Diabetic retinopathy (DR), a complication caused by diabetes mellitus, is a serious eye condition that needs utmost care and treatment. If left untreated, it can lead to blindness. It is the leading cause of blindness, especially in the United States.

People with diabetes mellitus, or simply diabetes, have the inability to efficiently produce and effectively use insulin to control blood sugar (glucose) levels in their body. Having high sugar levels can cause damage to many parts of the body, including the eye – it damages the blood vessels in the retina which results in DR.

Having diabetes does not automatically equate to having DR. One third (1/3) of those estimated 285 million people having diabetes worldwide have DR. According to the Centers for Disease and Control and Prevention (CDC), about 90% of vision loss because of diabetes can be prevented if it is detected earlier and managed properly.

If you are a person with diabetes, knowing more about this condition will enable you to prepare, manage and most importantly be equipped with preventive measures in acquiring this condition. This article will talk about what you need to know about DR to get you started and help you with your journey to detecting and battling with it.

What is Diabetic Retinopathy?

Diabetic Retinopathy illustration

Diabetic retinopathy is an eye condition characterized by the damage (leaking, swelling, or closing off completely) of the blood vessels in the retina caused by uncontrolled high levels of sugar (glucose) in the body.  Aside from damaging the retina, it can also bring about new formations of abnormal blood vessels that may disrupt its function.

Retina plays a very important role in vision. It is the membrane that covers the back of the eye and is responsible for sensing light.  When light hits our eyes, the retina converts it into signals that is interpreted by the brain into visual images. So any damage in its blood vessels will greatly impact a person’s vision.

There are two types of diabetic retinopathy:

Type of DR

Severity Description

Symptoms

Non-proliferative Diabetic Retinopathy (NPDR)

Mild

This is the early stage of DR; the macula or the centre of the retina may experience the following:

  • Macular edema – the macula leaks that results in the swelling of the retina; the most common reason for vision loss
  • Macular ischemia – blood vessels in the retina close off thus blocking blood to reach the macula
  • Blurry vision
  • Changes from blurry to clear vision
  • Poor night vision
Proliferative Diabetic Retinopathy (PDR)

Severe

This is the advanced stage of DR; it happens when the retina starts to grow new blood vessels called neovascularization. This new blood vessels usually bleed into the vitreous, jelly-like substances in the middle of the eye. It can also cause scar tissues that may further lead to a detached retina.
  • Blurry vision
  • Changes from blurry to clear vision
  • Poor night vision
  • Seeing increasing numbers of floaters
  • Seeing dark areas in the field of vision
  • Poor night vision
  • Colours appear faded or washed

How is diabetic retinopathy diagnosed?

eye check up for diabetic retinopathy

It is strongly recommended that people with diabetes have regular eye checkups, once or twice a year. This will help in early detection of DR. It can be diagnosed in different ways by an ophthalmologist or an eye specialist. Here are some test or methods that may be used:

  • Comprehensive dilated eye exam – this is the most common and best method used to diagnose DR. This eye examination, the ophthalmologist will use eye drops that will help dilate your pupil. This will enable him/her to see better inside your eye. Photographs will be taken so he/she can check it for the following:
    • Abnormal growth of blood vessels
    • Abnormalities in the optic nerve
    • Swelling or blood in the retina
    • Bleeding in the vitreous gel
    • Scar tissues
    • Retinal detachment
    • Measure eye pressure
    • Evidence of cataracts

The drops used may leave a sting and in some cases, may make vision blurry but will eventually subside after several hours.

  • Fluorescein angiography – this test is used to determine if the blood vessel/s are blocked, with leaking fluid, and/or closed. This method also uses drops to dilate the pupil but a special dye, called fluorescein will be injected into the bloodstream. The dye, when circulating in the eye, will highlight the blood vessels in the eye so they can be photographed.
  • Optical Coherence Tomography (OCT) – This is a non-invasive imaging technique that is used to capture images of the retina. With this, the eye specialist will be able to see a cross-section or a 3D image of the retina that allows detection of early signs of many different eye condition including DR. Early detection also leads to early treatment, thus makes this method very promising in preparing for appropriate treatments.

How is diabetic retinopathy treated?

Treatment for diabetic retinopathy is on a case to case basis and will greatly depend on the severity of the patient’s case. The primary goal of the available treatments is to slow down the progression of the condition, and if your body is cooperative enough, it is also possible that progression will completely stop.

Non-proliferative Diabetic Retinopathy (NPDR) – Mild Severity

If you have been diagnosed with NPDR, there is no immediate need for treatments yet. Your eye specialist will, however, closely monitor your eyes to determine the progression rate and the possible treatments that can curtail this.

Aside from eye monitoring, you will be highly encouraged to consult with your endocrinologist and seek help on how to manage diabetes. If DR is still in mild, controlling your blood sugar levels may be all you need to slow down and eventually stop its progression.

Proliferative Diabetic Retinopathy (PDR) – Severe

If DR reaches the advanced stage, immediate action is required that your doctor may suggest surgery as treatment. These are some available surgical treatments for DR:

  • Photocoagulation – also known as focal laser treatment, is a type of laser treatment that aids in stopping or slowing down the leakage of blood and fluid in the eye. This surgery is usually done in the eye clinic and is only a one-time session. 

The procedure involves treating the leaks from abnormal blood vessels with laser burns. This surgery, however, may not be able to fully return your vision to normal especially when blurred vision is already experience pre-surgery. The goal of the surgery is to manage the condition and prevent it from worsening.

  • Panretinal photocoagulation – also known as scatter laser treatment, is also a type of laser treatment that can shrink the abnormal blood vessels. This surgery is usually done in the eye clinic and is recommended for two or more sessions.

The procedure involves treating the areas of the retina away from the macula with scattered laser burns. These burns shrink and scar the abnormal new blood vessels. Post-surgery, expect that vision will be blurry but will subside a day after. Other side effects include loss of peripheral vision and/or night vision.

  • VitrectomyThis surgery involves creating an incision in your eye to remove blood from the middle of the eye and scar tissues in the retina. Local anaesthesia will be administered before surgery proceeds.

Other treatments

Aside from surgery, your eye specialist may also let you try medications to help treat advanced DR. This medication involves injecting medicine into the vitreous in the eye. Such medications, called vascular endothelial growth factor (VEGF) inhibitors, help in stopping the growth of new blood vessels.  Anti-VEGF therapy may be recommended as a stand-alone treatment or in combination with pan-retinal photocoagulation.

These treatments only manage, either stops or slows down the progression of DR, and should not be expected as a cure. Since it is a complication of the condition diabetes, getting these treatments and surgeries but not finding ways to properly manage diabetes may still result in future vision loss. Diabetes is a lifelong condition and should be taken seriously to avoid acquiring and/or worsening of diabetic retinopathy.

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