Diabetic Retinopathy

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Diabetic Retinopathy

Do you or someone you love live with diabetes? It occurs when diabetes increases your blood sugar (glucose) levels, damaging the tiny blood vessels in your eye’s retina. And while diabetes can take a serious toll on your entire body, your eyes and vision are at particular risk, in the form of diabetic retinopathy. This condition can develop with type 1, type 2, or gestational diabetes (occurring in pregnancy). More than half of all people with diabetes have been shown to be afflicted with diabetic retinopathy. In fact, it is the leading cause of vision loss in adults with diabetes.

While there’s no cure, you may be able to slow or stop its progression by properly managing your diabetes and following a healthy lifestyle. Early on, your doctor will monitor your eyes’ health, but should it progress, certain treatments, such as injectable medications and surgery, may limit further damage.

What is Diabetic Retinopathy?

Diabetes refers to a group of diseases that affect your body’s ability to control blood sugar (or glucose) levels, causing them to increase (known as hyperglycemia). Chronic (long-term) high blood sugar can damage blood vessels throughout the body. Diabetic retinopathy means that the increased blood sugar levels have weakened the walls of your retinal blood vessels.

Located on your back eyewall, the retina, a light-sensitive (photosensitive) tissue layer performs a crucial task. The retina receives light and images and transforms light and images and transforms them into nerve signals, which then travel to the brain via the optic nerve. These signals are then converted into images. But with diabetic retinopathy, microaneurysms (small red bulges) () can form, leaking fluid and blood into the retina. Blisters can also form along the vessel walls, resulting in retinal hemorrhages (excessive bleeding) when they burst.

Diabetic retinopathy usually affects both eyes. And you may be at greater risk for other serious eye conditions, such as glaucoma, cataracts, retinal detachment, and blindness. There are two main stages of diabetic retinopathy:

Nonproliferative diabetic retinopathy (NPDR) which develops earlier, is the more common form of this condition. Often, there are no symptoms, and you may not even be aware of it, but as more vessels are blocked, you may notice blurred vision, decreased clarity, and fluctuating vision quality. There may be such symptoms as cotton wool spots (white retinal areas), retinal swelling or bleeding, and exudate (pus).

Proliferative diabetic retinopathy (PDR), the more advanced form, may require the need for immediate medical treatment. With PDR, new abnormal, delicate blood vessels continue to grow, both in the retina and the vitreous, the clear, jelly-like substance filling the eye’s center. PDR may cause such vision problems as floaters, hazy vision, as well as issues with night vision and changes in Iighting.

• What is diabetic macular edema?

  A condition called diabetic macular edema (DME) may develop when fluid or blood accumulates in the macula, the retina’s center, which controls sharp, straight-ahead vision. DME can cause swelling and problems with central vision, such as seeing faces and close-up work, like reading or driving. DME can result in blindness and permanently damage retinal nerve cells.

• What complications may occur with PDR?

  If untreated, PDR can lead to serious complications, like permanent blindness and even loss of an eye. Other conditions may include:

  • Retinal detachment – As new blood vessels are so fragile, they easily bleed, causing scar tissue to form. Should this tissue pull back, your retina may be moved out of position, causing a retinal detachment.
  • Vitreous hemorrhage – This is heavy bleeding in the vitreous. It can cause floaters, or block vision, which may be temporary, as the blood may clear.
  • Retinal detachment – As new blood vessels are so fragile, they easily bleed, causing scar tissue to form. You may find that this tissue stretches back, moving your retina out of its proper position, resulting in a retinal detachment.
  • Neovascular glaucoma – New blood vessels may grow on the iris, which controls pupil size and the amount of light entering the eye. This may lead to neovascular glaucoma, a serious condition causing vision loss, eye redness, and severe pain. These new vessels can also interfere with the eye’s normal flow of fluids, increasing pressure.

Annual Diabetic Eye Screening Exams Are Essential

As NPDR may progress to the more dangerous PDR form, it’s vital to monitor your retinal health. Research suggests that the longer you’ve lived with diabetes, the greater your chances of developing diabetic retinopathy. If you have diabetes — especially for senior patients — we recommend a comprehensive dilated eye examination at least once a year.

During this visit, your retina specialist will inspect your eyes for abnormal blood vessels, bleeding, leakage, swelling, and retinal detachment. You should mention any visual changes, such as sudden changes or blurry, spotty, or hazy vision. But if you see dark, floating spots or cobweb-like streaks, seek immediate medical treatment.

• What are the typical diagnosis methods for diabetic retinopathy?

  • Eye dilation – Special eye drops are applied to keep the pupil open, providing your doctor with a closer look at your retina.
  • Ophthalmoscopy – An instrument called an ophthalmoscope enables doctors to observe and assess any retinal damage. Diabetic patients should have this test at least once every year.
  • Fluorescein angiography – Colored dye is injected into the bloodstream to highlight the eye’s blood vessels. Your doctor can take pictures and analyze the images for signs of closed, broken, or leaking blood vessels.
  • Optical coherence tomography (OCT) – Infrared light is used to capture cross-sectional retinal images. Doctors use OCT to check if fluid has leaked into the retinal tissue.

• Treatment for Diabetic Retinopathy

  Should your eye doctor diagnose diabetic retinopathy, they’ll initially monitor your eyes’ health. But if it progresses and you have vision changes, you may need to begin treatments to limit further damage, including:

  • Injectable medications specifically, anti-vascular endothelial growth factor (anti-VEGF) drugs, may slow or stop blood vessels from leaking in the eye, while preventing new blood vessel growth. Our doctors may also inject corticosteroids.
  • Laser treatments may reduce retinal swelling, shrink blood vessels, and stop leaking.
  • A vitrectomy, a surgical procedure involving the removal of the vitreous, may be performed if excessive retinal bleeding causes scarring in your eye.

Maintain Proper Diabetes Management

While there’s no cure for diabetic retinopathy, you can slow or prevent vision loss by never developing it at all. You’ll have to properly manage your diabetes and maintain healthy glucose levels. That means regularly taking your insulin and other medications. If necessary, you must also test your glucose levels as per your doctor’s directions. Your primary care doctor can prescribe a glycosylated hemoglobin test (hemoglobin A1C). The A1C details your average blood sugar levels for the previous 2-3 months. You should aim for an average level of below 7 percent.

As both high cholesterol and blood pressure are risk factors, you have to control your levels. Adults with diabetes should aim for a blood pressure of less than 130/80 mm Hg. You should also try to follow a healthy lifestyle, including engaging in regular physical activity, eating healthily, and avoiding smoking.