Health Effects of Cigarette Smoking

 

Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general.^1,2
Quitting smoking lowers your risk for smoking-related diseases and can add years to your life.^1,2

Smoking and Death

Cigarette smoking is the leading preventable cause of death in the United States.¹

• Cigarette smoking causes more than 480,000 deaths each year in the United States. This is nearly one in five deaths.^1,2,3
• Smoking causes more deaths each year than the following causes combined:⁴
  • Human immunodeficiency virus (HIV)
  • Illegal drug use
  • Alcohol use
  • Motor vehicle injuries
  • Firearm-related incidents

• More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States during its history.¹
• Smoking causes about 90% (or 9 out of 10) of all lung cancer deaths in men and women.^1,2 More women die from lung cancer each year than from breast cancer.⁵
• About 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease (COPD) are caused by smoking.¹
• Cigarette smoking increases risk for death from all causes in men and women.¹
• The risk of dying from cigarette smoking has increased over the last 50 years in men and women in the United States.¹

Smoking and Increased Health Risks

Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer.¹

• Smoking is estimated to increase the risk—
  • For coronary heart disease by 2 to 4 times^1,6
  • For stroke by 2 to 4 times¹
  • Of men developing lung cancer by 25 times¹
  • Of women developing lung cancer by 25.7 times¹
• Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost.¹

Smoking and Cardiovascular Disease

Smokers are at greater risk for diseases that affect the heart and blood vessels (cardiovascular disease).^1,2

• Smoking causes stroke and coronary heart disease, which are among the leading causes of death in the United States.^1,3
• Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease.¹
• Smoking damages blood vessels and can make them thicken and grow narrower. This makes your heart beat faster and your blood pressure go up. Clots can also form.^1,2
• A stroke occurs when a clot blocks the blood flow to part of your brain or when a blood vessel in or around your brain bursts.^1,2
• Blockages caused by smoking can also reduce blood flow to your legs and skin.^1,2

Smoking and Respiratory Disease

Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs.^1,2

• Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis.^1,2
• Cigarette smoking causes most cases of lung cancer.^1,2
• If you have asthma, tobacco smoke can trigger an attack or make an attack worse.^1,2
• Smokers are 12 to 13 times more likely to die from COPD than nonsmokers.¹

Smoking and Cancer

Smoking can cause cancer almost anywhere in your body:^1,2 (See figure above)

• Bladder
• Blood (acute myeloid leukemia)
• Cervix
• Colon and rectum (colorectal)
• Esophagus
• Kidney and ureter
• Larynx
• Liver
• Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils)
• Pancreas
• Stomach
• Trachea, bronchus, and lung

Smoking also increases the risk of dying from cancer and other diseases in cancer patients and survivors.¹
If nobody smoked, one of every three cancer deaths in the United States would not happen.^1,2

Smoking and Other Health Risks

Smoking harms nearly every organ of the body and affects a person’s overall health.^1,2

• Smoking can make it harder for a woman to become pregnant and can affect her baby's health before and after birth. Smoking increases risks for:^1,2,5
  • Preterm (early) delivery
  • Stillbirth (death of the baby before birth)
  • Low birth weight
  • Sudden infant death syndrome (known as SIDS or crib death)
  • Ectopic pregnancy
  • Orofacial clefts in infants

• Smoking can also affect men's sperm, which can reduce fertility and also increase risks for birth defects and miscarriage.²
• Smoking can affect bone health.^1,5
  • Women past childbearing years who smoke have weaker bones than women who never smoked, and are at greater risk for broken bones.
• Smoking affects the health of your teeth and gums and can cause tooth loss.¹
• Smoking can increase your risk for cataracts (clouding of the eye’s lens that makes it hard for you to see) and age-related macular degeneration (damage to a small spot near the center of the retina, the part of the eye needed for central vision).¹
• Smoking is a cause of type 2 diabetes mellitus and can make it harder to control. The risk of developing diabetes is 30–40% higher for active smokers than nonsmokers.^1,2
• Smoking causes general adverse effects on the body, including inflammation and decreased immune function.¹
• Smoking is a cause of rheumatoid arthritis.¹

Quitting and Reduced Risks

• Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.²
• Within 2 to 5 years after quitting smoking, your risk for stroke could fall to about the same as a nonsmoker’s.²
• If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.²
• Ten years after you quit smoking, your risk for lung cancer drops by half.²

What Causes Myoma

What is a Myoma?

Myomas, commonly referred to as uterine fibroids, are the most common benign (non-cancerous) tumors in women. Approximately 75% of women will have fibroids at some point in their lives, and a third of these women will have symptoms severe enough to need treatment. Fibroids account for many medical visits, tests, medications, and medical procedures. They are also a major reason for work absences and reduced quality of life.

