What is Diabetic Retinopathy?

Diabetic retinopathy is a diabetes complication that affects the eyes. It is caused by damage to the blood vessels on a light-sensitive layer (retina) at the back of your eye. When blood sugar levels are high, these blood vessels can swell and leak. They can also shut down, stopping blood from passing through. Abnormal new blood vessels may grow on the retina and possibly bleed into the cavity of the eye. These changes can diminish your vision.

Stages of Diabetic Retinopathy

NPDR (Non-Proliferative Diabetic Retinopathy) This is the early stage of diabetic eye disease. Many people with diabetes have it. At this stage, your vision may or may not be affected by the changes on the retina.

PDR (Proliferative Diabetic Retinopathy) PDR is the more advanced stage of diabetic eye disease. It happens when the retina starts growing abnormal and fragile new blood vessels, that may often bleed into the jelly eye substance (vitreous). They may give you floaters or totally block your vision.

These new blood vessels can later form scar tissues. Scar tissues can cause problems with the macula or lead to a detached retina.

PDR is a serious condition, and can steal both your central and peripheral (side) vision.

Stages of Diabetic Retinopathy

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Who is at Risk?

People with all types of diabetes:

Risk of developing diabetic retinopathy can increase as a result of:

• Duration of diabetes — the longer you have diabetes, the greater the risk of developing diabetic retinopathy
• Poor control of blood sugar level
• High blood pressure
• Pregnancy
• High cholesterol
• Tobacco use

Signs and Symptoms

• Blurry vision
• Dark spots
• Floaters
• Poor night vision
• Vision that changes from blurry to clear

How Is Diabetic Retinopathy Diagnosed?

Your eye doctor will:

• Check your visual acuity
• Look for evidence of cataracts
• Measure your eye pressure
• Dilate your eyes

For this assessment, eyedrops are placed into your eyes to widen your pupils to allow your doctor better view inside your eyes. The drops may cause your near vision to blur until they wear o", several hours later.

During the assessment, your eye doctor will look for:

• 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

Ancillary tests such as OCT (Optical Coherence Tomography) & FFA (Fundus Fluorescein Angiography) may be done for finer details.

How to Prevent Diabetic Retinopathy

You cannot always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.

If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:

• Manage your diabetes well
• Eating healthy
• Physical activity
• Ideal weight
• Take oral diabetes medications or insulin as directed
• Keep your blood pressure and cholesterol under control
• Quit smoking permanently
• Pay attention to vision changes - blurry/spotty/hazy

Remember, diabetes does not necessarily lead to blindness. Taking an active role in diabetes management can help you save your vision and other diabetes-related complications.

How to Treat Diabetic Eye Diseases

Treatment

Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is aimed at slowing or stopping progression of the condition.

Early diabetic retinopathy

If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment.

Advanced diabetic retinopathy

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

Photocoagulation:

1. Focal: This targeted laser treatment, can stop or slow the leakage of blood and fluid in the eye. Focal laser treatment is usually done in your doctor's eye clinic in a single session.
2. Panretinal (PRP): 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 is 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.
3. Vitrectomy: This procedure uses a tiny incision in your eye to remove blood from the gel of the eye (vitreous) as well as scar tissue that's tugging on the retina. It is done in a surgery center or hospital using local or general anesthesia.
4. 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 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 panretinal photocoagulation.
   Surgery often slows or stops the progression of diabetic retinopathy, but it is not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss is still possible.

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