Diabetic retinopathy is a leading cause of blindness in American adults. Changes in the blood vessels of the retina, the light sensitive layer of tissue at the back of the inner eye, can lead to this condition. In some people, retinal blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.
While you can’t completely avoid diabetic retinopathy, you can reduce your risk of developing it. Better control of blood sugar slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.
Diabetic eye disease refers to a group of eye problems that people with diabetes may face. All can cause severe vision loss or even blindness. Fortunately, diabetic eye disease often can be treated before vision loss occurs. All people with diabetes need a dilated eye exam at least once a year.
Diabetic eye diseases include:
- Diabetic retinopathy
Diabetic retinopathy is the most common eye disease in people with diabetes.
Changes in the blood vessels of the retina cause diabetic retinopathy. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.
Anyone with diabetes is at risk for diabetic retinopathy. The longer you have diabetes, the more likely you are to develop diabetic retinopathy.
In the early stages of diabetic retinopathy, you may have no symptoms. Vision may not change until the disease progresses. Then 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 as a consequence of diabetic retinopathy. It happens when the macula, a 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 (hemorrhage) into the eye, which may decrease vision.
Along with a complete medical history and eye exam, your eye care professional may do the following tests to diagnose diabetic retinopathy:
- Visual acuity test. This is the common eye chart test. It measures vision ability at various distances.
- Tonometry. This standard test is done to determine the pressure (intraocular pressure, or IOP) inside the eye.
- Pupil dilation. For a close up exam of the eye’s lens and retina, the pupil is widened with eye drops.
- Ophthalmoscopy. This is a test in which a doctor looks very closely at the retina using a special magnifying glass.
- Fluorescein angiography. In this test, a dye is injected into the bloodstream. The dye helps the blood vessels in the eye show up while pictures are taken with a special camera. This test lets the doctor see if the blood vessels are leaking.
- Optical coherence tomography. In this test, light waves are used to make detailed images of the retina.
Your healthcare provider will figure out the best treatment based on:
- How old you are
- Your overall health and medical history
- How well you can handle specific medicines, procedures, or therapies
- Your opinion or preference
Even people with advanced retinopathy have a good chance of keeping their vision if they seek treatment before the retina becomes severely damaged. Treatment for diabetic retinopathy may include:
- Laser surgery. This is often used to treat macular edema and proliferative retinopathy. It involves shrinking the abnormal blood vessels, or sealing the leaking ones.
- Vitrectomy. Vitrectomy is a procedure that involves removing the cloudy vitreous (the clear, jelly-like substance that fills the center of the eye) and replacing it with a saline solution.
- Injections. Certain chemicals can be injected into the eye to decrease the growth of the abnormal vessels of the retina.
Although you can't prevent diabetic retinopathy, you can reduce the risk of developing by:
- Having a dilated eye exam once a year. An eye exam does not prevent retinopathy, but it can help diagnose eye problems that can then be treated. An eye exam can also alert you and your healthcare provider if the diabetes needs to be better controlled.
Following your diabetes management plan by:
- Taking medicines as directed
- Using insulin as directed, if needed
- Eating to manage blood sugar level
- Exercising to lower and help the body use blood sugar
- Testing blood-sugar levels regularly
- Testing urine for ketone levels regularly
- Regular healthcare follow-up 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 for severe retinopathy.
- Changes in the blood vessels of the retina cause diabetic retinopathy. Retinal blood vessels may swell and leak fluid or new blood vessels may grow on the surface of the retina. These changes may result in vision loss or blindness.
- Anyone with diabetes is at risk for diabetic retinopathy. The longer you have diabetes, the more likely you are to develop diabetic retinopathy.
- Treatment for diabetic retinopathy may include laser surgery and vitrectomy (removing the jelly-like substance from the center of the eye and replacing it with a saline solution).
- Better control of blood sugar slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
January 16, 2018
Prevention and Treatment of Diabetic Retinopathy, Up To Date
Hurd, Robert, MD,Sather, Rita, RN