Diabetic Retinopathy

What is Diabetic Retinopathy?

Diabetes is a disease that affects all parts of the body by causing damage to the blood vessels. It affects the eyes, heart, kidneys and peripheral blood vessels. Diabetic retinopathy is a potentially blinding complication of diabetes that damages the eye’s retina, which is the lining at the back of the eye that is responsible for vision. You may not notice the damage in your eyes until it is too late, which is why it is important that you have regular eye examinations if you have diabetes. Waiting until you lose vision may result in irreversible damage to the vision and potentially blindness. Treatments are currently available that may be able to preserve the vision.

There are two types of diabetic retinopathy:

  • Non-proliferative diabetic retinopathy – This occurs when tiny retinal blood vessels are damaged by diabetes and begin to leak fluid or blood. If this leakage is in the macula, the central vision part of the retina, the macula swells and causes vision loss.
  • Proliferative diabetic retinopathy – New, but fragile blood vessels grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, scar, cloud vision, and destroy the retina. Proliferative diabetic retinopathy can affect both central and peripheral (side) vision and may cause severe vision loss.

Who is at Risk for Diabetic Retinopathy?

Anyone with diabetes. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. During pregnancy, diabetic retinopathy also may be a problem for women with diabetes. That’s why it is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.

Diabetics also are at risk for other non-diabetic eye diseases. Studies show that you are more likely to develop cataracts at an earlier age and glaucoma than other adults.

What are the Symptoms of Diabetic Retinopathy?

Early in the course of the disease you may have no symptoms, yet diabetes is causing damage to the blood vessels of the eye. You may experience blurred vision, loss of vision or floaters. If you experience any of these symptoms you should get seen in a timely manner.

What treatments are available?

When diabetes causes damage to the blood vessels it can lead to leakiness and swelling in the retina. If this leakiness threatens the center of the vision laser treatment will usually be recommended. The goal of the laser treatment is to stabilize the vision and prevent further progression. This form of laser treatment involves bright light but there is usually little discomfort. The treatment is done in the office.

As the diabetes progresses it causes the blood vessels to close down. Rather than opening these vessels the eye forms abnormal blood vessels that are very fragile called neovascularization. These abnormal blood vessels cause bleeding, scarring and potentially a severe from of glaucoma. This may cause severe vision loss and possibly pain. Your doctor will recommend a treatment called panretinal photocoagulation (PRP) to try to limit further visual loss. This treatment tends to be uncomfortable. Most patients require at least two treatment sessions and the treatment is done in the office.

When is Non-Laser Surgery Necessary?

Laser treatment may not be an effective option if you have problems such as significant bleeding, scar tissue or a retinal detachment. Your retina doctor may recommend an operation called a vitrectomy. A vitrectomy is a surgical procedure done in an operating room. During a vitrectomy, the blood, scar tissue and vitreous are removed and replaced with a clear solution, gas or silicone oil. Laser also may be performed. Surgery is not always needed with all vitreous hemorrhages. Instead, your retina doctor may wait several weeks or months to allow the blood to clear on its own.

What You Can Do to Protect Your Vision

The most important thing you can do to prevent complications of diabetes and diabetic retinopathy is to regularly monitor and control your blood sugar. Optimal control of blood sugar levels slows the onset and progression of diabetic retinopathy and lessens the need for laser surgery. High blood pressure also causes damage to the blood vessels and it is important to keep your blood pressure under good control. And, of course, everyone with diabetes should have a dilated eye examination at least once a year. Early detection and treatment, when indicated, is the best way to prevent vision loss.

Making the Most of Your Remaining Vision

Early detection and treatment may reduce the loss of vision from diabetic retinopathy. However, if some loss of vision should occur, it doesn’t have to rob you of life’s simplest pleasures if you learn how to use your remaining eyesight to see your best. Low vision aids, special lenses, or electronic systems and training can maximize your ability to read and perform other activities. Ask your doctor about low vision aids.

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