Diabetes is a serious condition that impairs the body’s ability to process blood glucose (blood sugar).
The prevalence of this condition is expected to reach 700 million by 2045. The CDC reports that a staggering 100 million US adults are living with diabetes or prediabetes.
Diabetes can cause several complications, including diabetic retinopathy.
Diabetic retinopathy is defined as an eye disease that causes loss of vision and blindness in people with diabetes.
Studies show that diabetic retinopathy is the leading cause of vision loss on a global level. About one-third of people with diabetes exhibit signs of diabetic retinopathy.
Of these, a further one-third have vision-threatening diabetic retinopathy, including diabetic macular edema.
In the United States, the number of people with diabetic retinopathy is expected to reach 14.6 million by 2050. In 2010, about 7.7 million people had this diabetes complication.
Early blindness caused by diabetic retinopathy can be prevented when diagnosed and treated early.
Early detection and diagnosis are vital, and people with diabetes need to learn how to spot it, which is the central topic of this post.
What causes diabetic retinopathy?
When patients with diabetes have high glucose levels over long periods, fluid can build up in the lens inside the eye. As a result, changes in the curvature of the lens occur and thereby impair vision.
When blood sugar levels are adequately controlled, the lens returns to the original shape. In turn, vision improves. But, when high blood glucose is not managed properly, it can negatively affect blood vessels and lead to diabetic retinopathy.
Diabetic retinopathy is a result of damage caused by small blood vessels in a patient’s retina.
Over time, the excessive amount of blood glucose can create a blockage in tiny blood vessels that nourish the retina and disrupt the blood supply. As a result, the eye tries to grow new blood vessels, but they fail to develop effectively and start leaking.
Types of Diabetic Retinopathy
When we are discussing the causes of diabetic retinopathy, it is essential to address two types of this condition. They are:
Early Diabetic Retinopathy
Also known as non-proliferative diabetic retinopathy (NPDR), is a more common type of this condition. It refers to the cases when new blood levels aren’t proliferating, i.e., growing properly.
People with NDPR experience weakening of blood vessels in the retina. This can cause protrusion of tiny bulges from the vessel walls, which can lead to leaking of blood and fluid into the retina.
Eventually, bigger vessels in the retina may dilate and develop an irregular diameter. This type of diabetic retinopathy can worsen over time as an increasing number of vessels in the retina are becoming blocked.
Moreover, retinal nerve fibers may start swelling the central part of the retina ( macular ), which allows us to see colors and fine details. Swelling needs treatment to avoid potentially severe complications. Swollen macular can cause blurred vision
Advanced Diabetic Retinopathy
Also known as proliferative diabetic retinopathy, the severe form of this condition. Damaged blood vessels are closed off, and new, abnormal blood vessels start growing inside the retina.
These vessels, just like in NDPR, can leak, but they do so in the clear and jelly-like substance in the center of the eye. Over time, the growth of new blood vessels stimulates scar tissue and leads to retinal detachment from the back of a patient’s eye.
In cases when new vessels disrupt the proper flow of fluid out of the eye, the blood pressure in the eyeball increases and damages optic nerves. As a result, a patient develops glaucoma.
When are you most likely to get Diabetic Retinopathy?
There is no timeline under which a patient develops diabetic retinopathy. The longer you have diabetes, the more likely you are to develop this complication. It takes longer for people with type 2 diabetes to develop diabetic retinopathy — those with type 1 who may develop the condition after at least five years.
What are the symptoms of Diabetic Retinopathy?
Non-proliferative diabetic retinopathy may not exhibit any noticeable signs and symptoms at all. But as the condition progresses from one stage to other various symptoms may occur. The most common signs and symptoms of this diabetic eye disease include:
- The appearance of spots or dark strings, i.e., floaters (because they look like they’re floating)
- Blurry vision
- Vision fluctuates
- Impaired color vision
- Presence of empty or dark areas in a patient’s vision
- Loss of vision
The condition tends to affect both eyes rather than just one.
Who is at risk of Developing Diabetic Retinopathy?