To determine if you have uterine fibroids, you must consult your physician. Fibroids can be painful and uncomfortable. Most commonly, symptoms include cramping, abdominal pain, heavy menstrual bleeding, anemia, frequent urination, constipation and a distended stomach.

What Causes Myoma?

The cause of myomas has not actually been determined, but most myomas develop in women during their reproductive years. Myomas tend to grow very quickly during pregnancy when the body is producing extra estrogen. Once menopause has begun, myomas generally stop growing and can begin to shrink due to the loss of estrogen.

What is a Myoma Treatment?

Until recently, hysterectomy was the preferred option for treating symptomatic fibroids. Now, however, there are a number of uterine  fibroid  treatments  including ExAblate,  ExAblate is a medical device that is a combination of a focused ultrasound system and an MRI scanner. It is being used with a technology called MR guided focused ultrasound (MRgFUS). ExAblate uses focused ultrasound waves to destroy uterine fibroids, without affecting any of the surrounding tissues. The treatment takes place inside an MRI scanner. The MRI helps the physician "see" inside the body to pinpoint, guide, and continuously monitor the treatment. The focused ultrasound energy is directed at a small volume of the fibroid, raising its temperature high enough to destroy it without affecting other parts of the body. Ultrasound pulses are repeated until the entire fibroid is treated.
The ExAblate treatment is an outpatient procedure, with no overnight hospital stay, meaning you can return to your normal routine within days. It takes from one to three hours depending on the size and number of fibroids you have, and you’re awake and able to talk to your doctor during the treatment.

Signs and Symptoms of Cancer

Signs and symptoms are both signals of injury, illness, disease – signals that something is not right in the body.

A sign is a signal that can be seen by someone else – maybe a loved one, or a doctor, nurse, or other health care professional. For example, fever, fast breathing, and abnormal lung sounds heard through a stethoscope may be signs of pneumonia.

A symptom is a signal that’s felt or noticed by the person who has it, but may not be easily seen by anyone else. For example, weakness, aching, and feeling short of breath may be symptoms of pneumonia.

Having one sign or symptom may not be enough to figure out what’s causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. Sometimes, a patient’s signs and symptoms still don’t give the doctor enough clues to be sure what’s causing the illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.

How does cancer cause signs and symptoms?

Cancer is a group of diseases that can cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects the organs or tissues. If a cancer has spread (metastasized), signs or symptoms may appear in different parts of the body.

As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure causes some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause symptoms. 

But sometimes cancer starts in places where it won’t cause any signs or symptoms until it has grown quite large. Cancers of the pancreas, for example, usually don’t cause symptoms until they grow large enough to press on nearby nerves or organs (this causes back or belly pain). Others may grow around the bile duct and block the flow of bile. This causes the eyes and skin to look yellow (jaundice). By the time a pancreatic cancer causes signs or symptoms like these, it’s usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.

A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Cancer can also cause the immune system to react in ways that produce these signs and symptoms.

Sometimes, cancer cells release substances into the bloodstream that cause symptoms that are not usually linked to cancer. For example, some cancers of the pancreas can release substances that cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.

How are signs and symptoms helpful?

Treatment works best when cancer is found early – while it’s still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.

A good example of the importance of finding cancer early is melanoma skin cancer. It can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people who live at least 5 years after diagnosis) at this early stage is around 98%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops to about 16%.

Sometimes people ignore symptoms. Maybe they don’t know that the symptoms could mean something is wrong. Or they might be frightened by what the symptoms could mean and don’t want to get medical help. Maybe they just can’t afford to get medical care.

Some symptoms, such as tiredness or coughing, are more likely caused by something other than cancer. Symptoms can seem unimportant, especially if there’s a clear cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has lasted a long time or is getting worse. 

Most likely, symptoms are not caused by cancer, but it’s important to have them checked out, just in case. If cancer is not the cause, a doctor can help figure out what the cause is and treat it, if needed.

Sometimes, it’s possible to find cancer before having symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early, before symptoms start. For more information on early detection tests, see our document called American Cancer Society Guidelines for the Early Detection of Cancer. But keep in mind, even if you have these recommended tests, it’s still important to see a doctor if you have any symptoms.

What are some general signs and symptoms of cancer?

You should know some of the general signs and symptoms of cancer. But remember, having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too. If you have any of these symptoms and they last for a long time or get worse, please see a doctor to find out what’s going on.

Unexplained weight loss

Most people with cancer will lose weight at some point. When you lose weight for no known reason, it’s called an unexplained weight loss. An unexplained weight loss of 10 pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus (swallowing tube), or lung.

