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Diabetes complications that damage the eyes are referred to as diabetic retinopathy. Damage to the blood vessels in the light-sensitive tissue at the back of the eye (retina) is what causes this condition.
Initially, diabetic retinopathy may not manifest any symptoms or may only result in minor eyesight issues. But later on, it may result in blindness.
Any person with type 1 or type 2 diabetes has the potential to acquire the illness. The likelihood of developing this eye problem increases with the duration of diabetes and how well the blood sugar is managed.
Symptoms
During the early stages of diabetic retinopathy, you might not experience any symptoms. As the situation worsens, you could get:
- Color blindness that just recently occurred or colors appear to be faded
- Dark spots or floating threads in your field of view (floaters)
- Problems with reading or not able to see things from afar
- Night blindness
- Fluctuating vision
- Blurring of vision
- Bank or dark spaces in your vision
- Blindness
To avoid losing your vision you need to carefully control your diabetes. Even if your eyesight seems fine, get a yearly eye checkup with dilation if you have diabetes.
Your risk of diabetic retinopathy can rise if you already have diabetes or develop it during pregnancy (gestational diabetes). Your eye doctor may advise further eye exams throughout your pregnancy if you’re expecting.
If your eyesight suddenly changes or becomes cloudy, splotchy, or blurry, call your eye doctor straight away.
Causes
As time goes by, having too much sugar in your blood can cause the small blood vessels that feed the retina to become blocked which hinders the retina’s blood supply. The eye makes an effort to generate new blood vessels as a result. However, these new blood vessels don’t grow properly and are highly prone to leakage.
Diabetic retinopathy comes in two different forms:
- Early diabetic retinopathy. Nonproliferative Diabetic Retinopathy (NPDR), the more prevalent variety, is marked by the absence of new blood vessel growth (proliferating).
The retinal blood vessel walls deteriorate when you have NPDR. Small protrusions from the smaller arteries’ walls can occasionally leak fluid and blood into the retina. The diameter of larger retinal vessels can also start to enlarge and change. NPDR can worsen when more blood vessels are blocked, going from mild to severe.
There may occasionally be an accumulation of fluid (edema) in the macular region of the retina as a result of retinal blood vessel injury. Treatment is needed if macular edema impairs vision in order to prevent irreversible blindness.
- Advanced diabetic retinopathy. Proliferative diabetic retinopathy is a more serious form of diabetic retinopathy that can develop. This type results in the development of new, abnormal blood vessels in the retina as injured blood vessels close off. Due to the fragility of the new blood vessels, they could leak into the vitreous (jellylike substance that fills the center of the eye).
The retina may eventually separate from the back of your eye as a result of scar tissue produced by the development of new blood vessels. The eyeball may become pressurized if the new blood vessels obstruct the usual drainage of fluid from the eye. Glaucoma can develop as a result of this buildup harming the optic nerve, which delivers images from your eye to your brain.
Risk factors
Diabetes can cause diabetic retinopathy in anyone with the disease. The following factors can raise the chance of developing the eye condition:
- Long-term diabetic condition (gestational diabetes, type 1 diabetes or type 2 diabetes)
- Ineffective blood sugar management
- Being pregnant
- High blood pressure
- High cholesterol level
- Using tobacco
- Being Black, Hispanic or Native American
Diagnosis
A thorough dilated eye exam is the most effective method for diagnosing diabetic retinopathy. For better observation inside your eyes during this examination, drops are used to enlarge (dilate) your pupils. Your close vision may get blurry while using the drops until they wear off many hours later.
Your eye doctor will examine both the inside and outside of your eyes during the examination.
Fluorescein angiography
An injection of dye will be given into your arm vein after your eyes have been dilated. Images are then captured when the dye passes through the blood vessels in your eyes. Blood vessels that are closed, damaged, or leaking might be located on the images.
Optical Coherence Tomography (OCT)
With this test, images show the retina in cross-section, revealing the thickness of the retina. This will aid in determining whether any fluid has spilled into the retinal tissue and the amount of fluid has leaked. OCT tests can then be performed to check on the effectiveness of the treatment.
Treatment
The aim of the treatment is to delay or stop the progression of diabetic retinopathy, which depends on the kind and severity of your condition.
Early diabetic retinopathy
You may not need therapy right away if you have mild or moderate nonproliferative diabetic retinopathy. To ascertain when you might require treatment, your eye specialist will nevertheless carefully check your eyes.
If there are any ways to improve your diabetes management, discuss them with your endocrinologist. The course of diabetic retinopathy can typically be slowed with effective blood sugar control in cases of mild to moderate disease.
Advanced diabetic retinopathy
You require quick medical attention if you have macular edema or proliferative diabetic retinopathy. Depending on the precise issues with your retina, you may have the following options:
- Injecting medications into the eye. The eye’s vitreous receives an injection of these drugs, which are also known as vascular endothelial growth factor inhibitors. They aid in terminating the development of new blood vessels and reducing fluid buildup.
Ranibizumab and aflibercept are two medications that the U.S. Food & Drug Administration (FDA) has approved for the treatment of diabetic macular edema. Bevacizumab, a third medication, is an off-label treatment option for diabetic macular edema.
Topical anesthesia are used while injecting these medications. There may be some moderate discomfort, such as burning, ripping, or soreness for up to 24 hours following the injection. Other negative effects may be infection and increased ocular pressure. There will be a need for more injections repeatedly. The drug is occasionally used with photocoagulation.
- Photocoagulation. The leakage of blood and fluid into the eye can be stopped or reduced by this laser procedure, sometimes referred to as a focused laser treatment. Laser burns are used during the operation to correct leakage from abnormal blood vessels.
A single session of focal laser therapy is often performed in your doctor’s office or eye clinic. The operation may not restore your vision to normal if you had macular edema-related blurry vision prior to the procedure, but it will lessen the likelihood of the worsening of the macular edema.
- Panretinal photocoagulation. The abnormal blood vessels may contract after receiving this laser therapy, also referred to as scatter laser therapy. During the operation, scattered laser burns are used to treat the retinal regions away from the macula. The abnormal new blood vessels shrink and scar as a result of the burns.
At most cases, it takes two or more sessions in your doctor’s office or eye clinic. After the surgery, your vision will be impaired for about a day and there may be some loss of night vision or peripheral vision.
- Vitrectomy. This technique makes a tiny incision in your eye to remove scar tissue that is pulling on the retina as well as blood from the vitreous (the interior of the eye). Using local or general anesthesia, it is carried out in a surgery center or hospital.
Treatment can not cure diabetic retinopathy, although it can delay or stop its progression. Future retinal degeneration and vision loss are still likely to develop due to diabetes’ lifetime nature.
You’ll need routine eye exams even once your diabetic retinopathy has been treated.
