What is diabetic retinopathy?Diabetic retinopathy is a medical condition that develops in some diabetes patient's eye(s) where tiny blood vessels at the back of the eye(s) narrow and constrict as a result of the diabetes patient having uncontrolled blood glucose ("sugar") levels over time. High blood pressure and cholesterol levels may also contribute to diebetic retinopathy.In response to the blockage of blood flow, the body naturally develops new blood vessels that bypass the blockage. But these new blood vessels tend to be very fragile and burst and hemorrhage (leak blood) into the eye(s) of the diabetic, which can ultimately lead to blindness, if the bleeding is not halted by a retina specialist. Virginia went to see her ophthalmologist immediately after she began to have difficulty seeing clearly while driving. She had begun to notice symptoms of diabetic retinopathy, which include the presence of tiny black specks ("floaters") in her sight, followed later by larger black spots or splotches, and blurry vision. Although her general eye exam was supposed to be "routine," it turned out to be anything but: her Tampa ophthalmologist told her that she had blood leaking in the back of both eyes and she needed to go see an eye specialist right away or she would eventually go blind due to the continual bleeding in the eyes. These were very stressful times for both of us. The ophthalmologist referred her to a retina specialist, Dr. Dan Montzka, M.D., and he turned out to be a Godsend. We cannot thank Dr. Montzka enough, along with his wife and the entire staff of Gulf Coast Retina's Clearwater, Florida office, for preventing Virginia from going blind, and restoring her to almost normal vision. Before she went to see him, her sight in her right eye was 20/500, and after the laser and vitrectomy surgeries, her vision dramatically improved to 20/40, hallelujah! What a miracle! She can almost drive again! She is so happy now, and feels so blessed to have her vision restored almost to normal (though she still needs to get cataract surgeries to correct some blurriness and see perfectly). Side Note: [If any of you need to see a retina specialist and you live in the Tampa Bay Florida area, Dr. Montzka's offices are located in Clearwater and Port Richey, and we could not recommend a better Tampa retina specialist. He is a little quiet and doesn't talk much (I think this is because he has a long line of patients), but he has God's touch when he is performing these delicate eye surgeries. Here's a link to his offices: http://www.gulfcoastretina.com] Dr. Montzka confirmed that my loved one, Virginia, had proliferative diabetic retinopathy. He explained that she first needed to have laser surgery performed to stop the bleeding from the broken blood vessels in both of her eyes, and then vitrectomy operations later, to remove blood and scar tissue that was putting pressure on each retina that could lead to retinal detachment and total blindness. The retina is located in the back of the eye and functions in the eye similar to how film functions in a camera. The light images that pass through the front of the eye impact the retina at the back of the eye and are transmitted to the optic nerve through to the brain where the images are processed by the brain. If the retina becomes fully detached, blindness occurs, because images cannot be transmitted to the optic nerve to be further transmitted to the brain. During Virginia's laser surgery, Dr. Montzka dilated her eye with eye drops. Then he poked a very long, sharp needle right below her eye to deaden it (yes, she cried like a baby); and then he used a scatter laser machine to cauterize (burn) the blood vessels in the back of her eye to seal the leaks and stop further bleeding. During this process, Virginia saw flashing, bright lights from the laser. It didn't sting or burn, although the doctor said that in a few of his patients they might experience a slight burning sensation after the procedure. The part that really bothered her was the presence of the "floaters" or blood splotches in her vision during the laser operation. The laser procedure only took about fifteen minutes (not including the long wait in the doctor's office for her eyes to dilate). The doctor would only do one laser surgery at a time. Eye doctors never perform eye surgeries on both eyes at the same time. After the first laser operation, Virginia's eye healed and we went back to the doctor after one week to do the same laser procedure on her other eye. Vitrectomy SurgeryWe had to wait three weeks after the last laser surgery follow-up appointment to schedule her "pre-op" physical and tests needed for clearance from her primary care doctor in order to schedule her first vitrectomy surgery that was to be performed in the hospital.The night before Virginia's vitrectomy surgery, she could not eat any foods after midnight, nor drink water; or anything before the operation the next morning. Our drive to the hospital took forty-five minutes, and we left at 4am to make it in time for her vitrectomy surgery scheduled for 7am. The vitrectomy surgery itself only takes about a half-hour in the operating room, but the hospital had to run several tests before the operation; and afterward, we had to wait for the general anesthesia to wear off. I waited all day, and we didn't leave the hospital until after 6pm that day! During the vitrectomy procedure, Dr. Montzka removed blood that had leaked into my loved one's eyes in the middle part of the eye called the vitreous gel. The vitreous gel is normally clear and allows light to pass straight through the middle part of the eye to the retina which is located in the back of the eye. The excess blood in the vitreous blocks the