Diabetic Retinopathy

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Diabetic Retinopathy

Do you or someone you love live with diabetic retinopathy? This condition develops as the result of diabetes raising your blood sugar (also called glucose) levels, thereby damaging the tiny blood vessels in your eye’s retina. Diabetes plays no favorites, as it is capable of damaging your entire body, including your eyes and vision. If you have any type of diabetes — whether type 1, type 2, or gestational diabetes (occurring in pregnancy) — you’re at risk of developing diabetic retinopathy. Ranked as the leading cause of vision loss among adults with diabetes, it has been found to affect more than half of all people 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 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 lighting.

• 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 – Unfortunately, as new blood vessels sprout, they’re likely to be fragile and easily bleed, causing the formation of scar tissue. As a result, your retinal tissue may stretch back, disrupting your retina so that it moves out of its proper position, leading to 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.
  • 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. Studies show that the longer a person has lived with diabetes (any type), the greater their likelihood of developing diabetic retinopathy. If you have diabetes — especially for senior patients — we recommend a comprehensive dilated eye examination at least once a year.

When you come in for this appointment, you can expect your retina specialist to thoroughly inspect your eyes for a host of distinctive symptoms, including unusual 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 – With this technique, your ophthalmologist applies special eye drops to keep your pupil open. This provides them with the chance to thoroughly examine your retina, closer up, without obstructions.
  • Ophthalmoscopy – An instrument called an ophthalmoscope enables doctors to observe and assess any retinal damage. If you have diabetes, it’s recommended you undergo this test annually (at least).
  • Fluorescein angiography – This method involves the retina specialist injecting colored dye into your bloodstream to illuminate the eye’s blood vessels. They’re then able to take photographs and analyze the images, searching for indications of closed, broken, or leaking blood vessels.
  • Optical coherence tomography (OCT) – Infrared light is used to capture cross-sectional retinal images. Retina specialists utilize OCT to determine if your retinal tissue has been the site of any leaked fluid.

• 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 is a surgical procedure in which the vitreous is removed from the back of the eye. This procedure may be performed if your eye has developed scarring, due to excessive retinal bleeding.

The Importance of Proper Diabetes Management

No cure currently exists for diabetic retinopathy, although you can slow or even prevent any vision loss by never developing it in the first place. 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 high 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.