Diabetes is a metabolic disease that could lead to devastating complications if left unchecked. Prolong uncontrolled high blood sugar level would lead to disorder in blood vessels known as angiopathy. There are two kind of angiopathy, microangiopathy and macroangiopathy. In macroangiopathy, atherosclerosis commenced and may blocks blood flow. Stroke, and ischemic heart disease are examples of complications that rise from macroangiopathy. In microangiopathy, smaller blood vessels wall structure becomes thick and weak. It may cause bleeding, protein leakage, and slowing the flow of blood through the body.  This may  lead to tissues damage due to lack of oxygen supply (termed ischemia) and may further lead to cellular death (necrosis).
One of so many organs that are affected is the eye. Pathological process of microangiopathy would cause damages to Retina. Receiving nutrients and oxygen from one of its layer that is rich in blood vessels, called the uvea, Retina could thrive and maintain its function akin to “camera film roll” to receive visual stimulus, convert them to neuron impulses and then send it to the brain for further process.  Microangiopathy would damage uvea blood vessel wall and cause bleeding.  This process would lead to damaged Retina (called diabetic retinopathy) and may cause blindness.
Although the eye is an organ that is rich in sensory ner ves, there are no nerve endings at retina that act as pain receptors. Therefore lots of diabetes patients are not aware of the ongoing process of diabetic retinopathy because it is painless and many of them came to ophthalmologist already in advance state.There are two stage of diabetic retinopathy, nonproliferative diabetic retinopathy and proliferative diabetic retinopathy.
Vessel walls weakened and hemorrhage ensues in the first stage. This leads to swelling in the retina and patient will feel their vision disturbed. In the second stage, blood vessels becomes inadequate providing oxygen to the retina and retina become ischemic.  New blood vessels are formed  as an attempt to provide better circulations and oxygen supply.  However, new blood vessels have weak wall and hemorrhage easily occurs, and this process is repeated and vicious cycles formed, hence the name “proliferative retinopathy”.
Most patients come to an ophthalmologist because of disturbed vision. Complaints of blurry vision, flashing lights, or floating spots may be told.  While symptoms of pain or pressure in one or both of the eye may indicate development of secondary glaucoma. Ultimately, diabetic retinopathy final outcome is blindness.
That is why it is important for diabetic patients to have their eyes checked and monitored by an ophthalmologist (especially a retina sub specialist) regularly.

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