Everyone with diabetes can develop diabetic retinopathy, but some people are at a higher risk than others. The most common risk factors of diabetic retinopathy include:
- Not managing high blood glucose effectively
- Duration of diabetes, i.e., the longer you have it, the higher the risk of developing diabetic retinopathy. As mentioned above, people with type 1 diabetes may develop diabetic retinopathy in at least five years after their diagnosis.
- High cholesterol
- High blood pressure
- Ethnicity – Native Americans, Hispanics, and African Americans are more likely to develop diabetic retinopathy
How does Diabetic Retinopathy progress?
Signs and symptoms of diabetic retinopathy develop gradually. To manage the condition and prevent complications, it’s crucial to understand what symptoms to expect in each stage. The stages of diabetic retinopathy are:
- Mild non-proliferative retinopathy – the first stage, also known as the background retinopathy. Tiny bulges indicate it in retinal blood vessels. In this stage patients usually don’t experience vision problems and don’t require treatment.
- Moderate non-proliferative retinopathy – is indicated by swelling of retinal blood vessels. This can induce physical changes to the retina, i.e., diabetic macular edema. Patients may experience vision problems in this stage.
- Severe non-proliferative retinopathy – also known as proliferative retinopathy. At this point, the blockage of retinal blood vessels worsens. Retina gets less blood than it used to and scar tissue forms. In this stage, patients experience blurry vision with dark spots that some patients refer to as “floaters.”
- Proliferative diabetic retinopathy – an advanced stage of the condition, indicated by neovascularization or growth of abnormal blood vessels in retinas and vitreous. These vessels are weak and tiny; they tend to bleed, which can lead to scar tissue and ensuing retinal detachment. In this stage, people tend to lose straight-ahead and side vision.
How does Diabetic Retinopathy cause vision loss over time?
In the early stages, the condition can be unnoticeable. However, over time, people experience complications that lead to vision loss.
As this diabetic eye disease goes from one stage to another, it leads to greater blockage of blood vessels, increased growth of abnormal vessels, and more leakage. This can cause the formation of scar tissue, subsequent retinal detachment, and loss of vision.
When not treated properly, various complications can happen, such as:
- Vitreous hemorrhage – occurs when newly formed blood vessels leak in vitreous. When small leakage is present, patients notice “floaters”. In the case of severe leaking, it can block vision completely as the blood fills the vitreous cavity. This complication doesn’t usually cause permanent loss of vision, and blood may clear out in a few weeks or months unless the damage of retina is also present.
- Retinal detachment – this complication occurs when abnormal blood vessels propel the growth of scar tissue. This then pulls the retina away from the patient’s back of the eye. As a result, patients may notice floaters, flashes in their eyes, and severe vision loss.
- Glaucoma – happens when newly formed abnormal vessels disrupt blood flow. This causes increased blood pressure that destroys the optic nerve.
- Blindness – glaucoma is the most common cause of blindness in the world. Diabetic retinopathy may progress to this common condition which can eventually cause complete vision loss and leave a patient blind.
How to diagnose Diabetic Retinopathy
The biggest mistake that most people make is that they refuse to see the doctor until their symptoms worsen.
The best way to manage any health condition is when it’s diagnosed in the early stages, and diabetic retinopathy is not the exception.
As soon as you notice changes in the vision, make sure to schedule an appointment and see your healthcare provider.
A healthcare provider can diagnose diabetic retinopathy through compressive eye examination, which usually includes:
- Patient history – the goal is to establish whether there are vision difficulties, presence of diabetes (in case a patient doesn’t have diagnosed type 1 or type 2 diabetes), and check for other health concerns that may contribute to problems with the vision.
- Visual acuity measurements to assess the severity of damage of central vision.
- Refraction to conclude whether a patient needs new eyeglasses.
- Evaluating ocular structures such as the retina.
- Measuring pressure in the eye.
During the examination, the doctor looks for the presence of :
- abnormal blood vessels.
- diabetic macular edema.
- fatty or blood deposits in the retina.
- scar tissue.
- vitreous leakage.
- retinal detachment.
- optic nerve abnormalities.