Fever

Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all people with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue

Fatigue is extreme tiredness that doesn’t get better with rest. It may be an important symptom as cancer grows. But it may happen early in some cancers, like leukemia. Some colon or stomach cancers can cause blood loss that’s not obvious. This is another way cancer can cause fatigue.

Pain

Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer means it has already spread (metastasized) from where it started.

Skin changes

Along with skin cancers, some other cancers can cause skin changes that can be seen. These signs and symptoms include:

• Darker looking skin (hyperpigmentation)
• Yellowish skin and eyes (jaundice)
• Reddened skin (erythema)
• Itching (pruritis)
• Excessive hair growth

Signs and symptoms of certain cancers

Along with the general symptoms, you should watch for certain other common signs and symptoms that could suggest cancer. Again, there may be other causes for each of these, but it’s important to see a doctor about them as soon as possible – especially if there’s no other cause you can identify, the problem lasts a long time, or it gets worse over time.

Change in bowel habits or bladder function

Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor.

Sores that do not heal

Skin cancers may bleed and look like sores that don’t heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should be seen by a health professional.

White patches inside the mouth or white spots on the tongue

White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that’s caused by frequent irritation. It’s often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it’s not treated, leukoplakia can become mouth cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.

Unusual bleeding or discharge

Unusual bleeding can happen in early or advanced cancer. Coughing up blood may be a sign of lung cancer. Blood in the stool (which can look like very dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

Thickening or lump in the breast or other parts of the body

Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size. Keep in mind that some breast cancers show up as red or thickened skin rather than a lump.

Indigestion or trouble swallowing

Indigestion or swallowing problems that don’t go away may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

Recent change in a wart or mole or any new skin change

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully. See pictures of skin cancers and other skin conditions in our Skin Cancer Image Gallery.

Nagging cough or hoarseness

A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx (voice box) or thyroid gland.

Other symptoms

The signs and symptoms listed above are the more common ones seen with cancer, but there are many others that are not listed here. If you notice any major changes in the way your body works or the way you feel – especially if it lasts for a long time or gets worse – let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what’s going on and, if needed, treat it. If it is cancer, you’ll give yourself the chance to have it treated early, when treatment works best.

Controlling your high blood pressure to normal condition

Alternate Names

Controlling hypertension

When Is Your Blood Pressure a Concern?

If your blood pressure is high, you need to lower it and keep it under control. Your blood pressure reading has 2 numbers. One or both of these numbers can be too high.
The top number is called the systolic blood pressure. This reading is too high if it is 140 or higher.
The bottom number is called the diastolic blood pressure. It is too high if it is 90 or higher.
You are more likely to have high blood pressure as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure can lead to stroke, heart attack, heart failure, kidney disease, and early death.
If you have heart or kidney problems, diabetes, or if you had a stroke, your doctor may want your blood pressure to be even lower than people who do not have these conditions.

Medications for Blood Pressure

Many medicines can help you control your blood pressure. Your health care provider will prescribe the best medicine for you. Your health care provider will also monitor your medicines and make changes if you need them.

Diet, Exercise, and Other Lifestyle Changes

In addition to taking medicine, you can do many things to help control your blood pressure.
Limit the amount of sodium (salt) you eat. Aim for less than 1,500 mg per day. Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men.
Eat a heart-healthy diet. Include potassium and fiber, and drink plenty of water. Stay at a healthy body weight. Find a weight-loss program to help you, if you need it.
Exercise regularly -- at least 30 minutes a day of moderate aerobic exercise.
Reduce stress. Try to avoid things that cause you stress. You can also try meditation or yoga.
If you smoke, quit. Find a program that will help you stop.
Your doctor can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian. The dietitian can help you plan a diet that is healthy for you.

Checking Your Blood Pressure

Your doctor may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. It is best to have one with a cuff for your arm and a digital readout. Practice with your health care provider to make sure you are taking your blood pressure correctly.
It is normal for your blood pressure to be different at different times of the day.
It is usually higher when you are at work. It drops slightly when you are at home. It is usually lowest when you are sleeping.
It is normal for your blood pressure to increase suddenly when you wake up. In people with very high blood pressure, this is when they are most at risk for heart attack and stroke.

Follow-up

Your doctor will give you a physical exam and check your blood pressure often. With your doctor, establish a goal for your blood pressure.

If you monitor your blood pressure at home, keep a written record. Bring the results to your clinic visit. Your doctor or nurse may ask you these questions. Having a written record will make them easy to answer:

• What was your most recent blood pressure reading?
• What was the blood pressure reading before that one?
• What is the average systolic (top) number and average diastolic (bottom) number?
• Has your blood pressure increased recently?

