#retinopathy

Fishy Looking

Eyesight often changes as we age, but those living with diabetes face an added challenge – high blood sugar levels can chip away at cells in the retina, leading to diabetic retinopathy and even blindness. Searching for a way to slow or stop the disorder, here scientists use a high-powered microscope to peer into the eye of a zebrafish with a genetic mutation that mimics human diabetes. In among the layers of retinal cells (with their DNA stained blue), the researchers watch as progenitor cells – stem-like cells with the ability to become specialised – react to the damaging sugars. Progenitors destined to become photoreceptors – cells shaped like ‘rods’ and ‘cones’ that are sensitive to light – are able to replenish these vital parts of the retina (the long cells highlighted in green). The aim is to coax similar cells in human eyes to repair or reduce the damage left by diabetic retinopathy.

Written by John Ankers

Image from work by Nicole Schmitner, Christina Recheis, Jakob Thönig and Robin A. Kimmel

Institute of Molecular Biology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Austria

Image contributed and copyright held by Robin A. Kimmel

Research published in Cells, November 2021

Which I am extra dreading, after repeatedly getting hold of that one blamey paternalistic fuck back in the UK.

(And just generally getting treated as subhuman by staff--and witnessing more than one big screwup in action--at that particular hospital clinic. A really fucking weird atmosphere, when eye doctors had seemed about as nonthreatening as you can get before?)

Not particularly looking forward to the minimum several days of photosensitive migraines afterwards, either, though at least it's not summer. 🌞

Plus, there's no way I do not need some kind of retinopathy treatment now, in at least that one eye. (Still out of pocket for now, just as icing.) Not only given the repeated Haunted Eyeball episodes, but also after seeing the referral notes and how much worse that eye had apparently gotten without their bothering to tell me.

(Besides the general NHS approach of treating people like mushrooms, IME? And the general shambolic state of that particular opthalmology department? It's easier to get away with ghosting and neglecting patients while the health service falls completely apart thanks to the Tories and added pandemic, if you don't even inform them of their need for treatment! 🙄)

Yeah, that's another fun thing! 🙃 To go along with the treatment-induced neuropathy.

On the plus side, though? At least this shit does not seem to be getting worse still. And the damage ought to slow way the hell down/somewhat heal itself, now that I am getting appropriate treatment for the diabetes. My control is actually looking pretty good and stable, now that I do have some freaking insulin in my body. (Storebought is fine! 🥴)

But yeah, I fully expect to be going back to get my eyeball(s) poked with hypodermic needles and/or zapped with lasers in the somewhat near future. With local anesthetics not working right for me, of course. 😬 Since they do seem to have a much more functional healthcare system here.

Pretty well resigned to that, for years now--and the risks there are looking so much better than, you know, eventually losing my vision! I would really like to continue seeing, thanks.

What I am more concerned about in advance, though? Hoping they WILL NOT treat me by default like all of this is just punishment for being an unrepentantly Fat Stupid Lazy Noncompliant Bad Diabetic Yank Slob--without bothering to even find out what's even going on. And I ought to show suitable gratitude that they are even charitable enough to see me at all, and do whatever the hell they choose to do for "help".

It was three years ago today that I was diagnosed with stress-related retinopathy.

The spots to the right of the center are from broken blood vessels in the retina. They take about 6 months to heal. Until then, I can't see anything through the spots.

I still have another large spot that's healing from earlier this year. Thankfully these only occur in my right eye. I'm hoping meditation will prevent more in the future.

I don't talk about this much because it's scary to think I, a visual artist, could lose my vision because of stress.

When left untreated, diabetes can have devastating effects. From chronic non-healing wounds to problems with visual acuity, diabetes is a full-body systemic disease. However, even when diabetes is under adequate control, it can still cause a multitude of other problems such as diabetic retinopathy. We will go over all four of the diabetic retinopathy stages.

WHAT IS DIABETES?

Diabetes is a disease that affects how a person’s body processes blood sugar. Also known as glucose, blood sugar is an extremely important source of fuel for your cells. It’s also the main source of energy for your brain. The cause of diabetes depends on what type it is. Having too much or not enough sugar in the blood can cause severe health issues.

There are various types of diabetes, but the two most common are type 1 and type 2 diabetes. Prediabetes and gestational diabetes are classified as being reversible. Prediabetes is when the glucose levels are higher than usual, but not to the point it can be clinically diagnosed as diabetes.

Gestational diabetes only occurs during pregnancy, but usually resolves after the baby is born. However, there are cases where gestational diabetes evolves into type 1 diabetes.

WHAT IS DIABETIC RETINOPATHY?

Diabetic retinopathy is a complication of diabetes. It’s caused when the blood vessels of the retina are damaged. In the beginning, you might not exhibit any symptoms of diabetic retinopathy.

Over time, diabetes damages the blood vessels inside your retina. Diabetic retinopathy happens when the tiny blood vessels begin to leak blood and other fluids. In turn, the retinal tissue swells, which can result in blurry or cloudy vision. Diabetic retinopathy typically affects both eyes. The longer someone has diabetes, the more likely they are to develop diabetic retinopathy. When left untreated, diabetic retinopathy can lead to blindness.

WHAT ARE THE SYMPTOMS OF DIABETIC RETINOPATHY?

