Diabetic Retinopathy: Risk Factors, Prevention, and Treatment
If you have diabetes, keeping an eye on your vision is essential. November is declared Diabetic Eye Disease Awareness month, and for a good reason: diabetic retinopathy, a serious complication from diabetes, affects up to 8 million people in the United States alone.
Can diabetic retinopathy be reversed? Luckily, it’s the most preventable cause of blindness in adults, meaning that you can take control of your eye health and prevent or stop the progression of the disease if you’ve been diagnosed.
Learn more about Diabetic Retinopathy with Juan M. Romero, MD and Jessica G. Lee, MD on the VRC Podcast, Retina in Focus.
Keep reading to learn more about diabetic retinopathy and another closely related condition, diabetic macular edema, the risk factors for developing both, and the treatment options available.
What Is Diabetic Retinopathy?
Both diabetic retinopathy and diabetic macular edema are serious complications that affect the retina and the nervous tissue that lines the back of the eye that helps with vision.
Diabetes can damage the blood vessels in the retina by causing swelling and leakage, as well as other problems that can lead to diabetic retinopathy vision loss.
The Two Stages of Diabetic Retinopathy
Nonproliferative diabetic retinopathy (NPDR) is an early stage of diabetic retinopathy characterized by swelling and leakage in the back of the eye due to increased pressure in the retina's blood vessels.
Proliferative diabetic retinopathy causes new blood vessels to form, which can lead to complications like vitreous hemorrhage (blood in the eye) and retinal scarring.
Complications from PDR include retinal detachment and blockage of the drainage of the aqueous fluid in the front of your eyes, which could develop into neovascular glaucoma.
What is the first sign of diabetic retinopathy? Early on, symptoms can include blurry vision, shadows, and temporary vision loss. Permanent vision loss is a symptom of a degenerative stage.
Diabetic Macular Edema
Diabetic macular edema can also develop from diabetic retinopathy and is the most common cause of vision loss in diabetics.
The macula is an integral part of the retina. Bleeding from blood vessels in the retina (vitreous hemorrhage) can cause the formation of edema in the macula, which affects vision.
Symptoms include blurry vision, eye floaters, shadows, and vision loss.
Risk Factors for Developing Diabetic Retinopathy
Those diagnosed with diabetes type one and two, and gestational or pregnancy-related diabetes, are at risk of developing diabetic retinopathy.
Some additional risk factors might include the following:
- The duration of your diabetes. Diabetes increases your risk the longer you have it.
- Poor diabetes management.
- High blood pressure.
- High cholesterol.
Early screening is key to stopping the progression of diabetic retinopathy and macular edema development, even if you don't develop diabetic symptoms.
How Do Doctors Check for Diabetic Retinopathy?
Your optometrist will refer you to a retinal specialist if they detect hemorrhage or loss of vision due to swelling in the eye during a regular eye exam.
A visit with a retinal specialist will be longer than a regular eye check-up. The specialist will perform a vision pressure test and examine the front of your eye.
They will also use drops to dilate the pupils to get a full view of the back of the eye, using imaging and special photography to evaluate the health of your retina.
Some standard tests include fluorescence angiography to evaluate the circulation of the back of the eye and check for leakage and any abnormal new vessel formation. An optical coherence tomography (OCT) may also be performed to look at the macula area and check the thickness of your retina.
What Are the Treatment Options?
Several treatment options may be recommended depending on the results during your visit with an eye doctor.
If a patient is diagnosed with NPDR, the specialist might recommend lifestyle changes, including lowering A1C levels. They will schedule a follow-up exam with the patient in 3 to 6 months to evaluate progress.
Treatment for These Eye Conditions
When diabetic retinopathy is more advanced or macular edema has been detected, it may require treatment.
Focal laser treatment to decrease swelling and leakage may be used depending on the stage of the disease. Only a small percentage of those with diabetic macular edema will benefit from this type of treatment, particularly if the localized area of the swelling hasn’t affected the retinal center.
In non-surgical cases of proliferative diabetic retinopathy, anti-VEGF treatment is the most effective.
The drug is injected into the patient’s eyes through a tiny, thin needle that goes through the white part of the eye. The patient is given an anesthetic and antiseptic for the eye, with minimal pain or discomfort and no risk of infection.
Anti-VEGF helps treat blood vessel growth and leakage. It is effective for only a few weeks, and patients must receive an infection regularly. The space between injections depends on how the patient responds to the drug.
Surgery is reserved for more aggressive forms of diabetic retinopathy. It involves a vitrectomy where the doctor removes the vitreous of the eye to access the retina and repair the damage: removing the blood in the eye, repairing scar tissue membranes, and reattaching the retina.
The patient’s eye is completely numbed, and small openings are made through the white part of the eye to access inside the eye. Pupils dilate, and surgeons can see everything inside the eye through a microscope.
Patients leave the hospital the same day.
All three options are effective, and the laser is sometimes recommended with surgery and injections in more advanced diabetic retinopathy stages of the condition.
Prevention and Long-Term Eye Care
The best way to prevent diabetic retinopathy and diabetic macular edema if you have diabetes is to make healthy lifestyle changes.
Maintaining a healthy blood sugar level, treating high blood pressure and cholesterol, and avoiding smoking are important. Small amounts of weight loss will also significantly impact your health.
Visiting your eye doctor for a regular checkup is essential, as many with minimal diabetic retinopathy don’t experience early symptoms. Also, a recent diagnosis doesn’t mean you’re not at risk: getting your eyes checked as soon as you’ve been diagnosed with diabetes is essential.
A treatment plan should be started as soon as possible to minimize complications and retinopathy progression.
Implementing lifestyle changes after diagnosis can also improve your eye health.