Diabetic Retinopathy: Causes, Symptoms, Diagnosis and Treatment


Diabetic retinopathy is a form of eye disease caused by chronically high or variable blood sugar that is associated with diabetes.

    “When the small blood vessels of the retina become compromised due to several years of high blood sugars, diabetic retinopathy occurs,” explains Farah Khan, MD, a physician at UW Medicine’s Diabetes Institute and an assistant professor of medicine specializing in metabolism, endocrinology, and nutrition at the University of Washington School of Medicine in Seattle. “Retinopathy is the catch-all word that encompasses any sort of damage to the retina of the eyes, which is one of the deepest tissues of the eye.”

    If left untreated, diabetic retinopathy can lead to vision loss and blindness, so it’s important to get a comprehensive eye exam at least once a year if you have diabetes, according to the National Eye Institute. Getting treatment as early as possible, as well as taking steps to manage diabetes, can help prevent or delay vision problems.

    Diabetic Retinopathy

    Signs and Symptoms of Diabetic Retinopathy

    DR progresses through four stages, each of which is associated with different symptoms.

    In the early stages, DR often does not have noticeable symptoms, so the disease often goes undetected until it affects vision. (1)

    Bleeding from damaged blood vessels in the retina can cause you to see “floaters,” or spots that appear across your field of vision. Floaters sometimes clear on their own.

    The stages of diabetic retinopathy are:

    Mild nonproliferative diabetic retinopathy (NPDR) In this stage, small areas of balloon-like swelling — called microaneurysms — form in the retinal blood vessels and may leak fluid into the retina.

    Moderate NPDR As the disease progresses, blood vessels that provide important nourishment to the retina may swell and lose their ability to transport blood.

    During this stage, the appearance of the retina may change as a result of these symptoms. But these changes would only be visible to your eye doctor during a comprehensive eye exam.

    Untreated moderate NPDR may lead to diabetic macular edema, or swelling in the macular region of the retina, which can cause serious vision loss.

    Mild and moderate NPDR are sometimes grouped together as “early” DR.

    Severe NPDR In this stage, the blood supply to the retina is disrupted, leading to more damage in the blood vessels.

    Proliferative diabetic retinopathy (PDR) At this advanced stage of DR, the retina secretes growth factors (substances that stimulate cell growth) to generate new blood vessels.

    These new blood vessels grow along the inside surface of the retina as well as in the vitreous gel, the jelly-like fluid that fills the center of the eye.

    Because they’re fragile, these new blood vessels are more likely to leak and bleed, producing scar tissue that can shrink and lead to retinal detachment — the pulling away of the retina from underlying tissue.

    The following factors may also raise your risk of developing retinopathy:

    • Having high cholesterol levels
    • Having high blood pressure
    • Becoming pregnant
    • Smoking
    • Being African-American, Hispanic, or Native American

    How Is Diabetic Retinopathy Diagnosed?

    You’ll need to undergo a comprehensive eye exam to receive a diagnosis of diabetic retinopathy.

    Your pupils will be dilated with eye drops during the exam, to allow your doctor to better view the inside of your eyes.

    The drops used to dilate your pupils may cause you to experience blurry vision until they wear off, which may be several hours later.

    Your eye doctor will use several different instruments to examine your eyes and identify potential:

    • Damaged blood vessels
    • Blood or fatty deposits in the retina
    • New blood vessels along the inside lining of the retina
    • Scar tissue in the retina
    • Bleeding in the vitreous fluid
    • Retinal detachment
    • Optic nerve abnormalities
    To take pictures of your retinas, your doctor may use fluorescein angiography, which uses a special dye that is injected into your arm.

    Your doctor can use these photos of your retinas to identify damaged blood vessels.

    In addition, your eye doctor may:

    • Test your vision
    • Test you for glaucoma
    • Check for the presence of cataracts (a common age-related eye disease that causes vision loss)

    Duration of Diabetic Retinopathy

    There is no cure for diabetic retinopathy, but there is some hope for relief. “Mild levels of [diabetic retinopathy] can be treated with careful diabetes management,” says Rishi Singh, MD, a retina specialist at the Cleveland Clinic Cole Eye Institute in Ohio. This includes a proper diet, exercise, and possibly medication, including injectable insulin. “Medical management alone can cause some regression but only in the earliest stages.” But even if diabetic retinopathy is treated, future retinal damage and vision loss may occur, since diabetes is a lifelong condition.

