People with diabetes may be surprised when their physician recommends seeing an eye doctor to screen for diabetic retinopathy. Diabetic retinopathy is a condition that occurs when Type 1 or Type 2 diabetes causes damage to blood vessels in the retina. The longer a person has diabetes, the higher their risk of developing retinopathy.
In its earliest, most treatable stages, diabetic retinopathy can only be confirmed by a full examination of the eye. A diabetic eye exam is painless and, for the most part, is very similar to a routine eye exam.
Are there different types of diabetic retinopathy?
There are 2 main types of diabetic retinopathy:
Non-proliferative Diabetic Retinopathy
Fluid from weakened blood vessels in the retina may leak into the retina and result in swelling of the macula, which is responsible for clear central vision.
Proliferative Diabetic Retinopathy
The retina becomes deprived of oxygen and new blood vessels form in the retina and in the fluid in the back of the eye in an effort to increase oxygen and blood supply to the retina. These new vessels are extremely fragile and prone to rupturing, though, causing blood to leak into the retina. The result is cloudy vision and possible detachment of the retina.
What causes diabetic retinopathy?
Copyright Nucleus Medical Media, Inc.
Glucose is a type of sugar that comes from the foods you eat and that is stored in the body to use for energy. Diabetes causes high levels of glucose in the blood. Over time, this excess glucose can cause damage to small blood vessels throughout the body. The blood vessels in the retina are particularly sensitive to this type of damage.
High glucose levels can cause the blood vessels in the retina to swell, leak, or close off. The damaged blood vessels may then be replaced with weaker blood vessels that also bleed into the eye or create scarring. The bleeding, swelling, and scarring can weaken or interfere with vision.
Are there risk factors for developing diabetic retinopathy?
A risk factor is something that increases your chances of developing a certain disease or condition. Risk factors for diabetic retinopathy include:
- Race: more common in people of African American, Hispanic, and South Asian descent
- Being diagnosed with diabetes at a young age
- Poorly-controlled diabetes
- Elevated cholesterol levels
- Recent cataract surgery
- High blood pressure
What are the symptoms?
Diabetic retinopathy may not cause any outward symptoms at first. During a routine eye examination, though, an eye doctor may see red and white dots on the retina, called microaneurysms, which are an early indicator of retinopathy. These pouches of blood damage the blood vessels in the eye and cause blood, fat, or fluid to lead into the tissue of the retina. Over time, diabetic retinopathy can lead to:
- Blurred or double vision
- Reduction or loss of vision in one or both eyes
- Dark spots or the appearance of floating objects in one or both eyes
- Eye pressure or pain
- Difficulty seeing in dim light
- Seeing flashing lights or rings around lights
- Sudden blindness (rare)
How is diabetic retinopathy diagnosed?
You will be asked about your symptoms and medical history, and a physical examination of your eyes will be done. Your physician will refer you to an eye doctor who specializes in diagnosing eye conditions. A comprehensive eye exam and vision test will be performed and images will be taken of your eyes after your pupils are dilated using eye drops. These images provide important information to help the eye doctor diagnose any diabetic retinopathy or other conditions like glaucoma, cataracts, or macular degeneration. These images can be taken with:
- Fundus photography: An advanced digital photo of the retina
- Optical coherence tomography: Light waves are used to take pictures of the retina
How is diabetic retinopathy treated?
If left untreated, diabetic retinopathy can lead to blindness. Early stages of diabetic retinopathy may not require eye treatment but management of blood glucose, cholesterol levels, and blood pressure will help slow or stop further damage. Your doctor will monitor your condition and treatment may include:
Proper management of blood glucose levels can help slow or stop damage in the eye. Management can include:
- Following a diet to control your blood glucose
- Maintaining a healthy weight
- Exercising regularly
- Regularly testing your blood glucose levels
Your eye doctor may advise medications to reduce the damage to your eye such as:
- Anti-vascular endothelial growth factor injections into your eye to improve oxygen levels in the retina tissue
- Steroid injection into the eye to slow inflammation and damage
In some cases, surgery may be recommended to help slow or stop the progression of the retinopathy. Surgical treatments may include:
- Laser treatment: A laser is used to shrink abnormal blood vessels or to stop or slow leaks. Laser treatment creates some scar tissue, but aims to preserve vision in the macula by stopping growth of new blood vessels.
- Vitrectomy: Blood vessels and/or scar tissue are removed from the middle of the eye (vitreous) and replaced with a clear saline-like solution
Is there a way to prevent getting diabetic retinopathy?
To help reduce your chance of getting diabetic retinopathy:
- Manage your diabetes.
- Monitor your blood glucose levels.
- Have regular blood glucose testing done as advised by your doctor.
- Manage your blood pressure and cholesterol levels.
- If you smoke, talk to your doctor about ways to quit.
- Have your eyes examined on a regular basis, as advised by your eye care specialist.