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Retinopathy refers to damage to the blood vessels of the retina. The retina, at the back of the eye, provides a window to the circulatory system. By examining it, a doctor can inspect a sample of the body's blood vessels and detect early signs of complications of diabetes or high blood pressure, as well as many other diseases (e.g., sickle cell disease, anemia, lupus). Retinopathy can also be seen in premature newborns.
Some of the kinds of damage that your doctor may see in your retina are hypertensive retinopathy, a complication of high blood pressure (hypertension), and diabetic retinopathy, a complication of long-term diabetes.
It's unusual for hypertension to impair vision, but hypertensive retinopathy can lead to blockage of retinal arteries or veins, which in turn may eventually result in the loss of vision. Smoking and diabetes increase the risk of developing hypertensive retinopathy.
Diabetic retinopathy is a deterioration of the blood vessels in the retina that usually affects both eyes. It is the leading cause of blindness in North America. Almost all people with diabetes show signs of retinal damage after about 20 years of living with the condition.
Retinopathy is usually a sign of another medical condition. Although several medical conditions (e.g., sickle cell disease, lupus) can cause retinopathy, the most common causes are diabetes and hypertension (high blood pressure).
Diabetic retinopathy is a complication of diabetes. Diabetes causes high blood sugar levels, which can damage blood vessels. The damaged vessels around the retina can leak protein and fats, forming deposits that can interfere with vision. The damaged blood vessels are also not as effective at carrying oxygen to the retina, which can also cause damage.
In the advanced stage, called proliferative retinopathy, new blood vessels grow in the eye. However, they are weak and often burst, causing bleeding in the eye. The bleeding can cause scarring of the eye and damage vision.
Hypertensive retinopathy is a complication of high blood pressure that usually takes many years to develop. High blood pressure damages the blood vessel walls, causing them to thicken and narrow. This reduces the blood supply available to the retina, leading to retinal damage. Eventually, blood can leak into the retina, causing further damage.
Early in diabetic retinopathy, there may be no symptoms at all. As the disease progresses, symptoms include:
The earliest sign of diabetic retinopathy that your doctor may detect is the formation of microaneurysms. These are balloon outpouchings of small blood vessels in the retina that appear as tiny red dots at the back of the eye; they sometimes break, causing bleeding in the retina and cloudy vision.
A more advanced form of diabetic retinopathy, called proliferative diabetic retinopathy, may lead to scars that decrease vision. In proliferative retinopathy, new blood vessels grow over the retina and into the vitreous humour (the gel-like substance between the lens and retina). These blood vessels may swell and burst, causing bleeding and damage to the eye. In some cases, the blood can be reabsorbed, but in many cases the retina can become detached causing total blindness.
As with diabetic retinopathy, there may be no symptoms early in hypertensive retinopathy. However, as the condition progresses, symptoms include: