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Diabetic Retinopathy II: the beginning
By: Robert Scheinman | July 24, 2010
Categories: Science, Type 1, Type 2

In my last post I discussed the anatomy of the eye. Keep this in mind as we begin to consider what diabetes does to this anatomy. Remember that the most important aspect of diabetes is high blood sugar. This is the source of all complications that will make life so miserable down the line. The two major issues with glucose, as I have written before, are that it is reactive outside the cell and that it can get converted to sorbitol inside the cell.

The tissue at risk here are the capillaries and other small blood vessels in the choroid. These are the sources of nutrients for the retina which is the most metabolically active tissue in the body. We have a great deal of information about how diabetes changes these vessels at very early times in the disease. The early heroes who made this possible are the people who have specified that their bodies can be used for research after they die. Sadly, there are too many of them. Car accidents probably account for the vast majority along with heart attacks and cancer. People studying diabetic retinopathy put together a proposal to obtain eyes from these people after they die. Once the proposal is reviewed and accepted, specific hospitals would be set up as sources for the material and everything would be scrutinized carefully by ethics committees before the work began. Once the eyes were in hand, these researchers carefully examined the vascular structure of the choroid and compare it to the status of diabetes in the person before they died. In the present day, we have very powerful imaging tools that can examine many aspects of the retinal vasculature in the living patient – more on this later.

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A big problem is that, you cannot do laser or any surgery for the patient unless the blood sugar is at control, and since the blood sugar does not come to a control, you can never get a suitable body condition for the appropriate surgery or treatment. Only topical medicines can be applied with little results.
 
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