Diabetic Retinopathy

Diabetic Retinopathy

Diabetic Retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults under the age of 60. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye, and a healthy retina is necessary for good vision.

Who is at Risk for Diabetic Retinopathy?

People with diabetes – both type 1 and type 2 – are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer you have diabetes, the more likely you will develop Diabetic Retinopathy.

During pregnancy, Diabetic Retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

How to Protect Your Vision

• If you have diabetes, get a comprehensive dilated eye exam at least once a year.
• If you already have diabetic retinopathy, you may need an eye exam more often.
• Control your blood sugar. Better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much fewer kidney and nerve diseases. Better control also reduces the need for sight-saving laser surgery.
• Studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health, as well as help, protect your vision.

Stages of Diabetic Retinopathy

1. Mild non-proliferative retinopathy – At this earliest stage, micro-aneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels. Generally, there are no symptoms with this stage of retinopathy.
2. Moderate/severe non-proliferative retinopathy – This is a stage where the micro-aneurysms begin to leak fluid or exudates. This can impair a patient’s vision.
3. Severe non-proliferative retinopathy – In severe cases, many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
4. Proliferative retinopathy – As the disease progresses, some blood vessels that nourish the retina are blocked. At this stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called Proliferative Retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

How is Diabetic Retinopathy Treated?

During the early stages of Diabetic Retinopathy, no treatment is needed, unless you have macular edema. To help prevent the progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. The treatment for macular edema is with focal laser treatment and/or anti-VEGF injections.

Proliferative retinopathy is treated with laser surgery. This procedure is called Pan Retinal Photo Coagulation (PRPC). PRPC laser treatment helps to shrink the abnormal blood vessels. Two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, PRCP treatment can save the rest of your sight.

PRCP laser treatment works better for the fragile, new blood vessels that have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, PRCP treatment may still be possible, depending on the amount of bleeding.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy, which removes blood from the center of your eye. During your evaluation, your doctor will discuss any surgical options or treatments that may be necessary.