Diabetic Retinopathy

A complication of diabetes

Symptoms and Causes

The primary cause of diabetic retinopathy is diabetes. Elevated blood sugar levels from diabetes can damage the small blood vessels that nourish the retina. When you have diabetic retinopathy, high blood pressure can make it worse. High blood pressure can cause more damage to the weakened vessels in your eye, clouding more of your vision. It is possible to have diabetic retinopathy for a long time without noticing symptoms. Often, diabetic retinopathy will cause symptoms unnoticeable to a patient until substantial damage already has occurred. Having your eyes checked regularly can find diabetic retinopathy early enough to treat it and help prevent vision loss.

Treatment

Surgery, laser treatment, or medicine may be done to prevent, treat, or reverse vision loss caused by diabetic retinopathy. You may need to be treated more than once as the disease gets worse. Discuss the options available with your doctor.

Prevention

You can lower your chance of damaging small blood vessels in the eye by keeping your blood sugar levels, cholesterol and blood pressure levels within a target range. If you smoke, quit. All of this reduces the risk of damage to the retina. It can also help slow down how quickly your retinopathy gets worse and can prevent future vision loss.

Avoid delayed diagnosis and treatment. Eye exams are extremely important. Getting a dilated eye exam won’t prevent retinopathy, but it can reduce the risk of more severe, if diagnosed early. You should schedule regular eye exams, and see a retina specialist if you are told that you have diabetic retinopathy.

Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that causes damage to the blood vessels of the retina. Retina is the light-sensitive tissue that lines the back part of the eye, allowing you to see fine detail. Diabetic retinopathy can lead to poor vision and even blindness.

Diabetic retinopathy occurs in more than half of the people who develop diabetes. The longer you have diabetes, and the less controlled your blood sugar is, the more likely the possibility that you will develop diabetic retinopathy. If blood sugar levels stay high, diabetic retinopathy will keep getting worse. In the early stages, the blood vessels in the eye get weak. This can lead to blood and other liquid leaking into the retina from the blood vessels. This is called non-proliferative retinopathy. This is the most common retinopathy. Most people with non-proliferative retinopathy have no symptoms. However, if the fluid leaks into the center of your eye, it will cause swelling in the central part of the retina, called macular edema. The macula, or center part, of the retina is used for sharp, straight-ahead vision. This swelling in this central part of the retina may lead to blurry vision.

If the blood sugars stay high, new blood vessels can grow on the retina. This may sound good, but these new blood vessels are weak. They may break very easily. When that happens, blood can leak into the middle part of your eye in front of the retina and change your vision. This bleeding can also cause scar tissue to form, which can pull on the retina and cause the retina to move away from the wall of the eye (retinal detachment). This is called proliferative retinopathy. Occasionally, these blood vessels and scar tissue may grow in the front of the eye, where fluid normally exits. When the fluid cannot escape, pressure can build in the eye, creating a rare type of glaucoma (neovascular glaucoma) that can damage the vision even further and cause the eye to become painful.

Risk factors

Anyone who has diabetes is at risk of developing diabetic retinopathy.

However, there are additional risks that my increase your chances of developing diabetic retinopathy.

  • Duration of diabetes – the longer you have diabetes, the greater the risk of developing retinopathy
  • High blood sugar – the higher your blood sugar runs, the greater the risk of developing retinopathy
  • High blood pressure and cholesterol can have affect the development of retinopathy, as well

Diagnostic tests

The best way to diagnose diabetic retinopathy is with a dilated eye exam. Having a dilated eye exam regularly can help find retinopathy before it changes your vision. On your own, you may not notice symptoms until the disease becomes severe.

During the exam, your doctor may do some other diagnostic tests to evaluate the extent of diabetic retinopathy and propose treatment. The diagnostic tests frequently used to detect and manage diabetic retinopathy:

  • Optical coherence tomography (OCT): This test provides cross-sectional images of the retina that show its thickness, helping determine whether fluid has leaked into retinal tissue.
  • Fundus photography: The photographs of the back of the eye are done to facilitate detection of diabetic retinopathy as well as to document the retinopathy to make it easier to determine if the condition is worsening at a subsequent visit.
  • Fluorescein angiography: After dilating your pupils, a dye will be injected into your arm that will circulate through your eyes. It is like a food coloring however, it does not affect the kidneys, and is unlike the dye that is used with MRIs or CAT scans. As the dye circulates, pictures are taken of the retina, allowing your doctor to accurately detect blood vessels that are closed, damaged, or leaking fluid. The pictures are black and white to facilitate the detection of these changes, but the process is not the same as having an x-ray. Your doctor can discuss the risks and benefits of obtaining these images.

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