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Kent W. Small, MD

Board-Certified: American Board of Ophthalmology

Fellowship: Vitreoretinal Diseases and Surgery, Duke University Eye Center, Durham, NC; Molecular Genetics, Duke University School of Medicine, Durham, NC

MD: Tulane University School of Medicine, New Orleans, LA

Specialized care for retinal diseases:

  • Macular degeneration
  • Diabetic retinopathy
  • Retinal tears & detachments
  • Inherited retinal diseases
  • Retinal vascular disease
  • Macular holes
  • Macular puckers
  • Macular edema
  • Proliferative vitreoretinopathy/scar tissue

State-of-the-art diagnostic exams:

  • Fluorescein & indocyanine green (ICG) angiography
  • Fundus photography
  • Scanning laser ophthalmoscopy (SLO)
  • Ultrasound A & B scans
  • Visual field testing
  • Microperimetry
  • Optical coherence tomography (OCT)

Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy (PDR) is a complication of diabetes caused by changes in the blood vessels of the eye. If you have diabetes, your body does not use and store sugar properly. High blood sugar levels create changes in the veins, arteries, and capillaries that carry blood throughout the body. This includes the tiny blood vessels in the retina, the light-sensitive nerve layer that lines the back of the eye.

In PDR, the retinal blood vessels are so damaged they close off. In response, the retina grows new, fragile blood vessels. Unfortunately, these new blood vessels are abnormal and grow on the surface of the retina, so they do not resupply the retina with blood.

Occasionally, these new blood vessels bleed and cause a vitreous hemorrhage. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception.

The new blood vessels can also cause scar tissue to grow. The scar tissue shrinks, wrinkling and pulling on the retina and distorting vision. If the pulling is severe, the macula may detach from its normal position and cause vision loss.

Laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding. The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months, or even years. If the vitreous hemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, an operation called a vitrectomy can be performed. During a vitrectomy, the eye surgeon removes the hemorrhage and any scar tissue that has developed, and performs laser treatment to prevent new abnormal vessel growth.

People with PDR sometimes have no symptoms until it is too late to treat them. The retina may be badly injured before there is any change in vision. There is considerable evidence to suggest that rigorous control of blood sugar decreases the chance of developing serious proliferative diabetic retinopathy.

Because PDR often has no symptoms, if you have any form of diabetes you should have your eyes examined regularly by an ophthalmologist, Dr. Kent Small.

Cedars-Sinai medical towers | 8635 West 3rd Street, Suite 395-W, Los Angeles, CA 90048 | Tel: (310) 659-2200 | Fax: (310) 659-2822 Glendale Office | 501 North Orange Street Suite 250, Glendale, CA 91203 | Tel: (818) 552-5040 | Fax: (818) 552-5044

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