When to Call the Doctor

Call your doctor if your blood pressure goes well above your normal range.
Also call your doctor if you have any of these symptoms:

• Severe headache
• Irregular heartbeat or pulse
• Chest pain
• Sweating, nausea, or vomiting
• Shortness of breath
• Dizziness or lightheadedness
• Pain or tingling in the neck, jaw, shoulder, or arms
• Numbness or weakness in your body
• Fainting
• Trouble seeing
• Confusion
• Difficulty speaking
• Other side effects that you think might be from your medicine or your blood pressure

Description of High Blood Pressure

High blood pressure is a common disease in which blood flows through blood vessels (arteries) at higher than normal pressures.

Measuring Blood Pressure

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. High blood pressure, sometimes called hypertension, happens when this force is too high. Health care workers check blood pressure readings the same way for children, teens, and adults. They use a gauge, stethoscope or electronic sensor, and a blood pressure cuff. With this equipment, they measure:

• Systolic Pressure: blood pressure when the heart beats while pumping blood
• Diastolic Pressure: blood pressure when the heart is at rest between beats

Health care workers write blood pressure numbers with the systolic number above the diastolic number. For example:

118/76 mmHg People read "118 over 76" millimeters of mercury.

Normal Blood Pressure

Normal blood pressure for adults is defined as a systolic pressure below 120 mmHg and a diastolic pressure below 80 mmHg. It is normal for blood pressures to change when you sleep, wake up, or are excited or nervous. When you are active, it is normal for your blood pressure to increase. However, once the activity stops, your blood pressure returns to your normal baseline range.
Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers that are considered normal for babies, while older teens have numbers similar to adults.

Abnormal Blood Pressure

Abnormal increases in blood pressure are defined as having blood pressures higher than 120/80 mmHg. The following table outlines and defines high blood pressure severity levels.

Stages of High Blood Pressure in Adults

Stages	Systolic (top number)		Diastolic (bottom number)
Prehypertension	120–139	OR	80–89
High blood pressure Stage 1	140–159	OR	90–99
High blood pressure Stage 2	160 or higher	OR	100 or higher

The ranges in the table are blood pressure guides for adults who do not have any short-term serious illnesses. People with diabetes or chronic kidney disease should keep their blood pressure below 130/80 mmHg.
Although blood pressure increases seen in prehypertension are less than those used to diagnose high blood pressure, prehypertension can progress to high blood pressure and should be taken seriously. Over time, consistently high blood pressure weakens and damages your blood vessels, which can lead to complications.

Types of High Blood Pressure

There are two main types of high blood pressure: primary and secondary high blood pressure.

Primary High Blood Pressure

Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages.

Secondary High Blood Pressure

Secondary high blood pressure is caused by another medical condition or use of certain medicines. This type usually resolves after the cause is treated or removed.

Hair loss: Who gets and causes

Who experiences hair loss?

Millions of people experience hair loss. Some people see their hair re-grow without doing anything. Others need treatment for their hair to re-grow. Sometimes, hair will not re-grow.

To find out what is possible, you should see a dermatologist. These doctors specialize in treating diseases that affect the skin, hair, and nails.

What causes hair loss?

The reasons for hair loss are many. When hair loss begins suddenly, the cause may be due to illness, diet, medicine, or childbirth. If hair loss is gradual and becomes more noticeable with each passing year, a person may have hereditary hair loss. Certain hair care practices also can cause noticeable hair loss.

The following describes some of the many things that cause hair loss: 

Hair disorders

• Hereditary thinning or baldness (also called androgenetic alopecia): This is the most common cause of hair loss. It affects men and women. About 80 million people in the United States have hereditary thinning or baldness.
  
  When men have hereditary hair loss, they often get a receding hairline. Many men see bald patches, especially on the top of the head. Women, on the other hand, tend to keep their hairline. They see noticeably thinning hair. The first sign of hair loss for many women is a widening part. In rare cases, men see noticeably thinning hair. And in rare cases, women can see a receding hairline or bald patches. The reasons for this are unknown.
  
  
• Alopecia areata: Researchers believe that this is an autoimmune disease. Autoimmune means the body attacks itself. In this case, the body attacks its own hair. This causes smooth, round patches of hair loss on the scalp and other areas of the body. People with alopecia areata are often in excellent health. Most people see their hair re-grow. Dermatologists treat people with this disorder to help the hair re-grow more quickly.
  