    Tips for Aging Well With Diabetes

    If you have an earlier stage of diabetic retinopathy, treatment may not be needed right away and your doctor will monitor your eyes closely. Managing blood sugar appropriately can help slow or stop the progression of this eye disease.

    Treatment Options for Diabetic Retinopathy

    The longer diabetic retinopathy goes untreated, the greater your risk of permanent vision loss.

    If you have early or mild- to moderate NPDR, you may not need treatment immediately. Still, your eye doctor will probably want to monitor your condition closely with regular eye exams.

    A diagnosis of severe NPDR or PDR will most likely require immediate surgery.

    Because diabetes is a lifelong condition, additional retinal damage and vision loss are possible even after surgery. You should continue to get routine eye exams to monitor your condition.

    Also, ask your endocrinologist about ways to improve your diabetes management plan. Effective blood sugar control can usually slow the progression of mild- to moderate diabetic retinopathy.

    Surgery Options

    Surgical options for advanced diabetic retinopathy include:

    Injections into the eye Medications called vascular endothelial growth factor (VEGF) inhibitors can be used to help stop the growth of new blood vessels and improve vision. Most people who receive these injections will need to get them for at least three months. Over time, some people may need to get them less often or may no longer need them at all, but others will need to continue in order to protect their vision

    Focal laser surgery This surgery attempts to stop or reduce the leaking of blood or fluid into the eye by burning — and sealing — the damaged blood vessels.

    Also called photocoagulation, this is usually done in your doctor’s office as an outpatient procedure during a single session.

    The procedure may or may not restore your vision to normal, but it should prevent your condition from worsening.

    Scatter laser surgery This surgery uses lasers to burn the damaged blood vessels so that they shrink.

    This procedure may require more than one application, and your vision may be blurry for a day or more after each session.

    You may also experience loss of peripheral vision or night vision after the procedure.

    Vitrectomy This surgery involves making a tiny incision in the eye to remove blood from the vitreous fluid, as well as any scar tissue that may cause retinal detachment.

    Prevention of Diabetic Retinopathy

    The primary way to prevent diabetic retinopathy is to follow your prescribed diabetes treatment plan. Keeping your blood sugar within the goal range should help reduce your risk for not only diabetic retinopathy but also all types of diabetes-related complications.

    “Because diabetic retinopathy is essentially irreversible, it is very important to take care of your health to prevent it from happening in the first place,” Khan says. “Good blood sugar control is crucial to preventing long-term complications such as diabetic retinopathy.”

    The Centers for Disease Control and Prevention (CDC) recommends the following steps to keep your eyes healthy:

    • A healthy diet and regular physical activity can help control weight, blood sugar, blood pressure, and cholesterol, which can all reduce the risk of diabetic retinopathy.
    • Schedule an annual comprehensive dilated-eye exam if you have diabetes. This will help ensure any problems with your vision are caught early.
    • Quit smoking or if you don’t smoke, never start. Smoking cigarettes increases the risk of diabetes complications, including diabetic retinopathy.
    • Contact an eye doctor immediately if you notice any changes in your vision.

    Complications of Diabetic Retinopathy

    Complications of diabetic retinopathy can lead to serious vision problems, including:

    Vitreous hemorrhage This complication occurs when new blood vessels bleed into the vitreous fluid.

    Minor vitreous hemorrhage can cause you to see floaters. With severe vitreous hemorrhage, blood can fill the vitreous cavity and completely block your vision.

    This vision loss is temporary and usually clears within a few weeks or months, unless your retina is damaged.

    Retinal detachment This condition develops when damaged blood vessels form scar tissue, which pulls your retina away from the back of your eye.

    Retinal detachment can cause you to see floaters or flashes of light. If left untreated, it may lead to severe, permanent vision loss.

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