normal passage of light through to the retina and causes the "floaters" or splotches that are seen by the vitrectomy patient. He also removed scar tissue inside the eye that was putting pressure on the retina that could have lead to a retinal tear or retinal detachment, which could have resulted in total blindness. The vitrectomy operation is a very delicate eye surgery. During the procedure, small incisions are made in the outer wall of the eye with an instrument called a trocar, and a tiny tube called a canulla is inserted. Another instrument is inserted into the canulla, and the vitreous gel and blood are cut up and removed and replaced with a clear saline solution. The saline solution is inserted to keep normal pressure in the eye, without which, the eye would collapse in on itself. After the vitreous gel and blood are removed and any leaking stopped by laser cauterization, an air or gas bubble is injected into the eye to assist in healing after the procedure. After injection of the air or gas bubble, the vitrectomy instruments are removed from the outer wall of the eye and the operation is over. The reason she had to keep her "head-bent-face-down" after her vitrectomy surgery was because Dr. Montzka had injected a gas bubble into her eye during the vitrectomy surgery. During the vitrectomy operation, he removed blood that had leaked into the vitreous gel (the clear fluid located in the center white part of the eye) and injected a saline solution in its place. Scar tissue was removed near the back of the eye where the retina is located. The gas bubble (some doctors use an air bubble) injected into the eye aided in healing after the vitrectomy procedure. The reason is that the gas or air bubble rises up and when the diabetes patient keeps their head-bent-face-down in the proper position, the bubble compresses up properly against the back of the eye where the retina is located, and allows for proper healing. If a diabetes patient sleeps on their side or back, or keeps their head up for too long, the gas (or air) bubble can dissipate too soon before proper healing; and, so by staying face down, appropriate compression against the retina for proper healing can occur. The retina could become detached if the diabetes patient does not keep their "head-bent-face-down," as instructed by their eye doctor. Unless you have been through this, keeping your "head-bent-face-down [routine]," you have no idea how really difficult this is to accomplish. Especially after the diabetes patient has to go home on a long drive from the hospital; continue to eat; go to the bathroom; and take showers and insulin injections while keeping their "head-bent-face-down," with the exception of the allotted 10-minute break each hour. The eye doctor gives goggles and a plastic eye patch the diabetes patient can tape to the eye and wear in the shower and while sleeping to protect their eye. It is very important for the diabetes patient not to let water get into the eye after the vitrectomy surgery while healing. The diabetes patient will also be instructed not to lift anything heavy (> 5 lbs.) while they are healing after the vitrectomy surgery. Four times a day, I had to administer two different types of eye drops into my loved one's eyes: Zymar that acted as an antibiotic to prevent eye infection; and a steroid (Pred forte), that reduced swelling and redness. I had to wash my hands and wait five minutes in between each of the different eye drops and make sure the tip of each bottle did not touch anything to prevent cross-contamination of the medicine. We had to rent from a special "face down" vendor a vitrectomy pillow (see photo to the left) in order for her to be able to sleep flat on her stomach and that allowed us to take the  This particular vitrectomy equipment allowed us to adjust how high or how low to set her head to leave enough room for breathing, but not too high to hurt her back. This wasn't that big of deal, the hardest part of the process for her was having to sleep flat on her stomach all night long without naturally turning over (except for the allowed 10-minute breaks). The diabetes patient can also rent a special chair from a "face down" vitrectomy vendor that allows them to sit up while keeping their head in the proper face down position during the day, but it was too small for Virginia to sit on comfortably. So, she mainly stayed in the bed flat on her stomach and watched television or napped all day. If you go through this vitrectomy procedure, make sure to check with your eye doctor to find out if you are allowed to watch television or read during your healing. We were able to position and angle a mirror in between the box springs and mattress of the bed that allowed her to look face down while using the special face down cushion, but allowed her to pass the time by watching her favorite programs and DVD's by viewing the T.V. images in the mirror. If we weren't going to rent the special head-down cushion (cost was a consideration--$75 per week rental!), the nurse recommended we tape a tennis ball to her back so that if she turned over during her sleep she would notice the lump and turn back over. I gave her constant back and neck rubs because this was extremely uncomfortable and tough on her neck, back and shoulder muscles, for an entire week. It's hard to remember now, but I think the hospital said that Virginia might have to keep her head down for the entire month until the gas bubble fully dissipated; but thankfully, she was allowed to put her head back to normal one full week after the surgery. She cries when she sees this picture immediately below, but here is what her swelling looked like a few days after her vitrectomy operation and the patch was removed:  |