Diabetic Retinopathy






Can diabetes affect sight?

If you have diabetes mellitus, your body does not use and store sugar properly. High blood sugar levels can damage blood vessels in the retina and the nerve layer at the back of the eye. Such damage to retinal vessels is referred to as diabetic retinopathy.


Types of diabetic retinopathy

If you have diabetes mellitus, your body does not use and store sugar properly. High blood sugar levels can damage blood vessels in the retina and the nerve layer at the back of the eye. Such damage to retinal vessels is referred to as diabetic retinopathy.

There are two types of diabetic retinopathy:

  • Non Proliferative Diabetic Retinopathy (NPDR)
  • Proliferative diabetic retinopathy (PDR)

Non Proliferative Diabetic Retinopathy (NPDR)

Non Proliferative Diabetic Retinopathy (NPDR)



Proliferative diabetic retinopathy (PDR)

Proliferative diabetic retinopathy (PDR)



NPDR, commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or form deposits called exudates.

Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is because of macular edema (pronounced “eh-DEEM-uh”), macular ischemia (pronounced “ih-SKEE-me-uh”), or both.

Macular edema is the swelling or thickening of the macula, which is a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from the retinal blood vessels. It is the most common cause of visual loss in diabetes.

Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs when the macula does not receive sufficient blood supply to function. PDR is present when abnormal new vessels begin growing (neovascularization) on the surface of the retina or optic nerve. The main cause of PDR is the widespread closure of retinal blood vessels, preventing adequate blood flow. The retina responds by growing new blood vessels in an attempt to supply blood to the area where the original vessels have closed.

PDR causes visual loss in the following ways:

Vitreous hemorrhage. The fragile new vessels may bleed pouring their contents into the vitreous, which is the clear gel-like substance that fills the center of the eye. If the vitreous hemorrhage is small, a person might see only a few new dark floaters. A very large hemorrhage might block out all vision. It may take days, months, or even years to reabsorb the blood, depending on the amount of blood present. If the eye does not clear the vitreous blood adequately within a reasonable time, vitrectomy may be recommended.

Traction retinal detachment. When PDR is present, scar tissue associated with the neovascularization can shrink, causing the retina to wrinkle and pull away from its normal position. Macular wrinkling can cause visual distortion. More severe vision loss can occur if the macula or large areas of the retina are detached.

Neovascular glaucoma. Occasionally, extensive retinal vessel closure causes new, abnormal blood vessels to grow on the iris (colored part of the eye) and in the drainage channels in the front of the eye. This can block the normal flow of fluid out of the eye. Pressure in the eye builds up, resulting in neovascular glaucoma, a severe eye disease that causes damage to the optic nerve.

Unfortunately, the new abnormal blood vessels do not supply the retina with normal blood flow. The new vessels are often accompanied by scar tissue that may cause wrinkling or detachment of the retina. PDR may cause more severe vision loss than NDPR because it can affect both central and peripheral vision.


How is diabetic retinopathy diagnosed?

A medical eye examination is the best way to detect changes inside the eye. An ophthalmologist (eye M.D.) can often diagnose and treat serious retinopathy before you are aware of any vision problems. The ophthalmologist dilates your pupil and looks inside the eye with the help of special equipment and lenses. If your ophthalmologist diagnoses diabetic retinopathy, he/she may order color photographs of the retina or a special test called fluorescein angiography to determine whether you need treatment. In this fluorescein test, a dye is injected into your arm and photos of your eye are taken to detect where the fluid is leaking.


How is diabetic retinopathy treated?

The best treatment is to prevent the development of retinopathy as much as possible. Strict control of blood sugar will significantly reduce the long-term risk of vision loss in diabetic retinopathy. If high blood pressure and similar problems are present, they need to be treated.



Medical Treatment

Medical Treatment



Laser surgery

Laser surgery



Vitrectomy

Vitrectomy



Medical treatment. In certain cases, your eye M.D. may choose to treat your macular edema with injections of medicine in your eye. These special injections of medicine-called intravitreal injections-may be steroids or other medications. They are designed to shrink the swelling of the macula.

Laser surgery. Laser surgery is often recommended for people with macular edema, PDR, and neovascular glaucoma. For macular edema, the laser is focused on the damaged retina near the macula to decrease the fluid leakage.

For PDR, the laser is focused on all parts of the retina except the macula. This panretinal photocoagulation treatment causes the existent abnormal vessels to shrink and often prevents the growth of new abnormal vessels. It also decreases the risk of vitreous bleeding or retinal distortion.

This pan retinal photocoagulation treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur.

Vitrectomy. In advanced PDR, your ophthalmologist may recommend a vitrectomy. During this microsurgical procedure, which is performed in the operating room, the blood-filled vitreous is removed and replaced with a clear solution. Your ophthalmologist may refrain from a vitrectomy for several months to check if the blood clears on its own. Vitrectomy often prevents further bleeding by removing the abnormal vessels that caused the bleeding. If the retina is detached, it can be repaired during the vitrectomy. Surgery should usually be done early because macular distortion or traction retinal detachment causes permanent visual loss. The longer the macula is distorted or out of place, the more serious the vision loss will be.


Is vision loss largely preventable?

If you have diabetes, it is important to know that today, with improved methods of diagnosis and treatment, a smaller percentage of people who develop retinopathy have serious vision problems. Early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision by maintaining strict control of your blood sugar and visiting your ophthalmologist regularly.

When to schedule an examination?

People with diabetes should schedule an examination at least once a year. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy. Pregnant women with diabetes should schedule an appointment in the first trimester, because retinopathy can progress quickly during pregnancy. If you need to be examined for eyeglasses, it is important that your blood sugar is consistently under control several days before you see your ophthalmologist. Eyeglasses that work well when blood sugar is out of control will not work well when blood sugar is stable. Rapid changes in blood sugar can cause fluctuating vision in both eyes, even if retinopathy is not present. You should have your eyes checked promptly if you have visual changes that

  • affect either one or both eyes,
  • last more than a few days, and
  • are not associated with a change in blood sugar.

When you are first diagnosed with diabetes, you should have your eyes checked.


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