I have had diabetic retinopathy for many years, this has been treated with so much laser, that my peripheral vision, certainly in the right eye became very poor.  Whilst this isn’t good, the words of the consultant keep ringing in my ears, when he said, if we don’t laser, then you will loose your sight.

Recently, I got diagnosed with the CSR, and this is what has taken my vision to the next level of loosing my sight.

Diabetic retinopathy:

A complication of diabetes, caused by raised blood sugar levels damaging the back of the eye (Retina). If left undiagnosed/untreated, blindness can occur.

The retina is the light-sensitive layer of cells at the back of the eye that converts light into electrical signals. The signals are sent to the brain and the brain turns them into the images you see.

The retina needs a constant supply of blood, which it receives through a network of tiny blood vessels. Over time, a persistently high blood sugar level can damage these blood vessels in three main stages:

Background retinopathy – 

tiny bulges (microaneurysms) develop in the blood vessels, at the back of your eye which may bleed slightly but don’t usually affect your vision. Usually, at this stage your vision isn’t affected, although your chances of developing visual problems in the future is higher. At this point, treatment isn’t usually required, but you do need to extra care to prevent it from getting worse. Keeping your blood sugar levels, blood pressure and cholesterol levels under control is what is needed at this stage.

Pre-proliferative retinopathy 

more severe and widespread changes affect the blood vessels, including more significant bleeding into the eye. At this stage, there’s a high risk that your vision could eventually be affected and you will usually be advised to have more frequent screening appointments every three or six months to monitor your eyes.

Proliferative retinopathy – 

new blood vessels and scar tissue have formed on your retina, which can cause significant bleeding and lead to retinal detachment (where the retina pulls away from the back of the eye). At this stage there’s a very high risk you could lose your vision, and treatment will usually be offered to stabilise your vision as much as possible, although it won’t be possible to restore any vision you’ve lost

Diabetic maculopathy –

sometimes the blood vessels in the part of the eye called the macula (the central area of the retina) can also become leaky or blocked. If this is the case, there’s a high risk that your vision could eventually be affected. It is likely that you will be advised to have more frequent specialised testing to monitor your eyes and you may be referred to a hospital specialist to discuss treatments that can help stop the problem getting worse.

Symptoms of diabetic retinopathy:

Ordinarily, you wouldn’t notice any obvious symptoms as these don’t start to occur until it is in the more advanced stages. However, early signs of the condition can be picked up by taking photographs of the eyes during routine diabetic eye screening.Typically, symptoms of the condition advancing are:

  • gradually worsening vision
  • sudden vision loss
  • shapes floating in your field of vision (floaters)
  • blurred or patchy vision
  • eye pain or redness

If you have these symptoms it doesn’t necessarily mean you have diabetic retinopathy, but it’s important to get them checked out as soon as you notice them. Don’t wait until your next routine screening appointment.

Central serous retinopathy (CSR)

It isn’t entirely clear what causes CSR, and quite often no cause is found to explain why it occurs.  However, there are several possible risk factors that have been identified. The condition seems to occur more frequently in people:

  • with a Type A personality (individuals who are stressed and find it hard to relax)
  • who use steroid medication
  • during pregnancy
  • with Cushing syndrome

When under stress, your body releases a natural steroid into your bloodstream called cortisol which helps your body to cope with he stress.

Whilst cortisol is essential for your health, raised levels can sometimes cause problems for your body. This can include immune suppression (reducing the body’s ability to fight infection) and increased fragility and permeability of the blood vessels.

Although cortisol is currently thought to be linked to CSR, it is not thought to be solely responsible for the condition and cannot explain every case.

CSR affects the central area of your retina, known as the macula. CSR can cause your vision to be blurry and distorted due to a build up of fluid collecting underneath your macula. Objects often appear smaller and distorted in the affected eye.

The good news is that in most cases, CSR gets better on its own and doesn’t cause long-term changes to vision. However, it may re-occur. The more times someone has CSR, the higher the chance of having some permanent changes in your vision.  In my particular case, if I have had out before, it certainly wasn’t noticed.
CSR is also sometimes called central serous chorioretinopathy

The way in which CSR affects the eye:

When you look at something, light passes through the front of your eye, and is focused by the cornea and lens, through a jelly like substance known as vitreous gel, onto your retina. The retina is made of several layers.
The retina converts light into electrical signals that travel along the optic nerve to your brain. The brain interprets these signals to “see” the world around you.Light is focused onto a small central area of the retina called the macula. The macula enables you to see fine detail when you are looking directly at something such as words, photos or the television.
It is also important for colour vision.
The rest of the retina, gives you side vision (peripheral vision).Your retina is made up of a number of layers including a layer called the retinal pigment epithelium (RPE) that separates the sensory retina from the choroid. The RPE prevents fluid and blood from the choroid entering under your retina.CSR is thought to occur when there is a small break in the RPE.
Fluid starts to collect underneath your retina ( a bit like when fluid collects in a blister) which causes the central macula area to swell. When this happens, blurry vision, distortion, blind spots and objects appearing smaller than they are can occur.
You may also have trouble with bright light and contrast sensitivity could be greatly reduced. If this happens,  it will affect how well you can see an object from its background.CSR usually affects young to middle age men, aged 20-45 years old and often in just one eye. However, women and other are groups can also be affected.Treatment is not usually needed for CSR. Most people will find that their vision will improve within 3-6 months and without the need for treatment. Vision often returns to how it was before CSR developed, although in some people small changes to vision may persist.
About 30-50 per cent of people will have a recurrence either in the same or fellow eye.In a minority of people, the condition can be chronic, lasting longer than 12 months. In these cases, sight is more at risk because the retinal layers at the back of your eye can become damaged. As a result treatment may be recommended for CSR lasting longer than six months.In rare cases, central serous retinopathy with bullous serous retinal detachment can occur; in this type of retinal detachment fluid collects under the retina and away from your central macula without causing the retina to break.

Disclaimer:

I think it is important to state here, that this is my current understanding of the eye conditions that have caused me to have very low vision.  It is my understanding of the conditions, based upon my understanding, discussions with health professionals treating me, and what I have gleaned from various research sources.

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