• Diabetic Retinopathy

    Definition

    Retinopathy is damage to the thin layer of tissue in the back of the eye called the retina. Diabetic retinopathy is damage to the blood vessels in the retina caused by Type 1 or Type 2 diabetes.
    There are 2 types of diabetic retinopathy:
    • Non-proliferative diabetic retinopathy—fluid from weakened blood vessels in the retina may leak into the retina and result in swelling of the macula, which is responsible for clear central vision
    • Proliferative diabetic retinopathy—the retina becomes deprived of oxygen and new blood vessels form in the retina and in the fluid in the back of the eye, which can cause leaking and cloudy vision, and possible detachment of the retina
    The Retina
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Diabetes causes high levels of glucose in the blood. Over time, this excess glucose can cause damage to small blood vessels throughout the body. The blood vessels in the retina are sensitive to this type of damage.
    High glucose can cause the blood vessels in the retina to swell, leak, or close off. The damaged blood vessels may then be replaced with weaker blood vessels that also bleed into the eye or create scarring. The bleeding, swelling, and scarring can weaken or interfere with vision.

    Risk Factors

    Diabetic retinopathy is more common in people of African American, Hispanic, and south Asian descent.
    Factors that may increase your risk of diabetic retinopathy include:
    • Being diagnosed with diabetes at a young age
    • Poorly-controlled diabetes
    • Elevated cholesterol levels
    • Pregnancy
    • Recent cataract surgery
    • High blood pressure

    Symptoms

    Early diabetic retinopathy may not cause any symptoms. Over time, diabetic retinopathy can cause:
    • Blurred or double vision
    • Reduction or loss of vision in one or both eyes
    • Dark spots or the appearance of floating objects in one or both eyes
    • Eye pressure or pain
    • Difficulty seeing in dim light
    • Seeing flashing lights or rings around lights
    • Sudden blindness (rare)

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. You will be referred to an eye specialist. A comprehensive eye exam and vision test will be done.
    Images will be taken of your eye after dilation of your pupils. This can be done with:
    • Fundus photography—an advanced digital photo of the retina
    • Optical coherence tomography—light waves are used to take pictures of the retina

    Treatment

    Early stages of the disease may not require eye treatment but management of blood glucose, cholesterol levels, and blood pressure will help slow or stop damage. Your doctor will monitor your condition.
    Talk with your doctor about the best treatment plan for you.

    Managing Diabetes

    Proper management of blood glucose levels can help slow or stop damage in the eye. Management can include:
    • Following a diet to control your blood glucose
    • Maintaining a healthy weight
    • Exercising regularly
    • Regularly testing your blood glucose levels

    Medications

    Your eye doctor may advise medications to reduce the damage to your eye such as:
    • Anti-vascular endothelial growth factor injections into your eye to improve oxygen levels in the retina tissue
    • Steroid injection into the eye to slow inflammation and damage

    Surgery

    In some cases, surgery may be recommended to help slow or stop the progression on the retinopathy. Surgical treatments may include:
    • Laser treatment—a laser is used to shrink abnormal blood vessels or to stop or slow leaks
    • Vitrectomy—blood vessels and/or scar tissue are removed from the middle of the eye (vitreous) and replaced with a clear solution

    Prevention

    To help reduce your chance of getting diabetic retinopathy:
    • Manage your diabetes.
    • Monitor your blood glucose levels.
    • Have regular blood glucose testing done as advised by your doctor.
    • Manage your blood pressure and cholesterol levels.
    • If you smoke, talk to your doctor about ways to quit.
    • Have your eyes examined as advised by your eye specialist.

    RESOURCES

    American Diabetes Association http://www.diabetes.org

    American Optometric Association http://www.aoa.org

    CANADIAN RESOURCES

    Canadian Ophthalmological Society http://www.cos-sco.ca

    Health Canada http://www.cos-sco-ca

    References

    Diabetic retinopathy. American Optometric Association website. Available at: http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy?sso=y. Accessed August 24, 2017.

    Diabetic retinopathy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116611/Diabetic-retinopathy. Updated February 7, 2017. Accessed August 24, 2017.

    Diabetic retinopathy. University of Michigan Kellogg Eye Center website. Available at: http://www.kellogg.umich.edu/patientcare/conditions/diabetic.retinopathy.html. Accessed August 24, 2017.

    Facts about diabetic retinopathy. National Eye Institute website. Available at: https://nei.nih.gov/health/diabetic/retinopathy. Updated September 2015. Accessed August 24, 2017.

    What is diabetic retinopathy? Eye Smart—American Academy of Ophthalmology website. Available at: http://www.geteyesmart.org/eyesmart/diseases/diabetic-retinopathy/index.cfm. Updated March 1, 2017. Accessed August 24, 2017.

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