Diabetic Retinopathy

Several years back a diabetic man walks in my door.  He had been diabetic for years but hadn't taken his meds for years.  Deciding he didn't want to die, he started taking his medications again and came in for an eye examination. When I dilated him and looked into his eyes, this is what I saw:

Sutton James labels

Ok, this is a great photo of diabetic retinopathy.  He's got it all.  Look just below the label neovascularization.  You will see some squiggly blood vessles.  These are "new" blood vessels which have grown in an effort to supply the retina with more oxygen.  Unfortunately, this newly grown blood vessels leak fluid which enters the retina and causes the retina to swell.  Our retinas are composed of neurons (brain cells) so when the retina swells these connections between neurons are torn apart which of course leads to blindness.  Left untreated, eventually, the blood vessels will break and bleed and ultimatley scar down.  The specks just below that are exudate; exudates are crystaized deposits caused by the fluid in the retina.  Fluid enters the retina which elevated the photoreceptors off of the blood supply of the eye (choroid), eventually without a good blood supply, the photoreceptors wither and die.   The cotton wool spot, the white puffy areas, are produced by hypoxia (lack of oxygen).  It turns out that neurons have little organelles and travel up and down the length of the cell.  Well, it takes energy to transport and if an area has little or no oxygen, the transport system stops.  The white puffy areas represent a log jam of intracellular material which in mass have gotton stuck and can be seen as these puffy spots. This man's vision was headed south.

Naturally, I referred him to a retina specialist for treatment. I hadn't seen him for a years, but eventually he came back to my office.  When I dilated him, this is what I saw:

sutton keel hem

Now, looks bad doesn't it?  But actually it's a vast improvement.  The little circular whitish dots are laser burns which the retina specialist laid down.  Where a laser burn is, the retina is dead.  A dead retina doesn't use oxygen.  So a treated retina doesn't need as much oxygen, leaving more oxygen available for the remainder.  Notice the neovascularization is receding.  The exudates are drying up.  The cotton wool is less pronounced.  The large hemorrhage is called a keel boat hemorrhage because of its shape.  This occurred because the newly grown blood vessels, while vastly improved, were still present, and an old one broke.  This eventually will clear.

As of this writing, this patient is seeing very well, considering what his eyes went through.

Edit: December 13, 2016. Sadly my friend passed away.  His zany humor will be missed.

© Richard Randolph 2012