What is Diabetic Retinopathy?

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Diabetic Retinopathy

People with diabetes are often suggested to get their vision checked at least once a year. Well, that’s if they want to rule out Diabetic Retinopathy (DR)

Diabetic Retinopathy is an eye complication caused by type 1 or type 2 diabetes. 

It injures the blood vessels within the retinal tissue, which is responsible for converting light into signals that could be interpreted by the brain. 

As a result of this damage, the vision distorts. 

People with prolonged diabetes are at a higher risk of falling victim to this eye condition. The longer a person has uncontrolled blood sugar, the higher are his or her chances of forming ocular issues. 

DR is marked as the leading cause of blindness across the United States. 

Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness.

Worldwide, one-third of the estimated 285 million Trusted Source people with diabetes show signs of DR.

Signs and Symptoms

Diabetic retinopathy does not come with early warning signs. 

It occurs in two stages. The first stage – non-proliferative diabetic retinopathy (NPDR) shows no indicators and the patients may have 20/20 vision. Whereas the second stage comes when new abnormal blood vessels start to form at the back of the eye as part of proliferative diabetic retinopathy (PDR).

Most noticeable symptoms in the progressive stage of DR are as follows; 

  • Floaters, or transparent and colorless spots and dark hooks that float in the field of vision
  • Patches or streaks that block the vision
  • Blurred vision
  • Impaired color vision
  • Occurrence of Dark or empty areas in the vision
  • poor night vision
  • sudden and total loss of vision

Diabetic retinopathy usually affects both eyes. The only way diabetic patients can avoid DR from reaching an advanced stage is by taking regular eye examinations as suggested by the doctor. 

Risk Factors

Risk of developing Diabetic Retinopathy can accelerate as a result of:

  • Prolonged diabetes — the longer you have diabetes, the greater your risk      of developing diabetic retinopathy.
  • Uncontrolled blood sugar levels
  • High blood pressure
  • High cholesterol
  • Pregnancy
  • Tobacco use

Prevention

In most cases of people with diabetes, Diabetic Retinopathy is an inevitable complication. However, patients with diabetes who successfully maintain their blood sugar levels at normal can save themselves. 

Hypertension is another contributing factor for Diabetic Retinopathy. Patients with diabetes need to control their blood pressure by:

  • Eating a healthy and balanced diet
  • Regularly exercising
  • Maintaining a healthy body weight
  • Quitting smoking 
  • Strictly controlling alcohol intake
  • Taking any antihypertensive measures according to their doctor’s instructions
  • Attending regular screenings

Early detection of symptoms increases the effectiveness of the treatment.

Diagnosis 

The Diagnosis of Diabetic Retinopathy is relatively simple and comprehensive. It involves the use of drops in your eyes that widen the pupils and allow the doctor a better view inside your eyes. The eye drops may blur your close vision until they wear off, several hours later. 

This dilated eye exam helps the doctor look for the following things; 

  • Abnormal blood vessels
  • Swelling, blood or fatty deposits in the retina
  • Growth of new blood vessels and scar tissue
  • Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)
  • Retinal detachment
  • Abnormalities in your optic nerve

In addition, your eye doctor may:

  • Test your vision
  • Measure your eye pressure to test for glaucoma
  • Look for evidence of cataracts

Fluorescein angiography

Fluorescein angiography is a medical procedure conducted in a way that the doctor takes images inside your eye with your pupils dilated. A fluorescent dye is injected into the bloodstream that highlights the closed or broken down blood vessels in the back of the eye so they can be photographed.

This test is often used to diagnose ocular disorders. 

Optical coherence tomography

Optical coherence tomography (OCT) is yet another non-invasive imaging test that your doctor may request for the diagnosis of Diabetic Retinopathy. OCT uses light waves to capture cross-section images of your retina. This test is mainly conducted to find out the thickness of the retina and determine whether fluid has leaked into retinal tissue as a result of DR. 

In the later stages of diagnosis, OCT exams are used to monitor the success of treatment.

Treatment

Once Diabetic Retinopathy has been diagnosed and the stage or intensity has been determined, the treatment begins. However, the treatment largely depends on the type of DR and it’s severity.

Early diabetic retinopathy

If you have mild or moderate nonproliferative diabetic retinopathy (NPDR)  which has already been discussed above, you may not need any treatment right away. However, your doctor may conduct closely monitored eye exams to determine when you might need the treatment.

In most cases of moderate DR, maintaining good blood sugar slows the progression of this complication.

Laser photocoagulation

Photocoagulation

This laser treatment, also known as focal laser treatment, 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 your doctor’s office or eye clinic in a single session. If you had blurred vision from macular edema before surgery, the treatment might not return your vision to normal, but it’s likely to reduce the chance of your macular edema getting worse.

Medication 

Although, you should take only those medicines that are prescribed to you by your doctor, but generally there are 3 common drugs that your eye doctor may prescribe. 

Eylea

This is new and long-lasting and is likely to be the best for the moment.

Avastin

  • Many diseases of the eye, such as age-related macular degeneration (AMD) and diabetic retinopathy, damage the retina and result in blindness when blood vessels around the retina show abnormal growth and leak fluid. This abnormal growth is caused by VEGF and Avastin has proven to successfully slow this abnormal growth. 

Lucentis

  • A popular drug. It reduces macular edema and proliferation (blood vessel growth) in diabetic retinopathy, but their effect usually wears off. To keep good sight in the long term, diabetes and blood pressure (BP) must be controlled: the drugs are very useful for use whilst patients are trying to control their diabetes and BP

The risk of anti-VEGF treatment is small with a chance of 1/1000 serious infections.

There are small risks of other less serious problems as well, such as cataract and retinal tears.

Several medications are indicated for the treatment of diabetic retinopathy. At present, these medications are administered into the eye by intravitreal injection.

Triamcinolone

  • Triamcinolone is a long-acting steroid preparation. When injected in the vitreous cavity, it decreases the macular edema (thickening of the retina at the macula) caused due to diabetic maculopathy and results in an increase in visual acuity. The effect of triamcinolone is transient, lasting up to three months, which necessitates repeated injections for maintaining the beneficial effect.

Be sure to let your doctor know if you are taking any herbs or supplements. They have the potential to interact with other medications or cause complications in surgery, such as excessive bleeding.

Surgery 

Advanced diabetic retinopathy

If you have proliferative diabetic retinopathy or macular edema, you’ll need prompt surgical treatment. Depending on the specific problems with your retina, options may include:

Panretinal photocoagulation.

  • This laser treatment, also known as scatter laser treatment, 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 cause the abnormal new blood vessels to shrink and scar.
    It’s usually done in your 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.

Vitrectomy.

  • This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that’s tugging on the retina. It’s done in a surgery center or hospital using local or general anesthesia.

Injecting medicine into the eye.

  • Your doctor may suggest injecting medication into the vitreous in the eye. These medications, called vascular endothelial growth factor (VEGF) inhibitors, may help stop the growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels.
  • Your doctor may recommend these medications, also called anti-VEGF therapy, as a stand-alone treatment or in combination with pan-retinal photocoagulation. While studies of anti-VEGF therapy in the treatment of diabetic retinopathy are promising, this approach is not yet considered standard.
  • Surgery often slows or stops the progression of diabetic retinopathy, but it’s not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.

Even after treatment for diabetic retinopathy, you’ll need regular eye exams. At some point, additional treatment may be recommended.


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