to normal, but it's likely to reduce the chance the macular edema may worsen.
Pan retinal photocoagulation. This laser treatment, also known as scatter laser treatment, can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar. It's usually done in your doctor's office or eye clinic in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.
Vitrectomy. This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that are tugging on the retina. It's done in a surgery center or hospital using local or general anesthesia.
Injecting medicine into the eye. Your doctor may suggest injecting medication into the vitreous in the eye. These medications, called vascular endothelial growth factor (VEGF) inhibitors, may help stop growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels. Surgery often slows or stops the progression of diabetic retinopathy, but it's not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible. Even after treatment for diabetic retinopathy, you'll need regular eye exams. At some point, additional treatment may be recommended.
Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight.
There is no cure for diabetic retinopathy. But treatment works very well to prevent, delay, or reduce vision loss. The sooner the condition is found, the easier it is to treat. And it's more likely that vision will be saved.
People who have diabetic retinopathy, laser photocoagulation will very likely help prevent more severe vision loss over time. Diabetes experts agree that early detection and treatment of retinopathy can prevent many, or even most, cases of severe vision loss and blindness in people who have diabetes.
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