Diabetic retinopathy is a condition that occurs in people having diabetes for longer period of time. Diabetes causes progressive damage to the retina, the light-sensitive lining at the back of the eye. This can be considered as one of the serious sight-threatening complications of diabetes. It occurs when tiny blood vessels in retina leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. It usually affects both eyes. Chronic Diabetic patients are prone to diabetic retinopathy. Diabetic retinopathy can cause blindness, if it is left untreated.
What causes Diabetic Retinopathy?
The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or bleed, which in turn distorts the vision. In its most advanced stage, new abnormal blood vessels increase in number on the surface of the retina, which can lead to scarring and cell loss in the retina.
Diabetic retinopathy may progress through four different stages:
- Mild non-proliferative retinopathy
- Moderate non-proliferative retinopathy
- Severe non-proliferative retinopathy
- Proliferative diabetic retinopathy
Who is at risk for Diabetic Retinopathy?
People with Type 1, Type 2 & Gestational Diabetes are at risk for diabetic retinopathy. Risk increases the longer a person has diabetes. Women who has Gestational diabetes may have rapid onset or worsening of diabetic retinopathy. Diabetic retinopathy usually affects both eyes. Risk of developing the eye condition can increase as a result of:
- Duration of diabetes — the longer the person has diabetes, the greater is the risk of developing diabetic retinopathy
- Poor control over blood sugar level
- High cholesterol
- High blood pressure
- Tobacco use
Diabetes Retinopathy Symptoms
The early stages of diabetic retinopathy usually have no symptoms. The disease often progresses unnoticed till the time it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots. These spots sometimes clear on their own. But without prompt treatment, bleeding often continues and increases the risk of permanent vision loss. Diabetic retinopathy symptoms may include:
- Spots or dark strings floating in vision
- Blurred vision
- Fluctuating vision
- Impaired color vision
- Having a dark or empty spot in the center of vision
- Vision loss
- Difficulty seeing well at night
How are Diabetic Retinopathy detected?
Diabetic retinopathy can be diagnosed through a comprehensive eye examination. These examinations mostly give emphasis on evaluating the retina and macula, may include:
- Patient history to determine vision difficulties, presence of diabetes, and other general health concerns that might affect vision
- Visual acuity measurements is to determine how much central vision has been affected
- Refraction test to determine if any refraction problem
- Evaluation of the ocular structures, which includes the evaluation of the retina through a dilated pupil
- Visual acuity testing is to measures a person’s ability to see at various distances.
- Tonometry is the test to measures pressure inside the eye.
- Optical coherence tomography (OCT) is similar to ultrasound but it uses light waves instead of sound. OCT provides detailed images of tissues that can be penetrated by light, such as the eye.
- Retinal photography or tomography to document current status of the retina
- In case of severe diabetic retinopathy, a fluorescein angiogram is used to look for damaged or leaky blood vessels. In this test, a fluorescent dye is injected into the bloodstream, through an arm vein. Pictures of the retinal blood vessels are taken as the dye reaches the eye.
A comprehensive dilated eye exam allows the doctor to check the retina for:
- Changes to blood vessels
- Leaking blood vessels
- Warning signs of leaky blood vessels, such as fatty deposits
- Damage to nerve tissue
- Changes in the lens
Prevention and Treatment
Treatment of diabetic retinopathy varies depending on the extent of the disease. People with diabetic retinopathy may need laser surgery to seal leaking blood vessels or to prevent other blood vessels from leaking. Your eye specialist might inject medications into the eye to decrease inflammation or stop the formation of new blood vessels. People with advanced cases might need to go through surgical procedure to remove and replace the gel-like fluid in the back of the eye. Surgery at times may also be needed to repair a retinal detachment. This procedure is separation of the light-receiving lining in the back of the eye.
If you are diabetic, you can help prevent or slow the development of diabetic retinopathy by:
- Taking your prescribed medication
- Sticking to your diet
- Exercising regularly
- Controlling high blood pressure
- Avoiding alcohol & smoking
How can people with diabetes protect their vision?
Vision lost due to diabetes retinopathy is sometimes irreversible. However, early detection and treatment can reduce the risk of vision loss by 95 percent. Because diabetes retinopathy often lacks early symptoms, people with diabetes should go for comprehensive dilated eye exam at least once a year. Women with gestational diabetes should have a comprehensive dilated eye exam as soon as possible. People with severe non-proliferative diabetic retinopathy have a high risk of developing proliferative diabetic retinopathy and may need a comprehensive dilated eye exam as often as every 2 to 4 months.
Studies have shown that controlling diabetes slows the onset and worsening of diabetes retinopathy. People who able manage their blood glucose level close to normal were significantly less likely than those without optimal glucose control to develop diabetic retinopathy, as well as kidney and nerve diseases. Some people have also shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss among people with diabetes.
Points to Remember
- Diabetic eye disease comprises of diabetes retinopathy, diabetic macular edema, cataract & glaucoma.
- All forms of diabetic eye disease have the potential to cause severe vision loss and blindness.
- In this case retinal blood vessels causes bleeding or leak fluid, distorting vision.
- Diabetes retinopathy is the most common cause of vision loss & a leading cause of blindness among working-age adults.
- DME is a consequence of diabetic retinopathy that causes swelling in the area of the retina called the macula.
- Controlling diabetes—by taking medications as prescribed, staying physically active, and maintaining a healthy diet—can prevent or delay vision loss.
- Because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.
- Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss.
- Diabetes Prevention & Management –Steps we can take
- Diabetes Risk Assessment
- Diagnostic Tests and Packages – Introduction to Diabetes Profile
- Living with Diabetes in India
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