Diabetic Retinopathy

Diabetic-Retinopathy

Diabetic retinopathy is the most common cause of vision loss for people with diabetes. According to the Centers for Disease Control and Prevention (CDC), Diabetic retinopathy is responsible for 12,000 to 24,000 new cases of blindness each year and is the leading cause of new cases of blindness in adults age 20 to 74 years of age. 

Diabetic retinopathy is a complication of diabetes. Diabetes causes abnormal glucose metabolism as a result of decreased levels of insulin or insulin resistance. Increased levels of blood glucose are thought to have a structural and physiological effect on retinal capillaries (small blood vessels in the back of the eye), causing them to be both functionally and anatomically incompetent.

As a result, diabetic retinopathy causes changes to the blood vessels in the retina. (The retina is the lining at the back of your eyes that changes light into images.) The blood vessels can swell, leak fluid, or bleed, which often leads to vision changes or blindness.

If your diabetic retinopathy causes fluid buildup and swelling in your macula, you can get diabetic macular edema (DME), a serious complication of diabetic retinopathy. DME is the most common reason people with diabetic retinopathy lose their vision.

What are the symptoms of diabetic retinopathy?

At first, you may not have any signs or symptoms of diabetic retinopathy, but as it starts to get more serious, you might notice 

  • Loss of central vision, which is used when you read or drive
  • Not being able to see colors
  • Blurry vision
  • Holes or black spots in your vision
  • Floaters or small spots in your vision caused by bleeding

What happens when diabetic retinopathy is left untreated?

If diabetic retinopathy is left untreated, it can scar and damage your retina.

What causes diabetic retinopathy?

If you have high blood glucose (blood sugar) for too long it blocks off the small blood vessels that keep your retina healthy. As the blood vessels start to weaken, they can leak blood and fluid into your retina.

As your condition gets worse, your eye will try to grow new blood vessels, but they won’t develop well and as a result more blood vessels become blocked. Consequently, scar tissue builds up because of the new blood vessels your eye has grown and this extra pressure can cause your retina to tear or detach.  This can lead to other eye diseases, such as glaucoma or cataracts (the clouding of your eye’s lens) that may result in blindness.

Who is at risk of developing diabetic retinopathy?

You are at risk of developing diabetic retinopathy if you have type 1, type 2, or gestational diabetes over a long period of time.  

Other things that can raise your risk of diabetic retinopathy include

  • High blood pressure
  • High cholesterol
  • Tobacco use
  • Being African American, Hispanic, or Native American

Are there different stages of disease for diabetic retinopathy?

There are four stages of the disease, as follows:

Mild Nonproliferative Retinopathy. This is the early stage of disease in which the tiny blood vessels in your retina change–small areas swell (microaneurysms) and fluid can leak out of them and into your retina. 

Moderate Nonproliferative Retinopathy. In this second stage, the disease gets worse where the blood vessels that should keep your retina healthy start to swell and change shape. This swelling prevents the delivery of blood to your retina and changes the way your retina should look. These blood vessel changes can trigger diabetic macular edema (DME)–swelling in the area of your retina called the macula.

Severe Nonproliferative Retinopathy. In this third stage of the disease, many blood vessels get blocked and can’t deliver blood to your retina to keep it healthy. As a result, special proteins called growth factors tell your retina to grow new blood vessels.

Proliferative Diabetic Retinopathy (PDR). This fourth stage of the disease is the most advanced stage where new blood vessels grow inside your retina and then into the jelly inside your eyeballs called vitreous humor. These fragile new blood vessels are more likely to leak fluid and bleed, which can then cause scar tissue. This scar tissue can cause retinal detachment (when your retina pulls away from the tissue underneath), which can lead to permanent blindness.

How is diabetic retinopathy diagnosed?

During your appointment, your eye doctor will examine your eyes and may perform one or more of the following tests

Pupil Dilation. Your doctor will dilate your pupils to check for any changes in your eye’s blood vessels or see if any new ones have grown. Your doctor will also check to see if your retina is swollen or detached. 

Fluorescein Angiogram. This test can tell your eye doctor if you have severe diabetic retinopathy, as it shows if any of your blood vessels are leaking or damaged. For the test, you are given a shot with fluorescent dye into a vein in your arm. When the dye reaches your eyes, your eye doctor will be able to see images of the blood vessels in your retina and spot any serious problems.

What is the treatment for diabetic retinopathy?

Treatments for diabetic retinopathy may include:

Anti-VEGF Injection Therapy. These are drugs that block vascular endothelial growth factor, a protein that makes abnormal blood vessels grow in your eye,  and can reverse blood vessel growths and lower fluid buildup in your retina.

Focal/Grid Macular Laser Surgery. The laser makes tiny burns on the leaky areas of vessels in your macula. Anti-VEGF therapy may be needed after this surgery.

Corticosteroids. Your eye doctor can implant or inject these short-term or long-acting medications into your eye. Since steroids can raise your chance of glaucoma or cataracts, your eye doctor will monitor the pressure in your eye.

Scatter Laser Surgery. This surgery is indicated for patients whose retina has detached from the macula. The treatment makes up to 2000 tiny burns to treat spots where the retina has detached from the macula and it can shrink abnormal blood vessels. It is best to get this treatment before new blood vessels start to bleed, as this laser surgery may save central vision, but it may lessen side, color, or nighttime vision.

Vitrectomy. This surgery is indicated for patients whose blood vessels leak into their retina and vitreous humor, causing cloudy vision. During the procedure, the leaked blood is removed from the retina so the patient can see better.

What can you do to prevent diabetic retinopathy?

The two major things you can do to prevent diabetic retinopathy are to keep your blood sugar and blood pressure under control. This will help slow down diabetic retinopathy and maybe even stop it from happening.

Annual comprehensive eye exams are also important and highly recommended.

Other tips to prevent diabetic retinopathy:

  • If you are pregnant and have diabetes, have a thorough eye exam during your first trimester.
  • If you develop gestational diabetes while you are pregnant, follow up with your eye doctor.
  • If you have diabetes or diabetic retinopathy, don’t smoke.

Diabetic Retinopathy Treatment at FSN Eye Center

If you have diabetes, annual comprehensive eye exams are important and highly recommended. Diabetic Retinopathy can often be prevented with good management of your blood sugar and blood pressure. If you have been diagnosed with diabetic retinopathy, early treatment can prevent advanced stages of the disease. Contact Fisher-Swale-Nicholson Eye Center today to schedule your eye exam.