What is Diabetic Retinopathy?
Diabetic retinopathy refers to damage to the retina, which is the light-sensitive tissue at the back of the eye, caused by complications from diabetes. Over time, high blood sugar levels from diabetes can damage blood vessels in the retina. This can potentially lead to vision changes or even vision loss if diabetic retinopathy isn't properly managed and treated.
Types of Diabetic Retinopathy
There are two main types of diabetic retinopathy - non-proliferative and proliferative.
Non-Proliferative Diabetic Retinopathy
In the early stages of diabetic retinopathy, known as non-proliferative diabetic retinopathy (NPDR), microaneurysms may form in the retina. Microaneurysms are small bulges in the tiny blood vessels of the retina. As NPDR progresses, some blood vessels may become blocked, and new blood vessels may grow in the retina. This results in retinal swelling or fluid in the retina.
Proliferative Diabetic Retinopathy
More advanced Diabetic Retinopathy is called proliferative diabetic retinopathy (PDR). In PDR, an abnormal growth of new blood vessels, called neovascularization, develops on the surface of the retina and the optic disc. These new blood vessels are fragile and can easily rupture, causing vitreous or preretinal hemorrhage. If left untreated, PDR eventually leads to a retinal detachment or severe vision loss.
Risk Factors for Diabetic Retinopathy
The major risk factors for developing diabetic retinopathy include:
- Duration of diabetes - The longer a person lives with diabetes, the higher the risk for developing retinopathy. Nearly all people with type 1 diabetes and over 60% of people with type 2 diabetes have some stage of retinopathy after 20 years of living with the disease.
- Glycemic control - Poor blood sugar management, reflected in consistently elevated A1C levels, increases the risk and progression of retinopathy. Keeping blood sugar levels as close to normal as safely possible helps reduce the risk.
- Nephropathy - The presence of kidney disease, or nephropathy, from long-term diabetes greatly increases the risk of developing retinopathy.
- Hypertension - High blood pressure raises the risk. keeping blood pressure levels controlled is important for eye health.
- Pregnancy - Diabetic retinopathy can advance more rapidly in women with diabetes during pregnancy. Careful screening during pregnancy and postpartum is important.
- Smoking - Smoking cigarettes boosts the risk of developing diabetic eye disease and accelerates its progression.
Symptoms of Diabetic Retinopathy
In the early stages of diabetic retinopathy, there are usually no detectable symptoms or changes in vision. As the condition progresses, people may experience:
- Blurred vision
- Trouble seeing at night or in poor lighting
- Difficulty with color vision or contrast in images
- Spots or dark strings floating in the field of vision
- Difficulty reading or seeing fine details
- Distorted or enlarged image of objects
Screening and Diagnosis
All people with diabetes should receive a comprehensive dilated eye exam at least yearly from an ophthalmologist to check for any signs of retinopathy. The eye doctor will dilate the pupils and examine the retina using an ophthalmoscope or by taking photos of the retina. This allows early detection of changes to the retinal blood vessels and appearance of lesions before any vision symptoms develop.
Grading the Severity
During an eye exam, the ophthalmologist grades the severity of diabetic retinopathy based on standard photographs:
- No retinopathy
- Mild NPDR
- Moderate NPDR
- Severe NPDR
- PDR
- Clinically significant macular edema (CSME)
This staging helps the doctor determine how often follow up exams should occur. More frequent monitoring may be needed for higher levels of retinopathy or if changes are detected on exams. For some advanced cases, imaging such as optical coherence tomography may also be performed.
Treatment and Management
For non-proliferative retinopathy without macular edema, close monitoring with eye exams is usually sufficient.
Early treatment focuses on controlling blood sugar, blood pressure, and managing other cardiovascular risk factors. For more advanced cases, specific medical or laser eye treatments may be needed to prevent vision loss.
- Lasers can be used to seal leaking blood vessels and prevent further damage in cases of severe NPDR or PDR with vessels growing on the retina. Different types of lasers are used depending on the extent of retinopathy.
- For diabetic macular edema, intravitreal injections of anti-VEGF medications such as ranibizumab or aflibercept help shrink abnormal blood vessels and reduce swelling in the macula. Multiple injections over months may be needed.
- In some cases, a vitrectomy surgery to remove the vitreous gel may be performed if there is a vitreous hemorrhage or traction retinal detachment from severe PDR.
With early diagnosis and appropriate treatment guided by an ophthalmologist, diabetic retinopathy can often be managed effectively to preserve vision. However, staying on top of office visits, screening, and glycemic control is critical for reducing the risk of vision loss over time. Following the ophthalmologist's treatment plan closely also maximizes outcomes.
In summary, diabetic retinopathy can progress from mild non-proliferative changes to more severe proliferative disease involving retinal scarring and neovascularization if hyperglycemia is not properly controlled. With early detection and timely medical intervention upon progression, vision loss can frequently be prevented or minimized. Maintaining good diabetes self-management and adherence to eye care recommendations long-term remains key to protecting sight.
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