Diabetic Retinopathy

Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the back of the eye (retina) change. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.

If it isn’t treated, it can cause blindness.

People who have diabetic retinopathy often don’t notice changes in their vision in the disease’s early stages. But as it progresses, diabetic retinopathy usually causes vision loss that in many cases cannot be reversed.

There are two types of diabetic retinopathy:

  • Background or nonproliferative diabetic retinopathy (NPDR)– ‚Ä®Nonproliferative diabetic retinopathy (NPDR) is the earliest stage of diabetic retinopathy. With this condition, damaged blood vessels in the retina begin to leak extra fluid and small amounts of blood into the eye. Sometimes, deposits of cholesterol or other fats from the blood may leak into the retina.
  • Proliferative diabetic retinopathy (PDR) mainly occurs when many of the blood vessels in the retina close, preventing enough blood flow. In an attempt to supply blood to the area where the original vessels closed, the retina responds by growing new blood vessels. This is called neovascularization. However, these new blood vessels are abnormal and do not supply the retina with proper blood flow. The new vessels are also often accompanied by scar tissue that may cause the retina to wrinkle or detach or cause vitreous hemorrhage.PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision.

Symptoms of Diabetic Retinopathy

During the initial stages, retinopathy does not cause any noticeable symptoms. You may not realise that your retina is damaged until the later stages, when your vision becomes affected.

Possible symptoms of late-stage retinopathy include:

  • shapes floating in your field of vision (floaters)
  • blurred vision
  • sudden blindness

Diabetic retinopathy symptoms usually affect both eyes

If you have diabetes and start to notice problems with your vision, contact your eye doctor immediately.

If you have diabetes and start to notice problems with your vision, contact your eye doctor immediately.

Diabetic Retinopathy Risk Factors
  • Blood sugar levels – Controlling your blood sugar is the key risk factor that you can affect.
  • Blood pressure – Target blood pressure for most people with diabetes is less than 130/80 mmHg.
  • Duration of diabetes – The risk of developing diabetic retinopathy or having your disease progress increases over time. After 15 years, 80 percent of Type 1 patients will have diabetic retinopathy. After 19 years, up to 84 percent of patients with Type 2 diabetes will have diabetic retinopathy.
  • Blood lipid levels (cholesterol and triglycerides) – Elevated blood lipid levels can lead to greater accumulation of exudates, protein deposits that leak into the retina.
  • Pregnancy – If you have diabetes and become pregnant, your risk for diabetic retinopathy increases. If you already have diabetic retinopathy, it may progress. However, some studies have suggested that with treatment these changes are reversed after you give birth and that there is no increase in long-term progression of the disease.

The only way to detect diabetic retinopathy and to monitor its progression is through a comprehensive eye exam.

Apart from a detailed eye examination and retinal evaluation after dilatation, your doctor can order Fluorescein Angiography to further evaluate your retina or to guide laser treatment of necessary.

Your doctor may also order OCT which is a non-invasive scanning laser that provides high-resolution images of the retina, helping your doctor evaluate its thickness. OCT can provide information about the presence and severity of macular edema (swelling).

When your diabetic retinopathy screening is complete, your ophthalmologist will decide when you need to be treated or re-examined.

Diabetic retinopathy usually takes years to develop, which is why it is important to have regular eye exams. Because people with Type 2 diabetes may have been living with the disease for some time before they are diagnosed, it is important that they see an ophthalmologist without delay.

The American Academy of Ophthalmology recommends the following diabetic eye screening schedule for people with diabetes:

  • Type 1 Diabetes: (usually diagnosed in children and young adults and previously known as juvenile diabetes) Within five years of being diagnosed and then yearly.
  • Type 2 Diabetes: (the most common form of diabetes) At the time of diabetes diagnosis and then yearly.
  • During Pregnancy: Pregnant women with diabetes should schedule an appointment with their ophthalmologist in the first trimester because retinopathy can progress quickly during pregnancy, then three monthly.

Maintaining strict control of blood sugar and blood pressure, as well as having regular diabetic retinopathy screenings even if your vision seems fine, by your Eye doctor, are keys to preventing diabetic retinopathy and vision loss. Controlling blood sugar and also help to prevent the development of cataracts, asdiabetes is a risk factor for cataracts.If you become pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy, because pregnancy can sometimes worsen diabetic retinopathy.

Treatment for retinopathy will depend on the stage the condition has reached. For example, if retinopathy is identified in its early stages, it can be treated by controlling your diabetes more effectively. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss.

If you have more advanced retinopathy, you may need to have laser surgery or injection therapy to prevent further damage to your eyes.

Treatment usually won’t cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages.

Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision. Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by your doctor.

Preventing Diabetic Retinopathy

To reduce your risk of developing retinopathy, it is important to control your blood sugar level and keep your blood pressure as close to normal as possible.

Other steps that you can take to help prevent retinopathy include:

  • attending your annual screening appointment
  • informing your eye doctor if you notice any changes to your vision
  • taking your medication as prescribed
  • losing weight (if you’re overweight) and eating ahealthy, balanced diet
  • exercising regularly
  • giving up smoking
  • controlling your blood pressure and cholesterol levels

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