Diabetic retinopathy

Description

Diabetic retinopathy (die-uh-BET-ik ret-ih-NOP-uh-thee) is a diabetes complication that affects the eyes. It is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).

At first, diabetic retinopathy may cause no symptoms or only mild vision problems. But it can lead to blindness.

The condition can develop in anyone who has type 1 diabetes or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar level, the more likely you are to develop this eye complication.

Symptoms

You may not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, you may develop:

  • Spots or dark strings floating in your vision (floaters).
  • Blurred vision
  • Fluctuating vision
  • Dark or empty areas in your vision
  • The loss of vision

When to see a doctor

The management of diabetes care is the best way to prevent vision loss. If you have diabetes, see your eye doctor for an annual eye exam with dilation — even if your vision seems fine.

The development of diabetes during pregnancy (gestational diabetes) or have diabetes before becoming pregnant can increase your risk of diabetic retinopathy. If you are pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy.

Contact your eye doctor immediately if your vision changes suddenly or becomes blurry, spotty or hazy.

Causes

Over time, the excess of sugar in the blood can lead to the blockage of the small blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily.

There are two types of diabetic retinopathy:

  • Early diabetic retinopathy.In this most common form, called non-proliferative diabetic retinopathy (NPDR) — new blood vessels are not growing (proliferation). When you have non-proliferative diabetic retinopathy (NPDR), the walls of the blood vessels of the retina become weak. Tiny bulges protrude from the walls of the smaller vessels, sometimes the loss of fluid and blood into the retina. Great vessels of the retina may begin to dilate and become irregular in diameter as well.NPDRcan progress from mild to severe as more blood vessels are blocked. Sometimes damage to the blood vessels of the retina that leads to an accumulation of fluid (edema) in the central part (macula) of the retina. If the macular edema decreases the vision, the treatment is necessary to prevent permanent loss of vision.
  • Advanced diabetic retinopathy.Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damage of the blood vessels nearby, causing the growth of new abnormal blood vessels in the retina. These new vessels are fragile and can leak into the clear, jelly-like substance that fills the center of the eye (vitreous humor). Finally, the scar tissue from the growth of new blood vessels can cause detachment of the retina from the back of your eye. If the new blood vessels interfere with the normal flow of fluid from the eye, the pressure can increase in the eyeball. This buildup can damage the nerve that carries images from the eye to the brain (optic nerve), resulting in glaucoma.

Early diabetic retinopathy. In this most common form, called non-proliferative diabetic retinopathy (NPDR) — new blood vessels are not growing (proliferation).

When you have non-proliferative diabetic retinopathy (NPDR), the walls of the blood vessels of the retina become weak. Tiny bulges protrude from the walls of the smaller vessels, sometimes the loss of fluid and blood into the retina. Great vessels of the retina may begin to dilate and become irregular in diameter as well. NPDR can progress from mild to severe as more blood vessels are blocked.

Sometimes damage to the blood vessels of the retina that leads to an accumulation of fluid (edema) in the central part (macula) of the retina. If the macular edema decreases the vision, the treatment is necessary to prevent permanent loss of vision.

Advanced diabetic retinopathy. Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damage of the blood vessels nearby, causing the growth of new abnormal blood vessels in the retina. These new vessels are fragile and can leak into the clear, jelly-like substance that fills the center of the eye (vitreous humor).

Finally, the scar tissue from the growth of new blood vessels can cause detachment of the retina from the back of your eye. If the new blood vessels interfere with the normal flow of fluid from the eye, the pressure can increase in the eyeball. This buildup can damage the nerve that carries images from the eye to the brain (optic nerve), resulting in glaucoma.

Risk factors

Any person who has diabetes can develop diabetic retinopathy. The risk of developing the eye disease can increase as a result of:

  • Having diabetes for a long time
  • The lack of control of their blood sugar level
  • High blood pressure
  • High cholesterol
  • Pregnancy
  • The consumption of tobacco
  • Being Black, Hispanic or Native American

Complications

Diabetic retinopathy is the abnormal growth of the blood vessels in the retina. Complications can lead to serious eye problems:

  • The vitreous hemorrhage.The new blood vessels can bleed into the clear, jelly-like substance that fills the center of the eye. If the amount of bleeding is small, you may only see a couple of dark spots (floaters). In the most severe cases, blood can fill the vitreous cavity and completely block your vision. The vitreous hemorrhage, which by itself usually does not cause permanent loss of vision. The blood often disappears from the eyes within a couple of weeks or months. Unless your retina is damaged, your vision is likely to return to its former clarity.
  • The detachment of the retina. The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This can cause spots floating in your vision, flashes of light or loss of vision.
  • Glaucoma. New blood vessels can grow on the front of the eye (iris) and interfere with the normal flow of fluid from the eye, causing pressure in the eye to build. This pressure can damage the nerve that carries images from the eye to the brain (optic nerve).
  • Blindness. Diabetic retinopathy, macular edema, glaucoma, or a combination of these conditions may lead to complete loss of vision, especially if the conditions are poorly managed.

