Diabetic Retinopathy

Jai Ganesh · Yesterday 16:38:19

Diabetic Retinopathy

Gist

Diabetic retinopathy is a serious diabetes complication caused by high blood sugar damaging retinal blood vessels, potentially leading to blindness. It often shows no early symptoms but progresses from mild vision changes to severe, permanent vision loss. Treatment includes managing blood sugar, laser therapy, or injections to stop vessel leakage and growth.

Summary

Diabetic retinopathy (also known as diabetic eye disease) is a medical condition in which damage occurs to the retina due to diabetes. It is a leading cause of blindness in developed countries and one of the leading causes of sight loss in the world, even though there are many new therapies and improved treatments for helping people living with diabetes.

Diabetic retinopathy affects up to 80 percent of those who have had both type 1 and type 2 diabetes for 20 years or more. In at least 90% of new cases, progression to more aggressive forms of sight-threatening retinopathy and maculopathy could be reduced with proper treatment and monitoring of the eyes. The longer a person has diabetes, the higher their chances of developing diabetic retinopathy. Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness in people aged 20 to 64.

Signs and symptoms

Nearly all people with diabetes develop some degree of retina damage ("retinopathy") over several decades with the disease. For many, that damage can only be detected by a retinal exam, and has no noticeable effect on vision. Over time, progressive retinal damage may appear on a retinal exam, first with small bulges in retinal blood vessels called microaneurysms. Then larger abnormalities in retinal vessels: cotton wool spots, hemorrhages, lipid deposits called "hard exudates", intraretinal microvascular abnormalities, and abnormal-looking retinal veins. Eventually, many progress to a stage where new blood vessels grow throughout the retina. These new blood vessels often break and bleed. Minor bleeding can cause dark floating spots obstructing vision; major bleeding can completely block vision.

Around half of people with diabetic retinopathy develop swelling of the macula, called macular edema, which can begin at any time. If the swelling occurs near the center of the macula, it can cause vision disruptions ranging from mildly blurred vision to severe loss of the center of an affected person's visual field. Left untreated, around 30% of those with such swelling experience vision disruption over the next 3–5 years. Macular edema is the most common cause of vision loss in people with diabetic retinopathy.

The repeated processes of blood vessel growth, swelling, and scarring can eventually cause retinal detachment, which manifests as the sudden appearance of dark floating spots, flashes of light, or blurred vision.

Details:

What is diabetic retinopathy?

Diabetic retinopathy is a condition that occurs when diabetes affects the blood vessels and nerve tissue in the retina.

There are two stages of diabetic retinopathy:

Nonproliferative retinopathy is the early stage of the disease in which blood vessels swell and leak. In some cases, this can cause macular edema (swelling of the retina) which may result in mild vision loss but can be treated. There can also be early changes to the nerve cells in the retina that may affect vision, in part due loss of adequate blood supply.

Proliferative retinopathy is the advanced stage where abnormal new blood vessels grow on the surface of the retina. These vessels may break and bleed into the vitreous, the clear watery gel that fills the eye, and cause severe vision loss. This stage of diabetic retinopathy typically requires urgent treatment.

While diabetic retinopathy often cannot be completely prevented, you can reduce your risk of having it develop or progress. Controlling your blood sugar slows the start of retinopathy and prevents it from getting worse. It also lessens the need for laser surgery or other procedures that treat severe retinopathy.

What causes diabetic retinopathy?

Diabetic retinopathy is caused by changes in the blood vessels of the retina, the light-sensitive layer of tissue at the back of the inner eye. In some people with diabetic retinopathy, the blood vessels in the retina may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. These changes may result in severe vision loss.

Who is at risk for diabetic retinopathy?

Anyone with diabetes is at risk for diabetic retinopathy. The longer you have diabetes, the more likely you are to develop diabetic retinopathy. Your risk rises if you have diabetes and you also smoke, have high blood pressure, or are pregnant.

What are the symptoms of diabetic retinopathy?

In the early stages of diabetic retinopathy, you may have no symptoms and your vision may not change until the disease gets worse. When the disease progresses, you may have blurry or double vision, dark or floating spots, pain or pressure in one or both eyes, rings, flashing lights, or blank spots in your vision.

A condition called macular edema may occur from diabetic retinopathy. Macular edema occurs when the macula, the central part of the retina, swells from the leaking fluid and causes blurred vision. When new vessels grow on the surface of the retina, they can bleed into the eye and lead to a decrease in vision as well.

How is diabetic retinopathy diagnosed?

Your eye doctor may do the following tests, as well as a complete health history and eye exam, to diagnose diabetic retinopathy:

* Visual acuity test. The common eye chart test that measures central vision ability at various distances.
* Tonometry. A standard test that checks the pressure (intraocular pressure, or IOP) inside the eye.
* Pupil dilation. An examination where your pupil is widened with eye drops for a close-up of the eye’s lens and retina.
* Ophthalmoscopy. An examination where your doctor looks very closely at the retina using a special magnifying glass.
* Fluorescein angiography. A test where an organic dye is injected into the bloodstream to show the blood vessels in the eye. This occurs while pictures are taken with a special camera and will show your doctor if the blood vessels are leaking or no longer supplying areas of retina.
* Optical coherence tomography. A test where light waves are used to make detailed images of the retina.

How is diabetic retinopathy treated?

Treatment for diabetic retinopathy will depend on your symptoms, age and general health. It will also depend on how severe the condition is.

People with advanced retinopathy have a good chance of keeping their vision if they are treated before the retina becomes severely damaged. Treatment for diabetic retinopathy may include one or a combination of the following:

* Laser surgery. This is often used to treat proliferative retinopathy and sometimes macular edema. It involves shrinking the abnormal blood vessels, or sealing the leaking ones.
* Vitrectomy. Vitrectomy is a procedure that involves removing the jelly-like substance (vitreous) that fills the center of the eye. The vitreous is replaced with a balanced saline solution.
* Injections. Certain medications can be injected into the eye to slow the growth of the abnormal vessels of the retina and to treat macular edema.

