Diabetic Retinopathy

What is Diabetic Retinopathy?

​​Diabetic retinopathy is an eye condition. It can cause vision loss and blindness in those with diabetes.

The condition affects blood vessels in the retina. This is the light-sensitive layer of tissue in the back of your eye.¹

If you have diabetes, it is essential to get a complete dilated eye exam at least once a year.

Diabetic retinopathy may not present any symptoms at first. However, finding it early can help you take steps to protect your eyesight.

Causes

Diabetic retinopathy occurs from high blood sugar due to diabetes.

Too much sugar in the blood can damage your retina. This is the part of your eye that detects light. It also sends signals to your brain through a nerve in the back of your eye.¹

Diabetes affects blood vessels all over the body.

The damage to your eyes begins when sugar affects the blood vessels that reach your retina. This causes them to leak fluid or bleed.

Your eyes grow new blood vessels to make up for the damaged ones. However, they do not work well. They can leak or bleed easily.

Who is at Risk for Diabetic Retinopathy?

Anyone with diabetes can get diabetic retinopathy.

The risk of developing the disease can increase due to:²

• Having diabetes for a while
• Poor control of your blood sugar level
• Pregnancy
• High blood pressure
• High cholesterol
• Tobacco use
• Being Black, Hispanic, or Native American

Symptoms

The early stages of diabetic retinopathy typically do not present any symptoms.

However, some people may begin to notice changes in their vision. For example, they may have trouble reading or seeing faraway objects.

These changes may come and go.

In the later stages of the condition, blood vessels in the retina begin to bleed into the vitreous. This is a gel-like fluid that fills your eye.

Potential symptoms of diabetic retinopathy include:²

• Dark spots or strings floating in your vision (floaters)
• Blurred vision
• Fluctuating vision
• Dark areas in your vision
• Vision loss

Sometimes the dark spots or strings can clear up on their own. However, it is essential to seek treatment immediately.

Without treatment, bleeding can occur again. It may worsen and cause scarring.

Complications

Diabetic retinopathy can cause the following vision and eye health complications:² 

1. Vitreous Hemorrhage

Diabetic retinopathy causes the growth of abnormal blood vessels in the retina. The abnormal blood vessels may bleed into the clear substance that fills the center of your eye. 

If the amount of bleeding is limited, you may only see a few floaters. In more severe cases, the blood can completely block your vision. 

Vitreous hemorrhage alone does not usually cause permanent vision loss. The blood usually clears from the eye within a few weeks or months. Your vision will likely return to its initial clarity.

2. Blindness

Diabetic retinopathy, glaucoma, macular edema, or a combination of these issues can result in complete vision loss. This is especially if the conditions are poorly managed.

All of these conditions are associated with diabetes.

3. Diabetic Macular Edema (DME) 

About one in 15 people with diabetes will develop DME.¹ DME occurs when blood vessels in the retina leak fluid into the macula. The macula is part of the retina. It is necessary for sharp, central vision. This leak causes blurry vision.

4. Neovascular Glaucoma

Diabetic retinopathy can cause abnormal blood vessels to develop in the retina. This blocks fluid from draining out of the eye and leads to neovascular glaucoma. Glaucoma refers to a group of eye diseases that cause vision loss and blindness.

5. Retinal Detachment

Diabetic retinopathy can cause scars to develop in the back of your eye. Tractional retinal detachment is when the scars pull your retina away from the back of your eye.

When to See an Eye Doctor 

Careful management of your diabetes is the most effective way to prevent vision loss.

If you have diabetes, visit your eye doctor annually for an eye exam with dilation. You should go even if your vision seems fine.²

Developing diabetes when pregnant can increase your risk of diabetic retinopathy. The same goes for having diabetes before becoming pregnant.

If you are pregnant, your eye doctor may suggest additional eye exams during pregnancy.

Speak to your doctor immediately if your vision changes suddenly or becomes:

• Blurry
• Spotty
• Hazy

How is Diabetic Retinopathy Diagnosed? 

Eye doctors can check for diabetic retinopathy during a dilated eye exam.

The eye exam is simple and painless. Your doctor will provide you with some eye drops to dilate your pupil. Then they will check your eyes for the condition and any other eye problems.

If you develop diabetic retinopathy, early treatment can stop the damage. This can prevent blindness.

If your eye doctor believes you may have severe diabetic retinopathy or DME, they may perform another test. This test is called a fluorescein angiogram. This allows the doctor to see pictures of the blood vessels in your retina and areas of fluid leakage.¹

Treatment Options

In the early stages of the condition, your eye doctor will likely just assess how your eyes are doing.

Some patients with diabetic retinopathy may require a complete dilated eye exam every two to four months.

In later stages, it is essential to begin treatment immediately. This is especially true if you notice changes in your vision.

Treatment can stop your vision from worsening and, in many cases, results in visual improvement.

It is also important to take steps to control your diabetes, blood pressure, and cholesterol.

Treatment options for diabetic retinopathy include:¹

• Injections. Medications called anti-VEGF drugs can slow down or reverse the condition. Other injections, called corticosteroids, can also help.
• Laser treatment. Eye doctors can use lasers to reduce swelling in your retina. This makes the blood vessels shrink and stop leaking.
• Eye surgery. If your retina is bleeding a lot or there are a lot of scars in your eye, your doctor may recommend vitrectomy surgery.

Prevention 

You cannot always prevent diabetic retinopathy.

However, the following can help prevent severe vision loss:

• Regular eye exams
• Proper control of your blood sugar and blood pressure
• Early intervention for vision problems

If you have diabetes, you can reduce your risk of developing diabetic retinopathy by doing the following:²

• Manage your diabetes. Make physical eating and healthy eating part of your daily routine. Try to complete at least 150 minutes of moderate aerobic activity each week. For example, walking.
• Take oral diabetes medicines or insulin as directed.
• Monitor your blood sugar levels. You may need to assess and record your blood sugar level several times a day, or more frequently if you are ill or feeling stressed. Ask your doctor how often you should test your blood sugar. You can also ask your doctor about a glycosylated hemoglobin test. This reflects your average blood sugar level for two to three months before the test.
• Keep your cholesterol and blood pressure under control. Eating a healthy diet, exercising regularly, and losing excess weight can help.
• Quit smoking. Smoking increases your risk of diabetes complications. This includes diabetic retinopathy.
• Pay attention to vision changes. Speak with your eye doctor immediately if your vision changes.

Remember, diabetes does not always lead to vision loss. Taking an active role in diabetes management can help prevent complications.