All about Diabetic Retinopathy - Symptoms, Causes, Stages (Non-Proliferative Diabetic Retinopathy, Proliferative Diabetic Retinopathy), Diagnosis, Treatment (Retina injections, Laser treatment, Vitrectomy)
What is Diabetic Retinopathy?
Diabetic Retinopathy is a complication of diabetes that affects the eyes. In Diabetic Retinopathy, high blood sugar levels cause damage to the blood vessels of Retina (the light-sensitive tissue at the back of the eye). These blood vessels can swell and leak or they can close, stopping blood from passing through. Sometimes abnormal new blood vessels grow on the Retina. All of these changes can adversely affect your vision. At first, Diabetic Retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness.
The condition can develop in anyone who has Type 1 or Type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop Diabetic Retinopathy.
If you are at risk of diabetes or have been diagnosed with the disease, it’s important to see your eye doctor for an annual comprehensive eye exam, even if your vision seems fine. Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy. Pregnancy may worsen diabetic retinopathy, so if you're pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy.
What are the symptoms of Diabetic Retinopathy?
Diabetic Retinopathy often has no symptoms in the early stages but as the condition progresses, you will notice symptoms such as:
Spots or floaters in your vision (floaters)
Impaired color vision (colors appear faded or washed out)
Dark or empty areas in your field of vision
Poor night vision
Diabetic retinopathy usually affects both eyes.
What are the different stages of Diabetic Retinopathy?
There are two main stages of diabetic retinopathy.
NPDR (Non-Proliferative Diabetic Retinopathy)
This is the early stage of diabetic eye disease. During this stage new blood vessels are not growing (hence the name Non-Proliferative). Many people with diabetes have it. Often no visual symptoms are present, but examination of the retina can reveal existence of the disease
During this stage, the walls of the blood vessels in your retina weaken. Tiny bulges called microaneurysms protrude from the vessel walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Also, tiny dot and blot hemorrhages may be seen. Larger retinal vessels can begin to dilate and become irregular in diameter, as well. NPDR can progress from mild to severe, as more blood vessels become blocked. Nerve fibers in the retina may begin to swell. Sometimes the central part of the retina (macula) begins to swell (macular edema), a condition that requires treatment.
PDR (Proliferative Diabetic Retinopathy)
Diabetic retinopathy can progress to this more severe type, known as Proliferative Diabetic Retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the Retina. These fragile new vessels often bleed into the clear, jelly-like substance that fills the center of your eye (vitreous). If they only bleed a little, you might see a few dark floaters. If they bleed a lot, it might block all vision.
Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of your eye and may need urgent retinal surgery
PDR is very serious and can steal both your central and peripheral (side) vision.
How is Diabetic Retinopathy diagnosed?
A comprehensive dilated eye exam is required to diagnose Diabetic retinopathy. Your eye doctor will look for signs of diabetic retinopathy such as
Abnormal blood vessels
Swelling, blood or fatty deposits in the retina
Growth of new blood vessels and scar tissue
Bleeding in the vitreous
Abnormalities in your optic nerve
Your doctor may do fluorescein angiography to see what is happening with your retina. Yellow dye (called fluorescein) 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. This shows if any blood vessels are blocked or leaking fluid. It also shows if any abnormal blood vessels are growing.
Your eye doctor may also do an Optical Coherence Tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working.
How is Diabetic Retinopathy treated?
Treatment depends on the type of diabetic retinopathy you have and how severe it is. Objective of the treatment is to slow or stop progression of the condition.
If you have mild or moderate non-proliferative diabetic retinopathy (NPDR), you may not need treatment immediately. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression of the disease. Sometimes, good sugar control can even bring some of your vision back. Your eye doctor will closely monitor your eyes to determine when you might need treatment.
If you have proliferative diabetic retinopathy (PDR) or macular edema, you may need prompt surgical treatment. It is important to understand that while surgery often slows or stops the progression of diabetic retinopathy, it is not a cure.
There are multiples surgical treatments available for Diabetic Retinopathy depending on the specific problems with your retina:
Retinal injections of anti-VEGF (vascular endothelial growth factor) medication such as Avastin, Eylea, and Accentrix/Lucentis. Anti-VEGF medication helps to reduce swelling of the macula, slowing vision loss and perhaps improving vision. Your doctor will recommend how many medication injections you will need over time.
Steroid injections or implants such as Ozurdex are other options to reduce macular swelling.
Laser surgery is another option which can help stop or slow the leakage of blood and fluid in the eye. This can reduce swelling of the retina. Laser surgery can also help shrink blood vessels and prevent them from growing again. Sometimes more than one treatment is needed.
If you have advanced PDR, your ophthalmologist may recommend surgery called Vitrectomy. In this procedure your ophthalmologist will make a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that's tugging on the retina. This allows light rays to focus properly on the retina again.
Even after treatment for diabetic retinopathy, you will need regular eye exams. Diabetes being a lifelong condition, future retinal damage and vision loss are still possible. At some point, additional treatment may be recommended.
How can we prevent Diabetic Retinopathy?
It is not always possible to prevent Diabetic Retinopathy, however, through regular eye exams and good control of your blood sugar and blood pressure, you can help prevent severe vision loss.
Have more questions about Diabetic Retinopathy? Schedule a consultation with our Specialist.
Disclaimer: All information, provided above is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Read our full disclaimer here.