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Diabetic Retinopathy – A Brief Overview

Diabetic retinopathy is an eye disease triggered by type 1 or type 2 diabetes. The longer one has diabetes, the more likely they are to develop diabetic retinopathy. For diabetic individuals, it is the most common cause of vision loss. 

Diabetic retinopathy occurs due to long-term damage of blood vessels within the retina. Overtime, this recurring damage can lead to floaters, blurry patches, or blindspots which all impair vision and may eventually lead to blindness. Not everyone with diabetes will develop diabetic retinopathy. With careful management of the blood sugar related disease, risk of this eye disease can be mitigated as well. 

Causes of diabetic retinopathy. 

Diabetes inflicts damage to blood vessels all over the body. Both type 1 and type 2 diabetes elevate blood sugar levels to unhealthy highs from either a lack of insulin or inability to use the body’s natural insulin. Elevated glucose levels and high blood pressure damage the interior layer of large and small arteries – like the ones that distribute oxygenated blood to the eyes. In response, the body lines these arteries with plaque to protect them. This plaque eventually causes blockages and prohibits the flow of healthy, oxygenated blood to various parts of the body. 

When this complication in the eye transpires, diabetic retinopathy occurs. Blood vessels in the eye either swell and leak, or squeeze shut, stopping the supply of healthy blood entirely. Stages of diabetic retinopathy can escalate slowly or rapidly, depending on the individual and how quickly they seek treatment. 

Stages of Diabetic Retinopathy.

This diabetic eye disease often progresses slowly, in various stages. Individuals may experience a wide array of symptoms and complications as they move through stage one and into stage two. However, catching diabetic retinopathy early on in stage one may slow or stop progression into more serious complications. Here are the two main benchmarks for diabetic retinopathy. 

Non-proliferative Diapetic Retinopathy (NPDR)

Non-proliferative diabetic retinopathy is an early stage of this disease and includes both macular edema (swelling and bursting of the blood vessels) and macular ischemia (narrowing and closure). 

Proliferative Diabetic Retinopathy (PDR)

Proliferative diabetic retinopathy occurs as a later stage of DR, when the retina starts creating new blood vessels. This process, called neovascularization, means that the newly formed blood vessels are leaking into the eye’s vitreous or scarring over as hard tissue. Either of these instances can cause central and peripheral vision loss. 

Signs and Symptoms of Diabetic Retinopathy 

Unfortunately, this diabetic eye disease doesn’t typically present symptoms early on, making it especially important for those with diabetes to schedule routine eye exams with an Orlando ophthalmologist

As the disease progresses, the following symptoms may occur: 

  • Dark floaters
  • Cob-web like shadows
  • Blind spots in central vision or periphery
  • Poor night vision
  • Fluctuating vision
  • Lack of vibrancy in colors
  • Blurry vision 

Risks factors of Diabetic Retinopathy

The greatest risk factor for developing diabetic retinopathy is experiencing long term type I or type II diabetes. The longer one lives with the disease, the greater his or her chances are to develop DR. Additionally, women who develop gestational diabetes are at a greater risk for experiencing diabetic retinopathy and should schedule an eye exam as soon as possible. 

Once living with diabetic retinopathy, the disease may cause other health complications, including: 

  • Diabetic macular edema. On average, half of people will develop diabetic macular edema, or DME. Once blood vessels in the retina begin to leak, the macular can swell, causing blurred vision. 
  • Neovascular glaucoma. Regular instances of glaucoma occur due to an imbalance of fluid in the eye and pressure build up. Diabetic retinopathy may cause its own type of glaucoma, in which the excess blood vessels cause a blockage and prevent fluid from draining. 
  • Retinal detachment. If diabetic retinopathy causes scar tissue to build up in the back of the eye, a retinal detachment may occur.

How is DR diagnosed?

Diabetic retinopathy can be diagnosed in a number of ways, including: 

  • A dilated eye exam performed by an experienced ophthalmologist. This simple, painless process usually occurs in the office and is similar to a routine eye examination. Your eye doctor will put drops in the eye to dilate the pupil so he or she may look through a lens to the inside of your eye. 
  • Fluorescein angiogram. This type of test takes pictures of blood vessels in the eye. If your opthamologist believes you may have already suffered a diametic macular edema, a fluorescein angiogram can be ordered. Fluorescein angiography uses a yellow dye, injected into the bloodstream through the arm, to reveal a closer look into the eye. A special camera snaps images of the retina as this yellow dye passes through, showing if leakage, new blood vessel growth, or scar tissue is present.
  • Optical coherence tomography. A special machine scans the retina and captures photos of its layers, depicting whether swelling has occurred in the macula. 

How is DR treated?

The American Institute of Ophthalmology lists a variety of treatments that may be utilized to prevent diabetic retinopathy, reduce risk factors, and halt further damage if this diabetic eye disease has already developed. 

  • Medicine. Diabetes medication is often the first step to preventing further damage from diapetic retinopathy. Staying on top of insulin injections and altering medication under a doctor’s supervision mitigates the risk of complications from diabetes. 
  • Anti VEGF medication. This type of medication is administered via shots in the eye and slows the swelling of the macula.
  • Eye drops. Those with early stage diabetic retinopathy may receive a prescription for medicated eye drops to slow the disease’s development. If the individual is experiencing complications from DR, like neovascular glaucoma, a corticosteroid drop may be issued. 
  • Laser surgery. This type of treatment is often employed to seal off leaking blood vessels in order to prevent further swelling and vision damage. Multiple laser treatments are usually needed. 
  • Vitrectomy. If one has already lived with diabetic retinopathy and the disease has entered advanced stages, a vitrectomy may be in order. This surgery removes excess vitreous gel, blood, and scar tissues from the retina and eye in an effort to let light back in. 
  • Eye care. Going out of the way to treat your eyes well can help protect their overall health and foster vision longevity. Taking vitamins, wearing sunglasses, and eating healthy foods are effective yet simple eye care practices that lay a solid foundation for optical health. 

Prevention is key

With diabetic retinopathy, the challenge comes in maintaining a healthy, active lifestyle and staying diligent about diabetes treatment. Things like high cholesterol, high blood pressure, elevated blood glucose, and sedentary practices can eventually lead to arterial damage throughout the body, including to the tiny blood vessels in the eyes. Living a high-quality life with diabetes is absolutely possible as is preventing diabetic retinopathy. Working with an ophthalmologist to schedule routine checkups and discuss healthy, preventative measures is a great way to protect your overall eye health. 

UCF Health makes it easy to connect with an opthamologist and maintain a healthy active lifestyle by offering a variety of resources through our patient portal. Use the online scheduling tool to book period appointments or stay on top of COVID-19 updates for patients. We care about your health and want you to have straightforward access to the resources you need to live well.