Diabetic Retinopathy

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Diabetic Retinopathy

Diabetic retinopathy is the most common complication of diabetes mellitus (DM). This condition is one of the largest causes of vision loss worldwide and is the leading cause of impaired vision in working age adults. In patients with diabetes mellitus, the body does not use and store sugar appropriately. High blood sugar levels cause damage to blood vessels in the retina, leading to bleeding, swelling, leakage, and abnormal new blood vessel growth. This retinal damage is referred to as diabetic retinopathy.

Risk Factors

In patients with diabetes mellitus, risk factors for the development of diabetic retinopathy have been identified. Blood sugar level and duration of disease are strong risk factors. Patients with type 1 diabetes have a higher risk than type 2 diabetes. In addition, associated conditions such as high blood pressure, high cholesterol, smoking, obesity, pregnancy, and kidney disease increase a patient’s risk of developing diabetic retinopathy.

Symptoms

Diabetic retinopathy often has no symptoms in its early stages. As the condition worsens, patients may experience blurred vision, vision loss, floaters, dark areas in the field of vision, and impaired color vision. Diabetic retinopathy usually affects both eyes. However, symptoms may affect one eye more than the other eye.

Subspecialties & Types

Diabetic retinopathy can be categorized into two main types: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is an earlier stage of diabetic retinopathy without the presence of abnormal new blood vessels. In this stage, blood vessels within the retina leak blood or fluid. PDR is a more advanced stage of diabetic retinopathy. The defining characteristic of PDR is the development of abnormal new blood vessels growing on the surface of the retina or optic nerve. These abnormal blood vessels may lead to significant bleeding and scar tissue formation.

Diagnosis

Dilated eye examination is the best way to detect changes from diabetes inside the eye. A retina specialist can often diagnose and treat diabetic retinopathy before symptoms develop. If diabetic findings are present, the retina specialist may order additional testing such as optical coherence tomography (OCT) to assess the thickness of the macula or central retina, or fluorescein angiography to evaluate the blood supply to the retina.

Treatment

The primary treatment is aimed at preventing the development of diabetic retinopathy with strict blood sugar control as well as controlling other associated risk factors. If diabetic retinopathy is present, retinal treatment may be necessary to prevent further loss of vision. Diabetic macular edema (swelling of the central retina) may be treated with laser, or more often with intravitreal injections (injections of medicine into the eye). For proliferative diabetic retinopathy, pan-retinal photocoagulation (PRP) laser treatment helps to shrink abnormal new blood vessels and prevents further significant bleeding. Intravitreal injection treatment may also be used for PDR. In advanced cases of PDR, surgery with vitrectomy (removal of the vitreous gel in the back of the eye) may be necessary in the setting of vitreous hemorrhage (bleeding into the back of the eye) or tractional retinal detachment (scar tissue formation leading to pulling on the retina from its normal position).

Conclusion

Diabetic retinopathy is a common complication of diabetes mellitus that has the potential for serious loss of vision. Vision loss from diabetic retinopathy may be preventable with early detection, intervention, and treatment. In addition to maintaining strict blood sugar control, regular visits with a Colorado Retina specialist may help to lower the risk of vision loss from diabetic retinopathy.