Vitreous Hemorrhage: What You Need to Know
Tiny leaks can mean big problems with your vision
By A.Paul Chous, MA, OD, FAAO
Diabetic retinopathy occurs when high blood sugar levels damage the tiny blood vessels nourishing the retina, the light-sensitive membrane lining the inside of the eye. In the early stages, these vessels begin to leak small amounts of blood, protein, and fat into the retina. Over time, areas of the retina suffer a lack of circulation and chemical signals are produced that may lead to the development of new blood vessels. Here are photographs demonstrating some of these changes:
Unless the very center of the retina (the macula) is affected, patients rarely notice any changes in their vision. Over time, some patients begin to grow new, abnormal blood vessels on the surface of the retina and the optic nerve, a condition called proliferative diabetic retinopathy. These new vessels, termed neovascularization, are very fragile and often leak large amounts of blood onto the surface of the retina and into the clear gelatin filling the majority of the inside of the eye. This gelatin, called the vitreous, is very thick so that blood becomes trapped within it, blocking vision. A vitreous hemorrhage has occurred.
Depending on the amount of blood trapped within the vitreous, eyesight will be more or less affected. Quite often, patients will experience severe vision loss or even blindness if the vitreous hemorrhage is substantial. Eventually, the red blood cells trapped within the vitreous begin to break down, turning somewhat yellowish, and vision begins to clear; however, this can take several months and only occurs if the abnormal blood vessels stop leaking. Fibrous tissue typically grows along with the new blood vessels and, if extensive, may pull on the retina leading to a retinal detachment and permanent vision loss. If a retinal specialist is able to see through the blood and visualize the neovascularization, she will perform laser treatment to cause regression (shrinkage) of the abnormal vessels – essentially like turning off a leaky faucet. This stops the source of the blood and greatly lowers the risk of retinal detachment.
If the bleeding makes it impossible to see the retina, specialists often ask patients to wait a few weeks or months in hopes the blood will clear sufficiently to perform laser treatment. If it does not, surgical removal of the vitreous is performed, called vitrectomy, which dramatically improves vision provided the retina does not detach. Vitrectomy can dramatically speed up recovery of vision, but is not without risk, especially in patients with diabetes; these include infection, cataract formation, and retinal detachment. Newer techniques for clearing vitreous hemorrhage are being developed, including medications like the so-called ‘VEGF inhibitors.'
Vitreous hemorrhage is very frightening for patients because it can be profoundly disabling – believe me, I know, because I developed it in both of my eyes after getting laser treatment for proliferative retinopathy while in graduate school, and it took several months for my vision to clear. I couldn't drive, I couldn't read, I could barely navigate my way around campus. Because I got laser treatment before I experienced vision loss from vitreous hemorrhage, the root cause of the bleeding was addressed and my vision recovered. My personal experience and those of many patients underscores the critical importance of detecting and treating neovascularization before vitreous hemorrhage occurs. If you have diabetes, please make sure to have a dilated retinal examination at least every year, or more often if your eye doctor recommends it.
For more information on diabetic eye disease, consult Dr. Chous' book Diabetic Eye Disease: Lessons From a Diabetic Eye Doctor, Fairwood Press, Seattle, 2003.
Read more about Dr. Chous here.
Visit Dr. Chous' website here.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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