Diabetic retinopathy refers to damage to the retina of one’s eye that occurs with long-term diabetes. It is very important that patients with diabetes see their ophthalmologist at least annually even if you believe your vision is fine. Many patients with diabetes have early changes in their eyes that, left untreated, will cause irreversible loss of vision. At Stahl Eyecare Experts, we very much believe that an ounce of prevention is worth a pound of cure. If we detect these early changes, many times we can prevent the loss of vision that otherwise would ensue.
Causes, incidence, and risk factors
Diabetic retinopathy is caused by damage to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. It changes light and images that enter the eye into nerve signals that are sent to the brain.
There are two types, or stages of diabetic retinopathy:
- Nonproliferative develops first
- Proliferative is the more advanced and severe form of the disease
Diabetic retinopathy is the leading cause of blindness in working-age Americans. People with type 1 diabetes and type 2 diabetes are at risk for this condition.
Having more severe diabetes for a longer period of time increases the chance of getting retinopathy. Retinopathy is also more likely to occur earlier and be more severe if your diabetes has been poorly controlled. Almost everyone who has had diabetes for more than 20 years will show signs of diabetic retinopathy.
Most often, diabetic retinopathy has no symptoms until the damage to your eyes is severe.
Symptoms of diabetic retinopathy include:
- Blurred vision and slow vision loss over time
- Shadows or missing areas of vision
- Trouble seeing at night
Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.
Signs and tests
The eye specialist can diagnose diabetic retinopathy by dilating your pupils with eye drops and then carefully examining the retina. A retinal photography , fluorescein angiography, or ocular coherence tomography test may also be used.
If you have nonproliferative diabetic retinopathy, your eyes may reveal:
- Blood vessels in the eye that are larger in certain spots (called microaneurysms)
- Blood vessels that are blocked
- Small amounts of bleeding (retinal hemorrhages) and fluid leaking into the retina
If you have proliferative retinopathy, your eyes may exhibit:
- New blood vessels starting to grow in the eye that are fragile and can bleed
- Small scars developing on the retina and in other parts of the eye (the vitreous)
To prevent diabetic retinopathy:
- Keep tight control of your blood sugar (glucose), blood pressure, and cholesterol levels
- Stop smoking
People with the earlier form (nonproliferative) of diabetic retinopathy may not need treatment. However, they should be closely followed by an eye care doctor who is trained to treat diabetic retinopathy.
Treatment usually does not reverse damage that has already occurred. However, it can help keep the disease from getting worse. Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.
Several procedures or surgeries are the main treatment for diabetic retinopathy.
Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels.
- Focal laser photocoagulation is used to treat macular edema.
- Scatter laser treatment or panretinal photocoagulation treats a large area of your retina. Often two or more sessions are needed.
A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may also be used to repair retinal detachment.
Drugs that prevent abnormal blood vessels from growing, and corticosteroids injected into the eyeball are also being investigated as new treatments for diabetic retinopathy. If you cannot see well: