Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging retina.
The risk factors for diabetic retinopathy include:
- Type 1 diabetes or type 2 diabetes
- Poorly managed diabetes
- Long standing hypertension
- High cholesterol levels
- Asian or Afro-Caribbean background
Symptoms of Diabetic Retinopathy
You won’t usually notice diabetic retinopathy in the early stages, as it doesn’t tend to have any obvious symptoms until it is more advanced. Symptoms that could be present are:
- gradual worsening of vision
- sudden vision loss
- shapes floating in your field of vision (floaters)
- blurred or patchy vision
- eye pain or redness
Types of Diabetic Retinopathy
Diabetic retinopathy is classified into two types.
Non-proliferative Diabetic Retinopathy (NPDR)
Non-proliferative diabetic retinopathy (NPDR) is the early stage of the disease in which symptoms will be mild or nonexistent. In NPDR, the blood vessels in the retina are weakened resulting in microaneurysms leaking fluid into the retina. This leakage may lead to swelling of the macula.
Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease. At this stage, circulation problems deprive the retina of oxygen. This results in neovascularizaion which is the process where new fragile blood vessels begin to grow in the retina and into the vitreous. Other signs are hemorrhages, formation of soft and hard exudates .
Complications of PDR include:
- Retinal detachment due to scar tissue formation and the development of glaucoma. In PDR, new blood vessels grow into the area of the eye that drains fluid from the eye. This greatly raises the eye pressure, which damages the optic nerve.
- Persistent Intragel vitreous hemorrhage
- Opaque membranes over the macula
- Rubeosis Iridis: abnormal blood vessels on the iris.
If left untreated, PDR can cause severe vision loss and blindness.
Diagnosis of Diabetic Retinopathy
Diabetic retinopathy can be diagnosed through a comprehensive eye examination. Testing, with emphasis on evaluating the retina and macula, may include:
- Patient history to determine vision difficulties, presence of diabetes, and other general health concerns that may be affecting vision.
- Visual acuity measurements to determine how much central vision has been affected.
- Refraction to determine if a new eyeglass prescription is needed.
- Evaluation of the ocular structures, including the evaluation of the retina through a dilated pupil.
- Measurement of the pressure within the eye.
Supplemental testing may include:
- Retinal photography or tomography to document the current status of the retina.
- Fluorescein angiography to evaluate abnormal blood vessel growth.
If you’re in a nonproliferative stage but experience some eye damage, treatment options might include:
- Laser surgery: Also called photocoagulation, this reduces the drive for abnormal blood vessels and swelling in the retina.
- Eye medications. A steroid injection in the eye can stop inflammation and prevent the formation of new blood vessels. Also anti-VEGF medication which can reduce macular edema.
For proliferative diabetic retinopathy, vitrectomy is the treatment option. This surgery treats problems with the retina and vitreous. The surgery can remove scar tissue, blood or fluid, and some of the vitreous gel so light rays can focus properly on the retina. At the same time, traction in the retina or retinal detachments can be corrected.