Specific tests that allow doctors to diagnose diabetic retinopathy include:
- Fluorescein angiography – involves taking pictures of the patient’s eyes when dilated. Then, a special dye is inserted in the arm vein so more images can be taken while the dye circulates through blood vessels in the eyes. This test shows blocked and broken blood vessels as well as those that are leaking fluid
- Optical coherence tomography – eye doctor uses imaging test that delivers cross-sectional images of a patient’s retina to show its thickness. This helps determine just how much fluid has leaked. Doctors may also use this exam to determine the efficacy of treatment for diabetic retinopathy.
You need to see your general physician regularly, especially if you already have diabetes. Based on the symptoms you describe, the doctor may suspect diabetic retinopathy could be the culprit.
Remember, diabetic retinopathy treatment depends on following doctor’s orders religiously and notifying healthcare providers as soon as you notice something is not okay.
For diagnosis, you may need to see an ophthalmologist, i.e., doctor who treats eye diseases. Patients may also benefit from seeing an endocrinologist who can help them manage diabetes more effectively.
Treatment of Diabetic Retinopathy
Diabetic retinopathy is a severe condition, but it doesn’t mean patients have no options to treat it. The treatment of this condition depends on the stage of diabetic retinopathy and the severity of blood vessel damage.
Patients with mild or moderate non-proliferative diabetic retinopathy usually don’t need any treatment at all in the beginning. But, the doctor will monitor the eyes closely to determine when the treatment is required.
Advanced stages require a proactive approach and prompt treatment. Various options are available depending on the condition of the retina. Treatment of diabetic retinopathy include:
- Laser photocoagulation – involves the usage of lasers to treat the leakage from abnormal blood vessels. Usually, one session is enough. While it can reduce the risk of worsening macular edema, this treatment may not restore vision to normal.
- Panretinal photocoagulation – this laser treatment shrinks the abnormal blood vessels. Two sessions are necessary in this case.
- Vitrectomy – eye doctor performs removal of blood from vitreous and scar tissue that’s pulling retina, which would otherwise cause retinal detachment. This is a complicated procedure that requires general anesthesia and hospital stay.
- Injection of medicine in the eye – the main goal of medications called VEGF (vascular endothelial growth factor) is to prevent new blood vessels from growing. The injection works by blocking the effects of growth signals sent by the body to promote the growth of new blood vessels.
Your eye doctor may also recommend anti-VEGF therapy to block VEGF. This is, as in some cases, cells may produce excessive amounts of VEGF, which promotes abnormal growth of blood vessels and lead to vision loss. This treatment is promising, but not a standard approach to protect vision, optic nerve, retina, etc.
How can you manage the symptoms of Diabetic Retinopathy?
Living with diabetes is challenging, let alone diabetic retinopathy. Although the condition may seem scary, you need to remember it’s entirely possible to maintain your quality of life.
In order to do that, you need to see your healthcare provider regularly and get your eyes checked at least once a year. Regular eye exams can detect the condition in the early stages.
To maintain your quality of life, you need to work on managing your diabetes actively. Bearing in mind that diabetic retinopathy is a complication of diabetes, it’s crucial to keep the underlying condition under your control.
Make healthier lifestyle decisions for a healthier and happier life. These include regular exercise, increased overall activity levels, and a well-balanced diet.
Managing symptoms of diabetic retinopathy revolve around making wiser lifestyle choices that will put diabetes under control and improve your vision. Some things you can do include:
- Enrich your diet with foods that are good for your health. Examples include fish, nuts and legumes, seeds, citrus fruits, leafy green vegetables, carrots, beef, eggs, etc.
- Limit or avoid junk food and other unhealthy foods.
- Reduce the consumption of salt, fat, and sugar.
- Keep weight in a healthy range, and if overweight or obese you may want to slim down.
- Exercise regularly.
- Quit smoking.
- Avoid alcohol.
- Manage blood sugar levels actively.
- Manage or control high blood pressure.
- Check cholesterol levels regularly.
- Go to screenings regularly.
Diabetic retinopathy is a complication of diabetes with severe consequences. Spotting this condition in the early stages is the best way to treat it with more success. If you have diabetic retinopathy, it is important to manage diabetes properly.