  
• Cicatricial (scarring) alopecia: This rare disease develops in otherwise healthy people. The disease destroys a person’s hair follicles. Scar tissue forms where the follicles once were, so the hair cannot re-grow. Treatment tries to stop the inflammation, which destroys the hair follicles.
• Central centrifugal cicatricial (scarring) alopecia: This type of hair loss occurs most often in women of African descent. It begins in the center of the scalp. As it progresses, the hair loss radiates out from the center of the scalp. The affected scalp becomes smooth and shiny. The hair loss can be very slow or rapid. When hair loss occurs quickly, the person may have tingling, burning, pain, or itching on the scalp. Treatment may help the hair re-grow if scarring has not occurred.

Disease

• Underlying medical condition: Hair loss can be the first sign of a disease. About 30 diseases, including thyroid disease and anemia, cause hair loss. By treating the disease, hair loss often can be stopped or reversed.
• Illness: Significant hair loss can occur after an illness. A major surgery, high fever, severe infection, or even the flu can cause hair loss. Your dermatologist may call this type of hair loss telogen (tee-lə-jen) effluvium (ih-flu-vee-uhm).
• Some cancer treatments: Radiation therapy and chemotherapy can cause hair loss. This hair loss is often temporary, but it can cause great distress.
• Ringworm of the scalp: This disease is contagious and common in children. Without effective treatment, ringworm can cause balding.
• Trichotillomania (trick-uh-til-uh-mey-knee-uh): This medical disorder causes people to repeatedly pull out their own hair. They often feel a constant urge to pull out the hair on the scalp. Some sufferers say they feel compelled to pull out their eyelashes, nose hairs, eyebrows, and other hairs on their bodies.

Hormones and stress

• Giving birth: After giving birth, some women have noticeable hair loss. Falling estrogen levels cause this type of hair loss. The hair loss is temporary. In a few months, women see their hair re-grow.
  
  
• Menopause: Hair loss is common during menopause. This loss is often temporary. Hair re-grows with time. If a woman is 40 years of age or older, she should not expect her hair to have the fullness that it did when she was younger.
  
  
• Stress: Experiencing a traumatic event (e.g., death of a loved one or divorce) can cause hair loss.

Dieting and poor nutrition

• Weight loss: Some people see hair loss after losing more than 15 pounds. The hair loss often appears 3 to 6 months after losing the weight. This hair loss is common. The hair re-grows without help.
  
  
• Vitamin A: Too much vitamin A can cause hair loss. People can get too much of this vitamin through vitamin supplements or medicines. Once the body stops getting too much vitamin A, normal hair growth resumes.
  
  
• Protein: When the body does not get enough protein, it rations the protein it does get. One way the body can ration protein is to shut down hair growth. About 2 to 3 months after a person does not eat enough protein, you can see the hair loss. Eating more protein will stop the hair loss. Meats, eggs, and fish are good sources of protein. Vegetarians can get more protein by adding nuts, seeds, and beans to their diet.
  
  
• Iron: Not getting enough iron can lead to hair loss. Good vegetarian sources of iron are iron-fortified cereals, soybeans, pumpkin seeds, white beans, lentils, and spinach. Clams, oysters, and organ meats top the list of good animal sources of iron.
  
  
• Eating disorder: When a person has an eating disorder, hair loss is common. Anorexia (not eating enough) and bulimia (vomiting after eating) can cause hair loss.

Medicine

Some prescription medicines can cause hair loss. These include:

• Blood thinners.
• High-dose vitamin A.
• Medicines that treat arthritis, depression, gout, heart problems, and high blood pressure.
• Birth control pills: Some women who take the pill see hair loss. Sometimes, the hair loss begins when a women stops taking the pill. Women who get this hair loss often have hereditary hair loss.
• Anabolic steroids (steroids taken to build muscle and improve athletic performance) may cause hair loss.

Hair care

Your hairstyle and even some of the products you use on your hair can cause hair loss.

• Products: Frequent bleaching or permanents can cause the hair to break. Regular or improper use of dyes, gels, relaxers, and hair sprays also can cause hair breakage. Dermatologists recommend limiting use of these hair products. Less use often means less hair breakage.
  
  
• Blow dryers, flat irons, and other devices: Frequent use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Dermatologists recommend that you allow your hair to air dry. Then style your hair when it is dry. Dermatologists also recommend limiting the use of flat irons (these straighten hair by using high heat) and curling irons.
  
  
• Hairpins, clips, and rubber bands: When used to hold hair tightly, hairpins, clips, and rubber bands can break hair. Here are dermatologists’ tips for choosing these:

• Hairpins: Use hairpins that have a smooth, ball-tipped surface.
• Hair clips: These should have spongy rubber padding where they touch the hair.
• Rubber bands: Try scrunchies made of fabric instead. Rubber bands often cause the hair to break. Scrunchies should fit loosely. To prevent hair loss, you should wear them in different areas of the scalp. This can prevent lots of hair breakage in one area.