As previously mentioned, you may not exhibit any symptoms in the early stages of the disease. However, if left untreated, you may experience the following:

Blurry vision

Floaters, which are dark strings or spots that float around

Unable to differentiate colors

Decrease in visual acuity

Dark areas in your line of sight

Random bleeding from the eyes

Complete loss of vision

Please note that diabetic retinopathy typically affects both of your eyes simultaneously.

WHO IS AT RISK FOR DIABETIC RETINOPATHY?

Anyone who suffers from type 1 or type 2 diabetes are at risk for this eye condition. The risk increases of diabetic retinopathy the longer you have diabetes. About 40 to 45 percent of people in America that are diagnosed with diabetes experience some form of diabetic retinopathy.

However, half of them are actually aware of it. If a woman has developed diabetes during pregnancy, they may experience a rapid onset of diabetic retinopathy or it can worsen it.

WHAT ARE THE STAGES OF DIABETIC RETINOPATHY?

We’ve mentioned before that diabetic retinopathy is caused when the retina’s blood vessels are damaged. Let’s go into more detail about this. To start, the retina is the part of the eye that detects light and converts it into signals. These signals are then sent through the optic nerve and into the brain. When diabetic retinopathy occurs, it causes the retina’s blood vessels to either hemorrhage or leak fluid, which causes vision distortion.

If diabetic retinopathy is allowed to evolve into its most extreme state, abnormal blood vessels will begin to grow on the retina’s surface. This can cause the retina to lose cells and become scarred.

Now that you have a general understanding of what causes diabetic retinopathy and how it affects you, it’s time to learn the various stages.

Here are the four diabetic retinopathy stages:

STAGE ONE: MILD NONPROLIFERATIVE RETINOPATHY

In this stage, tiny areas of the retina’s blood vessels will begin to swell. These are known as microaneurysms and can leak fluid in the retina.

STAGE TWO: MODERATE NONPROLIFERATIVE RETINOPATHY

As this condition progresses, the blood vessels that help nourish the retina might distort and swell. The blood vessels might even lose their ability to transport blood to the eye. Not only will this cause significant changes to the appearance of the retina, it may also contribute to another condition known as diabetic macular edema (DME).

STAGE THREE: SEVERE NONPROLIFERATIVE RETINOPATHY

In this stage, many blood vessels in the retina become blocked, which deprives the areas of their blood supply. These areas are what secretes the growth factors which signals the retina to grow brand new blood vessels.

STAGE FOUR: PROLIFERATIVE DIABETIC RETINOPATHY

This condition is known as proliferative diabetic retinopathy or PDR and it’s the most advanced stage. The growth factors are secreted at such a rapid pace, leading to the proliferation of new blood vessels. These new blood vessels grow alongside the surface of the retina and turn into a gel-like substance, which is known as vitreous fluid. This liquid is what fills the eye.

The blood vessels are very fragile, making them more vulnerable to bleeding along with developing scarred tissue. The scar tissue can end up contracting and cause retinal detachment. Retinal detachment is when the retina pulls itself away from the underlying tissue, similar to how wallpaper peels away from the wall. If retinal detachment occurs, it can lead to a permanent loss of vision.

DIAGNOSING DIABETIC RETINOPATHY

One of the best ways to diagnose diabetic retinopathy stages is with a dilated eye exam. During this exam, drops will be put in the eyes, which causes the pupils to widen or dilate. This helps the optometrist to get a better look inside your eyes. The drops that are used might cause your vision to blur, but it wears off after a couple of hours.

As the exam is performed, the doctor will look for:

Swelling

Blood in the retina

Newly developed blood vessels

Problems in the optic nerve

Retinal detachment

Deposits of fats in the retina

While a dilated eye exam is a great way to diagnose diabetic retinopathy, there are other ways to notice the diabetic retinopathy stages. Your doctor may recommend a fluorescein angiography or an optical coherence tomography.

FINAL THOUGHTS

Diabetes doesn’t need to take over your life. With proper management, you are able to live an active lifestyle and to thrive. If you’ve been recently diagnosed with diabetes, schedule an appointment with your ophthalmologist to maximize eye health.

Retinopathy 3 - Central Serous • Gone Tomorrow

Emerson, Lake & Palmer with Rachel Flowers* -- The Endless Enigma

* Rachel Flowers

Watch Rachel's Fugue about 6 minutes in!!!

About Rachel

Multi-talented instrumentalist and composer Rachel Flowers was born on December 21, 1993. Arriving 15 weeks premature, she lost her eyesight as an infant due to Retinopathy of Prematurity (ROP).

Leaky Pipes

Leaky pipes, in your home or body, can be disastrous. Leaky blood vessels are a major factor causing blindness, increasingly common in ageing populations and with rising diabetes rates. In both diabetic retinopathy and age-related macular degeneration, new blood vessels grow, but they tend to leak, depriving the eyes of essential oxygen and flooding them with unfiltered substances. Current treatments block the action of VEGF, a molecule that prompts this new blood vessel formation, but in doing so also damage existing blood vessels, causing even more harm. A new study used fluorescent markers to highlight any leaks (magenta) in and around the blood vessels (green) of damaged mouse eyes. Mice with particular genetic mutations related to VEGF were still able to form new vessels, but did not show leakage. The next question is whether a drug can be developed to achieve the same effect, and provide a welcome sight for patients.

Written by Anthony Lewis

Image from work by Ross O Smith and colleagues

Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Science for Life Laboratory Uppsala University, Uppsala, Sweden

Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)

Published in eLife, April 2020