HYPERTENSIVE RETINOPATHY

Definition : Hypertensive Retinopathy ( HR ) is a condition when the retinal vascular system gets damaged due to prolonged high blood pressure.

The retina located at the back of the eye converts light into signals that travel to the brain via the optic nerve for interpretation. Prolonged elevated blood pressure causes thickening of the blood vessels of the retina wall resulting in narrowing the lumen, resulting in an increase in pressure.

Uncontrolled blood pressure causes continuous pressure in these blood vessels of the retina leading to damages and in severe conditions, bursting of the blood vessels leading to bleeding in the eyes and loss of vision.

Types of Hypertensive Retinopathy based on the severity:

Grade 1-mild narrowing  of retinal artery.

Grade 2-severe narrowing and constrictions of retinal arteries called AV nicking.

Grade 3- Grade 2 plus retinal edema, microaneurysms,retinal bleeding and cotton-wool spots.

Grade 4- Grade 3 plus macular edema and optic disc swelling ( papilledema). Grade 4 Patients have greater risk to develop stroke, heart and kidney problems. 

Causes: The main cause for Hypertensive Retinopathy is prolonged uncontrolled high blood pressure. High blood pressure exerts force on the walls of the arteries subjecting them to stretching that may finally lead to damages and many other health issues.

Who is at risk: People who have cardiac problems, Diabetes, smokers, atherosclerosis,high cholesterol, overweight, alcoholics and prolonged uncontrolled blood pressure are the ones who are most likely to develop hypertensive retinopathy over a period of time.

Causes for Uncontrolled Blood Pressure:

  1. Overweight: Obesity is a condition associated with increased sympathetic and procoagulatory activity, increased leptin and insulin resistance, endothelial dysfunction and the activation of renin-angiotensin-aldosterone system. These factors lead to the constriction of the blood vessels and water retention in the body leading to an increase in the blood pressure.
  2. Sedentary life: It has been documented that a sedentary lifestyle promotes the risk of heart and blood pressure by 30 to 50 % and contributes to the development of obesity.
  3. Salt diet: High salt diet causes an imbalance in the sodium levels in our body leading to fluid retention resulting in stress to the heart and elevated blood pressure levels.
  4. Stress: Stress hormones constrict the blood vessels leading to high blood pressure and heart related problems.
  5. Alcohol: Prolonged excessive intake of alcohol activates the renin-angiotensin-aldosterone system, increases the cortisol levels, decreases baroreceptor sensitivity, reduces vasopressin levels, and increases the blood calcium levels that totally contribute to high blood pressure.
  6. Skipping BP medicines. Skipping medicines lead to uncontrolled BP.
  7. Diabetes:Diabetes is closely associated with increased fluid retention caused  by insulin hyperinsulinemia and hyperglycemia that leads to rise in blood pressure.

Early findings of hypertension: High blood pressure does not exhibit any symptoms at the beginning but gradually may cause health issues if not treated.

Symptoms of hypertensive retinopathy.

There are no significant signs during the onset of HR, however they gradually develop during the prognosis of the diseases. The patients may present with eye swelling associated with double image and headaches. If untreated it may lead to bleeding eyes and loss of vision. Hypertensive retinopathy can be diagnosed by ophthalmoscope,fundoscopic examination or fluorescein angiography.

The examination may reveal constriction of the the blood vessel of the retina, changes in the vascular walls, compression of the venules called arteriovenous nicking (AVN) and arteries, cotton-wool spots, haemorrhages in the shape of flames, edema of optic disk and retinal hard exudates.

Complications of HR: Hypertensive Retinopathy may lead to complications if untreated on time that include, Ischemic Optic Neuropathy, Retinal vein and artery occlusion, Malignant HR, and Nerve fibre layer Ischemia.

Treatment: The treatment for Hypertensive Retinopathy involves the control of high blood pressure with medications accompanied by lifestyle modifications.

Prevention of Hypertensive Retinopathy: All attempts should be made to keep B.P. under control. Simple steps like restriction of salt in diet, taking B.P. medication regularly, decrease or avoid alcohol consumption, keep cholesterol and diabetes under control and sincere attempt of bringing down weight should be carried out at first step to prevent hypertensive retinopathy.

When all these measures fail at reducing weight, diabetes, and hypertension a novel method that gives a multiple solution in a single attempt will help.

It is termed as Bariatric/Metabolic Surgery.

This keyhole surgery helps the person lose excess weight, get diabetes remission, B.P. under control and freedom from high cholesterol. This multi pronged approach can not only avoid hypertensive retinopathy but can also avoid diabetic retinopathy, chronic kidney disease, stroke, and coronary artery disease.

The earlier the surgery is done in the course of the disease, the results are better.

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