The vitreous hemorrhage. The new blood vessels can bleed into the clear, jelly-like substance that fills the center of the eye. If the amount of bleeding is small, you may only see a couple of dark spots (floaters). In the most severe cases, blood can fill the vitreous cavity and completely block your vision.

The vitreous hemorrhage, which by itself usually does not cause permanent loss of vision. The blood often disappears from the eyes within a couple of weeks or months. Unless your retina is damaged, your vision is likely to return to its former clarity.

Prevention

You can't always prevent diabetic retinopathy. However, regular eye exams, a good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent vision loss.

If you have diabetes, reduce the risk of developing diabetic retinopathy by doing the following:

  • Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Try to do at least 150 minutes of moderate aerobic activity, such as walking, every week. Take oral diabetes medications or insulin as directed.
  • Control your blood sugar level. You might need to check and record your blood sugar level several times a day or more often if you are ill or under stress. Ask your doctor how often you need to test your blood sugar.
  • Ask your doctor about a test of glycosylated hemoglobin. The glycosylated hemoglobin test, or hemoglobin A1C test reflects your average blood sugar level for two to three months before the test. To the majority of people with diabetes, the A1C goal is to be below 7%.
  • Keep your blood pressure and cholesterol under control. Eating healthy foods, exercising regularly and lose the excess weight can help. Sometimes medication is needed, too.
  • If you smoke or use other types of tobacco, ask your doctor to help you quit smoking. Smoking increases the risk of various complications of diabetes, such as diabetic retinopathy.
  • Pay attention to changes in the vision. Contact your eye doctor immediately if your vision changes suddenly or becomes blurry, spotty or hazy.

Remember, the diabetes does not necessarily lead to loss of vision. Take an active role in the management of diabetes can go a long way toward the prevention of complications.

Diabetic retinopathy

Diagnosis

Diabetic retinopathy is diagnosed with a comprehensive dilated eye exam. For this exam, drops placed in your eyes widen (dilate) your pupils to allow your doctor to better view inside your eyes. The drops may cause your close-up vision to blur until they wear off, several hours later.

During the exam, your eye doctor will look for abnormalities in the inner and outer parts of your eyes.

After your eyes are dilated, a dye is injected into a vein in your arm. Then, the photos are taken as the dye circulates through the eyes of blood vessels. The images can identify blood vessels that are closed, broken, or leaking.

With this test, images provide cross-sectional images of the retina that show the thickness of the retina. This will help determine the amount of liquid, if any, has been filtering in the retina of the tissues. Later, the optical coherence tomography (OCT) tests may be used to monitor how the treatment is working.

Treatment

The treatment, which largely depends on the type of diabetic retinopathy you have and how severe it is, is aimed to reduce the speed or stop the progression.

If you have mild or moderate non-proliferative diabetic retinopathy, you might not need treatment right away. However, your eye doctor close your eyes to determine if you need treatment.

Work with your diabetes doctor (endocrinologist) to determine if there are ways you can improve your diabetes control. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.

If you have proliferative retinopathy or macular edema, you will need prompt treatment. Depending on the specific problems of the retina, the options may include:

  • The injection of medications into the eye.These drugs, called vascular endothelial growth factor inhibitors, are injected into the vitreous humor of the eye. Help to stop the growth of new blood vessels and decrease the accumulation of fluid. Three medications approved by the Food and Drug Administration (FDA) for the treatment of diabetic macular edema — faricimab-svoa (Vabysmo), ranibizumab (Lucentis) and aflibercept (Eylea). A fourth drug, bevacizumab (Avastin), can be used off-label for the treatment of diabetic macular edema. These drugs are injected the use of topical anesthesia. Injections may cause mild discomfort, such as burning, tearing, or pain during 24 hours after injection. Possible side effects include a buildup of pressure in the eye, and infection. These injections must be repeated. In some cases, the drug is used with photocoagulation.
  • The photocoagulation.This laser treatment, also known as focal laser treatment, you can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns. Focal laser treatment is usually done in the doctor's office or eye clinic in a single session. If you had the blurred vision of macular edema before surgery, the treatment could not return to their normal vision, but is likely to reduce the possibility of worsening of macular edema.
  • Panretinal photocoagulation.This laser treatment, also known as a scatter laser treatment, you can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns that cause the abnormal new blood vessels to shrink and scar. It is usually done in the doctor's office or eye clinic in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.
  • The vitrectomy. This procedure uses a small incision in the eye to remove the blood from the center of the eye (the vitreous humour), as well as the scar tissue that is thrown in the retina. It is done in a surgery center, hospital or the use of local or general anesthesia.