Hairstyles
Years of wearing hair in a style that pulls on the hair such as a ponytail, cornrows, or braids can cause a type of hair loss known as traction alopecia. 

Improper washing, drying, and combing
The following practices often cause the hair to break:

• Too much shampooing, combing, or brushing (100 strokes or more a day).
• Rubbing wet hair dry with a towel.
• Brushing or combing wet hair (especially people who are Asian or Caucasian).

For many people, hair is more elastic when wet. This means it breaks off more easily than dry hair. When hair breakage occurs, the hair appears shaggy or too thin. For people who are of African descent, their hair is not more elastic when wet.

Symptoms and Causes of Low sperm count

 

Symptoms Low sperm count

The main sign of low sperm count is the inability to conceive a child. There might be no other obvious signs or symptoms. In some cases, an underlying problem such as an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms. Low sperm count symptoms might include:

• Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
• Pain, swelling or a lump in the testicle area
• Decreased facial or body hair or other signs of a chromosome or hormone abnormality

When to see a doctor

See a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or sooner if you have any of the following:

• Erection or ejaculation problems, low sex drive, or other problems with sexual function
• Pain, discomfort, a lump or swelling in the testicle area
• A history of testicle, prostate or sexual problems
• Groin, testicle, penis or scrotum surgery

Causes of Low sperm count

The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production.
Also, there can be problems of abnormal sperm shape (morphology), movement (motility) or function.
However, often the cause of low sperm count isn't identified.

Medical causes

Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:

• Varicocele. A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It's the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it might be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.
• Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
• Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde or lack of ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra.
  Certain medications also might result in ejaculatory problems, such as blood pressure medications known as alpha blockers. Some ejaculatory problems can be reversed, while others are permanent. In most cases of permanent ejaculation problems, sperm can still be retrieved directly from the testicles.
  
• Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.
• Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.
• Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
• Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal gland, may impair sperm production.
• Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.
  Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
  
• Chromosome defects. Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann's syndrome and Kartagener's syndrome.
• Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
• Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications and other medications can impair sperm production and decrease male fertility.
• Prior surgeries. Certain surgeries might prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.

Environmental causes

Sperm production or function can be affected by overexposure to certain environmental elements, including:

• Industrial chemicals. Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead might contribute to low sperm counts.
• Heavy metal exposure. Exposure to lead or other heavy metals also can cause infertility.
• Radiation or X-rays. Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.
• Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs might temporarily impair sperm count.
  Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature in your scrotum and slightly reduce sperm production.
  

Health, lifestyle and other causes

Other causes of low sperm count include:

• Drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana might reduce the number and quality of your sperm as well.
• Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
• Occupation. Certain occupations might be linked with a risk of infertility, including welding or those associated with prolonged sitting, such as truck driving. However, the data to support these associations is inconsistent.
• Tobacco smoking. Men who smoke might have a lower sperm count than do those who don't smoke.
• Emotional stress. Severe or prolonged emotional stress, including stress about fertility, might interfere with hormones needed to produce sperm.
• Weight. Obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes that reduce male fertility.
• Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn't contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time.

Risk factors that cause low sperm count

A number of risk factors are linked to low sperm count and other problems that can cause low sperm count. They include:

• Smoking tobacco
• Drinking alcohol
• Using certain illicit drugs
• Being overweight
• Having certain past or present infections
• Being exposed to toxins
• Overheating the testicles
• Having experienced trauma to the testicles
• Being born with a fertility disorder or having a blood relative with a fertility disorder
• Having certain medical conditions, including tumors and chronic illnesses
• Undergoing cancer treatments, such as radiation
• Taking certain medications
• Having a prior vasectomy or major abdominal or pelvic surgery
• Having a history of undescended testicles

What Causes Ulcers?

 

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Most ulcers are caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori).

Factors that can increase your risk for ulcers include:

• Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, some types of Midol, and others), and many others available by prescription; even safety-coated aspirin and aspirin in powered form can frequently cause ulcers.
• Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome)
• Excessive drinking of alcohol
• Smoking or chewing tobacco
• Serious illness
• Radiation treatment to the area

What Are the Symptoms of an Ulcer?

An ulcer may or may not have symptoms. When symptoms occur, they may include:

• A gnawing or burning pain in the middle or upper stomach between meals or at night
• Bloating
• Heartburn
• Nausea or vomiting

In severe cases, symptoms can include:

• Dark or black stool (due to bleeding)
• Vomiting blood (that can look like "coffee-grounds")
• Weight loss
• Severe pain in the mid to upper abdomen

How Serious Is an Ulcer?

