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Diabetic Retinopathy

Diabetes is growing at such a rapid pace that the disease has reached epidemic proportions in the United States. Over 18 million Americans have diabetes and many are yet to be diagnosed. Diabetes has its most damaging effects on small blood vessels or capillaries throughout the body. The retina is a body tissue that has many capillaries and therefore faces the worst of the damaging effects of diabetes. Diabetic retinopathy occurs when the blood vessels throughout the retina become damaged or blocked, resulting in lack of blood supply to small patches of the retina. The damaged blood vessels also tend to leak, producing swelling within the retina. Approximately 25% of diabetics have some degree of diabetic retinopathy.

There are Two Main Categories of Diabetic Eye Disease

The first type, nonproliferative diabetic retinopathy (NPDR), commonly known as background retinopathy, is the earlier state of the disease. This state is characterized by damage to small retinal blood vessels, causing them to leak blood or fluid into the retina. Most visual loss during this state is due to the fluid accumulating in the macula, the central area of the retina. This accumulation of fluid is called macular edema and can cause temporary or permanent decreased vision.

The second type, proliferative diabetic retinopathy (PDR), is the end result of closure of many small retinal blood vessels. The retinal tissue, which depends on those vessels for nutrition, will no longer work properly. The areas of the retina in which the blood vessels have closed then foster the growth of abnormal new blood vessels, called neovascularization. Neovascularization can be very damaging because it may cause bleeding in the eye, retinal scar tissue, diabetic retinal detachments, or glaucoma, any of which may cause decreased vision or blindness.

Diabetic retinopathy can occur in both Type I diabetics (onset of diabetes prior to age 40) and Type II diabetics (onset after age 40), although it tends to be more common and more severe in Type I patients. Because Type II diabetes is often not diagnosed until the patient has had the disease for many years, diabetic retinopathy may be present in a Type II patient at the time diabetes is discovered. In fact, many patients first learn that they have diabetes when their optometrist finds diabetic retinopathy on a routine eye exam.

The duration of diabetes is important in the development of diabetic retinopathy. The longer a patient has had diabetes, the more likely they are to have diabetic retinopathy. Diabetic retinopathy does not usually occur for at least three years after the onset of Type I diabetes. After having diabetes for 15 years, however, about 80% of Type I diabetics will have some degree of diabetic retinopathy, and 50% will have proliferative retinopathy.

The diagnosis of diabetic retinopathy is made based on the appearance of the retina as seen on a dilated retinal examination. Significant vision-threatening diabetic retinopathy may be present even if you have no visual symptoms. Retinal photographs and fluorescein angiography are also used to diagnose and document progression of diabetic retinopathy. Fluorescein angiography is a technique which involves injecting a dye (fluorescein) into the veins and taking a series of photographs of the retina while the dye circulates through the retinal vessels. Angiography is used to determine which retinal vessels are leaking, and helps direct laser treatment more precisely.

Symptoms

You can have diabetic retinopathy without knowing it. Usually, there is no pain or outward signs. Over a period of time, you may begin to notice a gradual blurring or some vision loss. Symptoms may come and go. If diabetic retinopathy becomes severe, you may have clouded vision or blindness.

Many diabetics notice blurred vision when their blood sugar is particularly high or low. This blurred vision is due to changes in the shape of the lens of the eye, and usually reverse when the blood sugar returns to normal. Diabetics are also prone to develop cataracts at a younger age than non-diabetics.

Early Detection Can Help Save Your Sight

The Retinal Institute is committed to preserving vision and preventing blindness in diabetics. The key to treatment is timely diagnosis. All diabetics should have a dilated eye examination with their doctor of optometry at least every 12 months, and more often for patients with retinopathy.

The Retinal Institute utilizes the most advanced digital imaging system, state-of-the-art retinal laser, and intravitreal therapies to provide superior diagnostic, monitoring and treatment options for diabetic eye disease.

Digital retinal photography and fluorescein angiography provide The Retinal Institute’s doctors with detailed images of the retina and its vasculature. These digital images are available instantly and greatly enhance the doctors’ ability to detect, monitor and treat diabetic retinopathy.

Treatment

The treatment of diabetic retinopathy in any particular case depends upon multiple factors, including the type and degree of retinopathy, associated ocular factors such as cataract or vitreous hemorrhage, and the medical history of the patient. Blindness due to diabetic eye disease is preventable in most cases. Strategies for preventing diabetic retinopathy include:

  • Careful control of blood sugar levels through attention to diet, exercise, and medications
  • Monitoring for and control of high blood pressure
  • Avoid smoking
  • Early detection and treatment of diabetic retinopathy

The digital images are sent electronically to the procedure room to guide laser treatment to seal leaking blood vessels.

Together these advanced technologies and techniques can reduce the number of diabetics who suffer severe vision loss.

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