The injection of medications into the eye. These drugs, called vascular endothelial growth factor inhibitors, are injected into the vitreous humor of the eye. Help to stop the growth of new blood vessels and decrease the accumulation of fluid.

Three medications approved by the Food and Drug Administration (FDA) for the treatment of diabetic macular edema — faricimab-svoa (Vabysmo), ranibizumab (Lucentis) and aflibercept (Eylea). A fourth drug, bevacizumab (Avastin), can be used off-label for the treatment of diabetic macular edema.

These drugs are injected the use of topical anesthesia. Injections may cause mild discomfort, such as burning, tearing, or pain during 24 hours after injection. Possible side effects include a buildup of pressure in the eye, and infection.

These injections must be repeated. In some cases, the drug is used with photocoagulation.

The photocoagulation. This laser treatment, also known as focal laser treatment, you can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns.

Focal laser treatment is usually done in the doctor's office or eye clinic in a single session. If you had the blurred vision of macular edema before surgery, the treatment could not return to their normal vision, but is likely to reduce the possibility of worsening of macular edema.

Panretinal photocoagulation. This laser treatment, also known as a scatter laser treatment, you can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns that cause the abnormal new blood vessels to shrink and scar.

It is usually done in the doctor's office or eye clinic in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.

While treatment can slow or halt the progression of diabetic retinopathy, it is not a cure. Given that diabetes is a condition for life, the future of retinal damage and loss of vision is still possible.

Even after treatment for diabetic retinopathy, you will need regular eye exams. At some point, you may need additional treatment.

Alternative medicine

Several alternative therapies have suggested some benefits for people with diabetic retinopathy, but more research is needed to understand whether these treatments are effective and safe.

Let your doctor know if you take supplements or herbs. You can interact with other medications or cause complications in the surgery, such as excessive bleeding.

It is vital not to delay the standard treatments to test therapies are not checked. Early treatment is the best way to prevent vision loss.

Coping and support

The thought that I could lose the view can be scary, and you may benefit from talking to a therapist, or find a support group. Ask your doctor for a referral.

If you've already lost the vision, ask your doctor about the low-vision products, such as magnifiers, and services that can make the daily life easier.

Preparing for your appointment

The American Diabetes Association (ADA) recommends that people with type 1 diabetes have an eye exam within five years of diagnosis. If you have type 2 diabetes, the American Diabetes Association (ADA) advises to get your initial eye exam at the time of diagnosis.

If there is no evidence of retinopathy in the initial review, the ADA recommends that people with diabetes get dilated and comprehensive eye exams at least every two years. If you have some degree of retinopathy, you will need eye exams at least once a year. Ask your eye doctor what he or she recommends.

The ADA recommends that women with diabetes have an eye exam before becoming pregnant or during the first trimester of pregnancy, and be followed closely during pregnancy and up to a year after giving birth. Pregnancy can sometimes cause diabetic retinopathy to develop or worsen.

Here's some information to help you prepare for your eye appointment.

What you can do

  • Write a brief summary of your diabetes history, even when they were diagnosed; medications taken for diabetes, now and in the past; the past average levels of sugar in blood; and his last couple of hemoglobin A1C readings, if known.
  • List of all the medicines, vitamins, and other supplements you are taking, including the dosage.
  • List of the symptoms, if any. Include those that may seem unrelated to your eyes.
  • Ask a family member or friend to go with you, if possible. Someone who accompanies you can help to remember the information that you receive. Also, because their eyes dilated, a partner can drive home.
  • List of questions for your doctor.

For diabetic retinopathy, questions to ask your doctor include:

  • How is that diabetes affect my vision?
  • I need other tests?
  • Is this condition temporary or long-term?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • I have other health conditions. How can I best manage them together?
  • If I can control my blood sugar, my eye symptoms improve?
  • What do my blood sugar goals should be to protect my eyes?
  • It may be recommended that services for people with visual disabilities?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your doctor may ask you questions, including:

  • Do you have any eye symptoms, such as blurred vision or floaters?
  • How long have you had symptoms?
  • In general, how to control your diabetes?
  • What was your last A1C?
  • Do you have other health conditions, such as high blood pressure or high cholesterol?
  • Has had eye surgery?
Symptoms and treatment of Diabetic retinopathy