Though ulcers often heal on their own, you shouldn't ignore their warning signs. If not properly treated, ulcers can lead to serious health problems, including:

• Bleeding
• Perforation (a hole through the wall of the stomach)
• Gastric outlet obstruction from swelling or scarring that blocks the passageway leading from the stomach to the small intestine

Taking NSAIDs can lead to an ulcer without any warning. The risk is especially concerning for the elderly and for those with a prior history of having peptic ulcer disease.

Who Is More Likely to Get Ulcers?

You may be more likely to develop ulcers if you:

• Are infected with the H. pylori bacterium
• Take NSAIDs such as aspirin, ibuprofen, or naproxen
• Have a family history of ulcers
• Have another illness such as liver, kidney, or lung disease
• Drink alcohol regularly
• Are age 50 or older

Causes of heart failure

Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn't need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff.
In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.

An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50 percent or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat. But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.

The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs. However, not all heart failure is congestive. You might have shortness of breath or weakness due to heart failure and not have any fluid building up.
Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart's main pumping chamber.

Type of heart failure	Description
Left-sided heart failure	Fluid may back up in your lungs, causing shortness of breath.
Right-sided heart failure	Fluid may back up into your abdomen, legs and feet, causing swelling.
Systolic heart failure	The left ventricle can't contract vigorously, indicating a pumping problem.
Diastolic heart failure (also called heart failure with preserved ejection fraction)	The left ventricle can't relax or fill fully, indicating a filling problem.

Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:

• Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits — a process called atherosclerosis. The buildup of plaques can cause reduced blood flow to your heart.
  A heart attack occurs if plaques formed by the fatty deposits in your arteries rupture. This causes a blood clot to form, which may block blood flow to an area of the heart muscle, weakening the heart's pumping ability and often leaving permanent damage. If the damage is significant, it can lead to a weakened heart muscle.
  
• High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body.
  Over time, the heart muscle may become thicker to compensate for the extra work it must perform. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
  
  
• Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve — due to a heart defect, coronary artery disease or heart infection — forces your heart to work harder to keep blood flowing as it should.
  Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed or replaced if found in time.
  
• Damage to the heart muscle (cardiomyopathy). Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy.
  Genetic factors play an important role in several types of cardiomyopathy, such as dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular noncompaction and restrictive cardiomyopathy.
  


• Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
• Heart defects you're born with (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.
• Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, which creates extra work for your heart. Over time, your heart may weaken, leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
• Other diseases. Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis) —also may contribute to heart failure.
  Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.
  

Why Do People Become Blind?

Blindness may result from a wide range of conditions, but is most commonly caused by an eye disease or condition such as glaucoma, diabetic retinopathy, cataract, age-related macular degeneration and retinitis pigmentosa.

A cataract is an opacity (cloudiness) within the lens. In the treatment of a cataract, the lens inside the eye is removed and replaced with a clear artificial lens. In diabetic retinopathy, retinal blood vessels are adversely affected and begin to leak. Treatment involves photocoagulation with a laser to destroy leaky blood vessels and to prevent the growth of abnormal blood vessels (angiogenesis).The first figure shows a cross-section of the eye and the location of a cataract lens. The actual cloudy appearance of the cataract can be seen through the pupil.

In glaucoma, the retinal ganglion cells (which send visual information from the retina to the brain) slowly die over time. The exact cause of this loss is unknown but frequently high eye (intraocular) pressure is often associated with this condition. Current treatment is with medications and surgical techniques aimed at trying to lower intraocular pressure.

Figure showing the back of the eye (retinal fundus) in a patient with diabetic retinopathy. Hemorrhages (bleeding) and fluid leakage (exudates) can be seen and are indicative of advanced complications due to diabetes

Figure showing a close up view of the optic nerve head in the back of the eye. The optic nerve relays visual information from the eye to the rest of the brain to be processed as visual information. Progressive enlargement of the optic nerve head “cup” (green outline) over time is indicative of damage to the nerve.

Age-related Macular Degeneration

The most common cause of blindness in the aging population is age-related macular degeneration (ARMD or AMD), which affects over 10 million Americans. ARMD causes loss of central vision due to the loss of photoreceptors (the light-sensing cells).This condition is particularly debilitating for the elderly who may have difficulty walking and remain confined to their homes. Age-related macular degeneration (ARMD) is a disease that affects the macula - the area responsible for central and fine detail vision. There are two forms of the disease: a less severe non-exudative form and the more devastating exudative form. Clinically, the "wet" form is characterized by the presence of newly formed blood vessels (subretinal choriodal neovascularization), exudation and hemorrhages. For some individuals, the "dry" form can convert and progress into the "wet" form. It is therefore important that individuals with ARMD have frequent eye examinations.

 

Figure showing the back of the eye (retinal fundus)in the “dry” form of ARMD.
Typically, there is thinning, scarring and atrophy of the central macular region.

