Diabetic RetinopathyDiabetic retinopathy is a complication of diabetes in which high levels of blood sugar cause damage to the retinal blood vessels. The condition can happen to people with Type 1 or Type 2 diabetes, especially if there are other risk factors present, such as high cholesterol, high blood pressure, or smoking. It can also develop in pregnant women who have been diagnosed with gestational diabetes.
Diabetic retinopathy can increase your chances of developing other serious eye conditions, including glaucoma, cataracts, retinal detachment, and blindness. It is the most common cause of vision loss in diabetics.
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Stages of Diabetic Retinopathy
The progression of diabetic retinopathy is categorized into four separate stages:
Mild non-proliferative diabetic retinopathy (NPDR): In this stage, the retinal blood vessels begin to develop tiny bulges known as microaneurysms, which can cause the vessels to leak fluids into the retina. At this early stage, you likely will not experience any issues with your vision.
Moderate non-proliferative diabetic retinopathy (NPDR): As the condition progresses into the second stage, the blood vessels begin to swell, which can impact their ability to carry blood. In some cases, patients develop diabetic macular edema (DME), which is when fluid and/or blood accumulates in the macula. DME can cause serious disruptions to our ability to see in fine detail, read, drive, and more.
Severe non-proliferative diabetic retinopathy (NPDR): During this stage, the retinal blood vessels become increasingly blocked, which cuts the retina off from its blood supply. Scar tissue begins to form and the retina starts to generate new blood vessels. At this stage, patients may experience vision problems like blurriness or dark spots.
Proliferative diabetic retinopathy (PDR): During the most advanced stage of diabetic retinopathy, abnormal blood vessels continue to grow in the retina and vitreous fluid. Because they are abnormally fragile, these blood vessels bleed easily and cause more scar tissue to form. Sometimes, the scar tissue recedes and pulls the retina out of position, causing a retinal detachment. This advanced stage can lead to permanent vision loss.
Diabetic Retinopathy Symptoms
In the early stages of diabetic retinopathy, many patients experience no symptoms or problems with vision. It’s not until the later stages that symptoms typically begin to appear. These symptoms include:
- Blurry vision
- Eye floaters
- Loss of central vision
- Black spots in vision
- Inability to see color
How Diabetic Retinopathy is Diagnosed
Diabetic retinopathy is diagnosed through a comprehensive eye exam. During the examination, your retina specialist will inspect your eyes for swelling, abnormal blood vessels, bleeding, leakage, and retinal detachment. Diagnostic methods include:
Eye dilation: Special eye drops are used to keep the pupil open so that your physician can get a closer look at your retina.
Ophthalmoscopy: In this test, a light is shined on the retinal area using an ophthalmoscope, which helps your doctor make observations about the retinal tissue and assess if there is any damage and how much. It is generally recommended that diabetics have an ophthalmoscopy exam done at least once every year.
Fluorescein angiography: This test uses colored dye injected into the bloodstream to highlight the blood vessels in the eye. As the dye circulates through the ocular blood vessels, your doctor takes pictures and analyzes the images for signs of closed, broken, or leaking blood vessels.
Optical coherence tomography (OCT): In some cases, your doctor may perform an OCT exam, which uses infrared light to capture cross-sectional images of the retina. OCT can be used to determine whether or not fluid has leaked into the retinal tissue.
Diabetic Retinopathy Treatment
Treatment for diabetic retinopathy depends on how far along the condition has progressed. In cases of mild and moderate nonproliferative diabetic retinopathy, the condition is generally treated by making adjustments to your diabetes management plan and getting high blood sugar levels under control. For more advanced cases, treatments can include:
Vitrectomy: This is a surgical procedure that is often used in the treatment of retinal tears and detachments. It involves the removal of the vitreous humor fluid from the inside of the eye so that any damage done to the retina can be repaired.
Focal laser treatment, also known as photocoagulation: This procedure uses a high-energy laser beam to seal leaking blood vessels.
Eye injections: In some cases, your doctor may inject anti-vascular endothelial growth factor (anti-VEGF) medications such as Avastin, Lucentis, or Eylea directly into your eye. These medications help to inhibit the growth of blood vessels in the retina.
It’s important to keep in mind that patients’ eyes are numbed or anesthetized before these procedures are performed. Most patients report feeling very little discomfort if any at all.
Diabetic Retinopathy: FAQ
You can prevent diabetic retinopathy and preserve your vision by maintaining healthy levels of blood sugar and blood pressure. Healthy eating and physical activity should be a part of your daily life. It’s also important that you do not smoke. Lastly, be sure to see an eye doctor at least once a year for a complete eye exam.
According to the American Diabetic Association, almost every Type 1 diabetic, as well as many Type 2 diabetics, will eventually develop mild or moderate nonproliferative diabetic retinopathy. The more advanced stages of diabetic retinopathy are far less common and can often be prevented by managing your blood sugar levels.
In the early stages of diabetic retinopathy, there are generally no changes to vision. However, as the condition progresses, vision can become seriously impaired. The images you see when you have advanced diabetic retinopathy will be like looking at a photograph that has large, irregular black spots throughout the picture.
The progression of diabetic retinopathy can be slowed down through blood sugar management, surgery, or medications. However, retina damage and vision loss caused by diabetic retinopathy are often irreversible.
For more information, please visit the American Society of Retina Specialists website.