Can diabetic retinopathy be prevented?

Although it can be challenging to prevent diabetic retinopathy, there are steps you can take to reduce the risk of it developing or progressing.

Get a diabetic eye exam once a year

An eye exam can help diagnose eye problems for treatment and can alert you and your health care provider if your diabetes needs to be better controlled. Women with diabetes should have an eye exam before pregnancy or in the first trimester. Continue to be monitored every trimester and for one year after birth depending on the severity of the retinopathy.

Follow your diabetes management plan

The following steps should be taken to maximize your treatment:

* Take medicines as directed.
* Use insulin as directed, if needed.
* Eat a healthy and balanced diet to manage blood sugar level.
* Exercise to lower and help the body use blood sugar.
* Test blood-sugar levels regularly.
* Test hemoglobin A1c levels regularly.
* Test urine for ketone levels regularly.
* Have regular health care follow-ups to evaluate diabetes control and rule out or treat other risk factors, such as high blood pressure.

Better control of blood sugar slows the onset and progression of retinopathy and lessens the need for laser surgery or other procedures for treating severe retinopathy.

Additional Information:

The Two Stages of Diabetic Eye Disease

There are two main stages of diabetic eye disease.

NPDR (non-proliferative diabetic retinopathy)

This is the early stage of diabetic eye disease and is caused by leaky blood vessels. Many people with diabetes have it.

With NPDR, tiny blood vessels leak, making the retina swell. When the macula swells, it is called macular edema. This is the most common reason why people with diabetes lose their vision. Sometimes tiny particles called exudates can form in the retina. These can affect your vision too.

When blood vessels close off, this is called macular ischemia. When that happens, blood cannot reach the macula.

If you have NPDR, your vision will be blurry.

PDR (proliferative diabetic retinopathy)

PDR is the more advanced stage of diabetic eye disease. It happens when the retina starts growing new blood vessels. This is called neovascularization. These fragile new vessels often bleed into the vitreous. If they only bleed a little, you might see a few dark floaters. If they bleed a lot, it might block all vision.

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

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

What Happens When You Have Diabetic Retinopathy?

You can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, you will notice symptoms such as:

* more floaters
* blurry vision
* vision that changes sometimes from blurry to clear
* blank or dark areas in your field of vision
* poor night vision
* colors appearing faded or washed out
* loss of vision

Diabetic retinopathy symptoms can affect both eyes.

Diabetic Retinopathy Diagnosis

Drops will be put in your eye to dilate (widen) your pupil. This allows your ophthalmologist to look through a special lens to see the inside of your eye.

Your doctor may do optical coherence tomography (OCT) to look closely at the retina. A machine scans the retina and provides detailed images of its thickness. This helps your doctor find and measure swelling of your macula.

Fluorescein angiography or OCT angiography helps your doctor see what is happening with the blood vessels in your retina. Fluorescein angiography uses a yellow dye called fluorescein, which is injected into a vein (usually in your arm). The dye travels through your blood vessels. A special camera takes photos of the retina as the dye travels throughout its blood vessels. It shows if any blood vessels are blocked or leaking fluid. It also shows if any abnormal blood vessels are growing. OCT angiography is a newer technique and does not need dye to look at the blood vessels. But it does not provide as much information as fluorescein angiography.

Can Diabetic Retinopathy Go Away?

Your treatment is based on what your ophthalmologist sees in your eyes. Treatment options may include:

* Medical control

Controlling your blood sugar and blood pressure can stop vision loss. Carefully follow the diet your nutritionist has recommended. Take the medicine your diabetes doctor prescribed for you. Sometimes, good sugar control can even bring some of your vision back. Controlling your blood pressure keeps your eye’s blood vessels healthy.

* Medicine

One class of medication is called anti-VEGF. These include Avastin, Eylea, and Lucentis. They help reduce swelling of the macula, slowing vision loss and perhaps improving vision. These drugs are given by injections (shots) in the eye. Steroid medicine is another option to reduce macular swelling. This is also given as injections in the eye. Your doctor will recommend how many medication injections you will need based on your response to treatment.

* Laser surgery

Laser surgery might be used to seal off leaking blood vessels. This can reduce swelling in the retina. Laser surgery can also help shrink blood vessels and prevent them from growing again. Often, more than one treatment is needed.

* Vitrectomy

If you have advanced PDR, your ophthalmologist may recommend surgery called vitrectomy. Your ophthalmologist removes vitreous gel and blood in the back of your eye. This allows light rays to focus properly on the retina again. Scar tissue also might be removed from the retina and laser may be used at the time of surgery.

5 Ways to Prevent Vision Loss from Diabetic Retinopathy

* If you have diabetes, talk with your primary care doctor about controlling your blood sugar. High blood sugar damages retinal blood vessels. That causes vision loss.
* Do you have high blood pressure or kidney problems? Ask your doctor about ways to manage and treat these problems.
* See your ophthalmologist regularly for dilated eye exams. Diabetic retinopathy may be found before you even notice any vision problems.
* If you notice vision changes in one or both eyes, call your ophthalmologist right away.
* Get treatment for diabetic retinopathy as soon as possible. This is the best way to prevent vision loss.

Do You Have Diabetes and Need an Eyeglasses Exam?

Changes in blood sugar levels can affect your vision. Make sure your blood sugar is under control for at least a week before an eye exam. Eyeglasses prescribed when your blood sugar levels are stable work best!

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Diabetic Retinopathy

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