Diabetic retinopathy occurs when prolonged high blood sugar levels from diabetes cause damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). Left untreated, diabetic retinopathy can cause blindness. Here is an in-depth look at this condition, its causes, symptoms, diagnosis and treatment.
What is Diabetic Retinopathy?
Diabetic retinopathy refers specifically to changes in the retinal blood vessels caused by complications of diabetes over time. There are two main stages of diabetic retinopathy - non-proliferative and proliferative. In the early stages called non-proliferative retinopathy, microaneurysms (small areas of balloon-like swelling in the retina's tiny blood vessels) occur due to damage from high blood sugar. If remaining uncontrolled over many years, these changes can progress to more advanced stages.
The proliferative stage is the more severe form of diabetic retinopathy where new, abnormal blood vessels start to grow on the surface of the retina. This growth is the retina's misguided attempt to get more blood flow by forming new fragile vessels. However, these new vessels are abnormal and can easily rupture, leading to vision loss from bleeding or scarring in the eye. Proliferative diabetic retinopathy significantly increases the risk of blindness and vision loss if left untreated.
Risk Factors and Causes
Diabetes is the major risk factor for developing diabetic retinopathy, and the longer a person has diabetes, the higher the risk. Uncontrolled blood glucose levels over many years are what cause the damage to retinal blood vessels over time. Some other important risk factors include:
- Type 1 vs Type 2 diabetes: Type 1 diabetes has a higher risk since it is usually diagnosed during childhood years.
- Hypertension: High blood pressure further complicates diabetes and increases retinopathy risk.
- Kidney disease: Diabetic kidney disease or nephropathy goes hand in hand with higher retinopathy risk.
- Genetics: Some family history or genetic factors may play a minor role in disease risk as well.
- Pregnancy: Women with diabetes having babies without tight blood sugar control during pregnancy are at a particularly high risk.
The exact causes are multifactorial, but the main underlying mechanism is that high blood glucose levels damage the tiny blood vessels in the retina over many years, disrupting normal blood flow and oxygen exchange over time. This triggers the abnormal changes seen in both early and late stages of this condition.
Symptoms
Unfortunately, Diabetic Retinopathy usually does not cause symptoms in its early stages which makes it a silent threat to vision. This is because the retina itself does not contain pain receptors. By the time any vision changes occur, the condition may have progressed significantly already.
Some common warning signs of advancing diabetic retinopathy include:
- Blurry or impaired vision
- Difficulty seeing at night or in low light
- Seeing spots or flashes in the field of vision
- Difficulty with colors or color distortion
- Shadow or curtain effect over part of the visual field
Some people may also experience clouded or doubled vision if the eye develops swelling due to fluid leakage. These symptoms require urgent medical attention.
Screening and Diagnosis
Because diabetic retinopathy often shows no warning signs initially, regular comprehensive dilated eye exams are strongly recommended for all people with diabetes. During the exam, eye drops are used to dilate the pupil which allows the eye care provider to get a clear view of the retina using an ophthalmoscope or retinal camera. This assists in properly screening, diagnosing and staging any retinopathy that may be present.
Imaging tests like retinal photographs, optical coherence tomography (OCT) scans, and angiography (injection of dye to visualize blood vessels) may also be done during the exam to precisely diagnose and monitor changes in the retina over time. The examiner will look for signs like microaneurysms, retinal thickening, neovascularization, vitreous hemorrhage, etc., to diagnose and determine the severity and stage of the condition.
Treatment and Management
For non-proliferative or early diabetic retinopathy, the mainstay of treatment is tight control and monitoring of blood glucose, blood pressure, and cholesterol levels. Controlling all diabetes-related risk factors helps slow disease progression. Laser surgery may be used at this stage, called panretinal photocoagulation (PRP), to seal off leaky blood vessels before they worsen.
More advanced proliferative retinopathy usually requires immediate laser treatment (PRP) to seal leaking blood vessels before they cause serious vision loss from hemorrhaging. For cases with bleeding in the eye, vitrectomy surgery may be required to remove any blood clots and repair retinal detachments. Anti-VEGF (vascular endothelial growth factor) injections are another option to suppress abnormal blood vessel growth in more severe cases.
Post-treatment, people will need life-long follow ups every 3-6 months with dilated eye exams to monitor disease status and catch any signs of recurrence early. Good control of diabetes and associated conditions via medication, diet, exercise remain crucial for prevention as well as slowing progression once present. With early diagnosis and timely intervention, vision loss can often be prevented or minimized for many patients. However, consistent follow through with recommended care plans is key.
In summary, diabetic retinopathy is a serious microvascular complication of diabetes that can ultimately lead to blindness if left undiagnosed and untreated. Good diabetes self-management forms the mainstay of prevention, but annual retinal screening checkups allow for early detection before symptoms arise. Catching this "silent thief of sight" in the milder stages provides the best chance of successful intervention and vision preservation. With cooperation between patients, diabetes specialists and retina specialists, we can work to reduce rates of vision loss and blindness from this increasingly prevalent condition. Educating at-risk communities is vital for raising awareness about this threat to sight.
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