Eye disease: Nonproliferative and proliferative retinopathy: causes, symptoms, complication, diagnosis and treatments.

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The retina is the lightsensitive tissue lining the inner surface of the eye. It receives visual images and converts them into nerve impulses for the brain to perceive as vision.
Retinopathy is disease of the retina. It typically involves damage of small blood vessels that nourish the retina.
Retinopathy can have different causes but the 2 most common are diabetes and hypertension.
In hypertension, persistent high blood pressures weaken small blood vessels everywhere in the body, including the eyes. Some patients may not be aware that they have hypertension until visual symptoms due to retinopathy develop.
Diabetes is by far the most common cause of retinopathy. High blood sugar levels can damage blood vessels of the retina just like any other blood vessels. Diabetic retinopathy can be nonproliferative or proliferative.
In the early, nonproliferative stage, weakened spots on blood vessels may bulge, forming tiny aneurysms. These aneurysms can bleed or leak fluid into the retina. When this happens, patient may see floating spots or strings. Some patients may experience eye pain or redness, while others may have no symptoms at this stage. Leaking of fluid into the central area of the retina – the macula – results in macular edema, which may cause blurry vision, or double vision.
Patients may also present with small white patches on the retina. These socalled cottonwool spots correspond to areas of poor blood supply.
As retinopathy progresses, new, abnormal blood vessels begin to grow in an attempt to compensate for the inadequate blood supply. This advanced stage is known as proliferative retinopathy. The abnormal blood vessels may grow and bleed into the vitreous the gellike structure that fills the space between the lens and the retina. Depending on the amount of bleeding, patients may see small dark spots, or experience cloudy vision or temporary loss of total vision.
Abnormal blood vessels may cause scar formation and detachment of the retina. They may also block the normal flow of fluid, causing pressure to build up in the eye, ultimately resulting in peripheral vision loss, in a condition known as glaucoma. Left untreated, complications of retinopathy will eventually lead to partial or total loss of vision.
Retinopathy can be diagnosed with a comprehensive eye exam with pupil dilation. Early diagnosis is crucial to prevent blindness. People with diabetes or hypertension are advised to have their eyes examined at least annually.
Treatment of nonproliferative retinopathy is typically directed at the cause. For most patients, this means control of blood sugar and/or blood pressure, which can help slow or stop progression of retinal damage.
Proliferative retinopathy requires prompt treatment in the eye to prevent vision loss. Treatment options include:
Medications, which act to stop the growth of new blood vessels and decrease fluid buildup. These medications are typically injected into the vitreous.
Photocoagulation, also called focal laser treatment, in which laser beams are used to seal the leakage from the abnormal blood vessels.
Panretinal photocoagulation, or scatter laser treatment, where laser beams are used to shrink the abnormal blood vessels.
– And vitrectomy, a surgical procedure in which the damaged vitreous is removed and replaced with a new fluid.