 

Figure showing the back of the eye (retinal fundus) in the “wet” form of ARMD.
In this condition, there is growth of abnormal blood vessels and hemorrhaging beneath the central macula region.

Retinitis Pigmentosa

Retinitis pigmentosa (RP) affects 1.6 million people worldwide and is the leading cause of inherited blindness. RP causes a slow and progressive blindness across the entire visual field. As with ARMD, this disease is associated with photoreceptor loss. To date, there are no treatments for either ARMD or RP. Molecular genetic therapy may represent a viable long-range hope although there are formidable challenges facing this therapeutic approach. It is also important to keep in mind that even successful repair of genetic function would only slow or prevent further deterioration rather than restore lost visual function (as would be possible with a prosthesis).

 

Figure showing the back of the eye (retinal fundus) in a patient with RP. The presence of black pigment flecks in the retina (bone spicules) is characteristic of this condition. This condition is also commonly associated with a narrowing of blood vessels and abnormalities of the optic nerve head.

Retinitis Pigmentosa (RP) is an inherited eye condition affecting initially the mid peripheral portion of the retina. Central vision is generally not affected until the very late stages of the disease. Clinically, the first observable sign of RP is a narrowing of the retinal arterioles (small arteries in the retina). Later, retinal pigment formations known as "bone spicules" and changes in the appearance of the optic nerve head are apparen

Facts About Diabetic Eye Disease

What is diabetic eye disease? Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss or even blindness.

Diabetic eye disease may include:

• Diabetic retinopathy—damage to the blood vessels in the retina.
• Cataract—clouding of the eye’s lens. Cataracts develop at an earlier age in people with diabetes.
• Glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

What is diabetic retinopathy?

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.
In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.
If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

What are the stages of diabetic retinopathy?

Diabetic retinopathy has four stages:

1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.
2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Causes and Risk Factors

How does diabetic retinopathy cause vision loss?

Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

1. Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy and is the fourth and most advanced stage of the disease.
2. Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.

Normal Vision and the same scene viewed by a person with diabetic retinopathy.

 

Normal vision

 

Same scene viewed by a person with diabetic retinopathy

Who is at risk for diabetic retinopathy?

All people with diabetes–both type 1 and type 2–are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

What can I do to protect my vision?

If you have diabetes get a comprehensive dilated eye exam at least once a year and remember:

• Proliferative retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
• Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
• You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
• Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow-up care.
The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery.
This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.
Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

Symptoms and Detection

Does diabetic retinopathy have any symptoms?

Often there are no symptoms in the early stages of the disease, nor is there any pain. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.
Blurred vision may occur when the macula—the part of the retina that provides sharp central vision—swells from leaking fluid. This condition is called macular edema.
If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision.

What are the symptoms of proliferative retinopathy if bleeding occurs?

At first, you will see a few specks of blood, or spots, “floating” in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.
Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.

How are diabetic retinopathy and macular edema detected?

Diabetic retinopathy and macular edema are detected during a comprehensive eye exam that includes:

1. Visual acuity test. This eye chart test measures how well you see at various distances.
2. Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
3. Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional checks your retina for early signs of the disease, including:

• Leaking blood vessels.
• Retinal swelling (macular edema).
• Pale, fatty deposits on the retina–signs of leaking blood vessels.
• Damaged nerve tissue.
• Any changes to the blood vessels.

If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.

Treatment

How is diabetic retinopathy treated?

During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.

Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.

Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.
If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.

How is a macular edema treated?

Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.

Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved. Contact your eye care professional if you have vision loss.
NEI research found that prompt treatment of macular edema with the drug Lucentis, with or without laser treatment, resulted in better vision than laser treatment alone or steroid injections. When injected into the eye, Lucentis, and two other similar drugs, Avastin or Aylea, reduce fluid leakage and interfere with the growth of new blood vessels in the retina. NEI is sponsoring a study comparing the three drugs, in the mean time, your doctor will help you decide what is best for you.

What happens during laser treatment?

Both focal and scatter laser treatment are performed in your doctor’s office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.
The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable.

You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.
For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.
Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

What is a vitrectomy?

If you have a lot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.
A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.
You will probably be able to return home after the vitrectomy. Some people stay in the hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eyedrops to protect against infection.

Are scatter laser treatment and vitrectomy effective in treating proliferative retinopathy?

Yes. Both treatments are very effective in reducing vision loss. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years when they get timely and appropriate treatment. Although both treatments have high success rates, they do not cure diabetic retinopathy.
Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight.

What can I do if I already have lost some vision from diabetic retinopathy?

If you have lost some sight from diabetic retinopathy, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services