What is diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. A healthy retina is required for normal vision.
In the early stages of diabetic retinopathy, you may not notice changes to your vision. But diabetic retinopathy can be progressive, and is generally exacerbated with poor control of blood sugar.
Diabetic Retinopathy has four stages:
- Mild Non-proliferative Retinopathy.
At this stage dilation of small vessels occurs, causing thin walled out-pouchings that are prone to leakage. - Moderate Non-proliferative Retinopathy.
As disease progression continues, vessels become blocked, and begin to leak. - Severe Non-proliferative Retinopathy.
Increased blockage and leakage leads to deprivation of blood supply downstream. Swelling occurs and signals are released that encourage new blood vessel growth.
- Proliferative Retinopathy.
At this advanced stage, the retina begins to grow incompetent wispy vessels. These vessels are abnormal and fragile. They grow along the surface of retina and into the clear, vitreous cavity in the back of the eye.
In, and of themselves, these incompetent vessels do not cause symptoms or vision loss. However, they have very weak walls, and if and when they leak blood, severe vision loss and even blindness can result.
Who is at risk for diabetic retinopathy?
All people with diabetes, both early-onset and adult-onset, are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. Between 40 to 50 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during pregnancy.
Does diabetic retinopathy have any symptoms?
Diabetic retinopathy often has no early warning sings. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.
What are the symptoms of proliferative retinopathy if bleeding occurs?
At first, you may see small “floaters” specks of blood in your vision. Hemorrhages tend to happen progressively, often while sleeping. Occasionally, without treatment the spots may clear. However, bleeding can reoccur and cause severely blurred vision. If left untreated, proliferative retinopathy can cause severe vision loss and even blindness.
How are macular edema and diabetic retinopathy detected?
Macular edema and diabetic retinopathy are detected during a comprehensive eye exam that includes:
Visual Acuity Test. Eye chart test.
Dilated Eye Exam. Drops are used to widen the pupil and a thorough examination of the retina and optic nerve is possible. Signs include: Leaking blood vessels, retinal swelling, fatty deposits on the retina, damage to the retinal nerve fiber layer, and any changes to the tiny vasculature of the retina.
Fluorescein Angiography. A special dye is injected into your arm, and pictures are taken as the dye passes through the vessels of the retina. This allows easy identification of leaking vessels.
How is diabetic retinopathy managed?
During all stages of diabetes, strict blood sugar control is the corner stone to care.
How is macular edema treated?
Macular edema is treated with laser surgery. This procedure is called focal laser treatment. Small laser burns are placed in the area of retinal leakage and swelling. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session, although further treatment may be needed. If both eyes require laser treatment, generally only one eye will be treated at a time. Focal laser treatment reduces the risk of further vision loss by fifty percent.
How is proliferative retinopathy treated?
Proliferative retinopathy is treated with laser surgery. This surgery is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Nearly 1500 laser burns are placed in the peripheral retina. Generally two sessions are needed. Although some loss of vision may occur, scatter laser treatment can save central vision. Scatter laser treatment works best before the fragile vessels begin to bleed. Therefore, regular dilated exams are needed.
What is vitrectomy?
If bleeding occurs in the center of the eye (vitreous gel), surgery to remove the blood may be warranted. A vitrectomy is performed under local anesthesia, through small incision in the eye. A highly speed, precise cutting devise is used to remove, in small sections, the blood that has accumulated in the eye. Eye drops and protection will be needed after the surgery. Visual rehabilitation is dependent on the degree of retinopathy before surgery.