Diabetic retinopathy (die-uh-BET-ik retin-NOP-uh-thee), is an eye-related consequence of diabetes.
The early stages of diabetic retinopathy may show no symptoms or very minor vision issues. However, it may result in blindness.
Anyone with type 1 or type 2 diabetes is susceptible to the illness. You are more prone to develop this eye issue if you have diabetes for a longer period of time and have poorly regulated blood sugar.
What symptoms indicate diabetic retinopathy?
In the early stages of diabetic retinopathy, there are typically no symptoms. Some persons have visual problems such as difficulty reading or focusing on distant objects. These changes could occur suddenly.
Retinal blood vessels begin to bleed into the vitreous in advanced stages of the illness (gel-like fluid that fills your eye). If this takes place, you might notice shadowy, floaty spots or streaks that resemble cobwebs. Even while it’s crucial to seek treatment right away, the spots occasionally go away on their own. The back of the eye may develop scars if untreated. Additionally, blood vessels may start bleeding again or may flow more heavily.
Diabetes Eye Disease: The Two Stages
Diabetic eye disease progresses through two primary stages.
NPDR (non-proliferative diabetic retinopathy)
Diabetic eye disease is currently in its early stages. Diabetes affects a large number of people.
Tiny blood vessels leak in NPDR, inducing swelling of the retina. Macular edoema refers to the swelling of the macula. The most typical cause of visual loss in diabetic patients is this.
Additionally, blood vessels in the retina may collapse with NPDR. We refer to this as macular ischemia. Blood cannot enter the macula in that situation. In the retina, small specks known as exudates can occasionally occur. Your vision may be impacted by these.
Your eyesight will be hazy if you have NPDR
PDR (proliferative diabetic retinopathy)
PDR is the later stage of diabetic retinopathy. It occurs when the retina begins to produce new blood vessels. The term for this is neovascularization. Frequently, the vitreous leaks into these tender young vessels. You might notice a few dark floaters if they bleed just a little bit. A lot of bleeding could completely impair vision.
Risk factors & causes
The damage that diabetes does to the tiny blood vessels in the retina leads to diabetic retinopathy. Vision loss can result from these damaged blood vessels:
- The region of the retina that is responsible for sharp central vision, the macula, might experience fluid leakage. The macula, a tiny portion of the retina, is what gives humans the ability to see colour and fine detail. Blurred results from the fluid swelling the macula.
- New blood vessels might develop on the retina’s surface in an effort to enhance blood flow there. These weak, aberrant blood vessels may rupture and leak blood into the back of the eye, impairing vision.
Diabetes’s effects on the eyes
The layer of light-sensitive cells in the back of the eye called the retina is responsible for converting light into electrical signals. Sending the signals to the brain causes it to transform them into the visuals you see.
The retina requires a steady flow of blood, which it gets via a web of small blood vessels.
A chronically high blood sugar level can harm these blood vessels over time in three primary stages:
- Background retinopathy: Tiny blood vessel bulges that may slightly bleed but typically do not impair vision occur.
- Pre-proliferative retinopathy: More extensive and pervasive alterations to the blood vessels, including increased eye bleeding
- Proliferative retinopathy causes the retina to generate scar tissue and new, weak blood vessels that bleed easily. This can cause some vision loss.
However, if an issue with your eyes is identified early, lifestyle modifications and treatment can prevent it from getting worse
Scar tissue may be created by these new blood vessels. The macula may experience issues or develop a detached retina as a result of scar tissue.
The highly serious condition known as PDR can rob you of both your central and peripheral (side) vision.
The four stages of diabetic retinopathy are as follows:
- Nonproliferative mild retinopathy. Your retina’s small blood vessels change in the early stages of the disease. Smaller regions swell. They are known as microaneurysms. Your retina may be affected by fluid leakage from them.
- Moderate nonproliferative retinopathy. Blood vessels that ought to maintain the health of your retina swell and alter shape as your condition worsens. They are unable to bring blood to your retina. This may alter how your retina appears. Diabetic macular edoema may result from these alterations in the blood vessels (DME). The macula, a portion of your retina, is swollen.
- Severe nonproliferative retinopathy. The third stage sees the blockage of numerous blood arteries. They are unable to provide blood to your retina to maintain its health.
Where this occurs in your retina, special proteins called growth factors are produced. These proteins instruct your retina to develop new blood vessels.
- Proliferative diabetic retinopathy (PDR). The most advanced stage is this one. Your retina and the vitreous humour, a jelly inside your eyeballs, both experience new blood vessel growth. It is more common for fragile young blood vessels to haemorrhage and leak liquids. Scar tissue begins to develop. Your retina may tear away from the tissue beneath as a result, leading to retinal detachment. Permanent blindness may result from this.
Diabetic retinopathy can cause a number of consequences if left untreated.
Vitreous haemorrhage is the medical term for when blood vessels flow into the vitreous, the primary jelly that fills the eye. Floaters are among the symptoms in moderate cases, but in more serious cases, vision loss may also occur because the blood in the vitreous inhibits light from entering the eye.
The vitreous haemorrhage may stop on its own if the retina is unharmed.
A detached retina can occur occasionally as a result of diabetic retinopathy. If scar tissue drags the retina away from the back of the eye, a problem may result.
It typically results in floating specks appearing in the person’s field of vision, light flashes, and significant vision loss.
If a person with a detached retina does not receive treatment, they run a serious danger of losing all of their eyesight.
The obstruction increases the risk of optic nerve injury and vision loss by causing a buildup of pressure inside the eye.
Diagnosis AND TESTS
How is diabetes-related retinopathy diagnosed?
Diagnosing diabetes-related retinopathy during a routine exam is possible for an ophthalmologist.
- Visual acuity: The ability to see clearly is referred to as acuity.
- Intraocular pressure to ensure that glaucoma is not present.
- Muscle mobility of the eyes is referred to as ocular muscle function.
- Peripheral vision is the ability to see out to the sides of your head.
- This evaluation examines your pupils’ responses to light
Our best eye doctor will then administer drops to your eyes. Your pupils enlarge due to the drops (centers of the eyes).
This examination involves the doctor looking for:
- Strange blood vessels.
- Your eye is bleeding in the middle.
- Development of new blood vessels
- Swollen retina.
Is diabetic retinopathy curable?
Background retinopathy is incurable, but patients must undergo routine eye exams.
Although typically painless and without any negative side effects, this can affect night driving and peripheral vision.
Though it won’t enhance vision, this kind of laser therapy for diabetic retinopathy can stop it from getting worse. With a scattering of lasers across the entire retina, proliferative retinopathy is also treated.
This causes the retina’s starving region to die.
Eye surgery may be necessary in severe diabetic retinopathy situations.
Usually, bleeding in the eye, late-stage proliferative retinopathy, or unsuccessful laser therapy lead to the diagnosis of this. The term “vitrectomy” refers to this kind of diabetic retinopathy eye surgery.
Can diabetes-related retinopathy be prevented?
There are steps you may take to lower the risk of diabetic retinopathy developing or worsening, despite the fact that prevention of it can be difficult.
Every year, have your eyes checked for diabetes
Before becoming pregnant or during the first trimester, women with diabetes should get an eye checkup.
Follow your diabetes management plan
To get the most out of your therapy, follow these instructions:
- As directed, take your medications.
- If needed, provide insulin as prescribed.
- To control blood sugar levels, eat a healthy, balanced diet.
- Exercise will lower blood sugar levels and aid the body’s utilisation of them.
- Regularly check your blood sugar levels.
- Check your haemoglobin A1c levels frequently.
- Maintain a regular urine ketone test.
- Maintain regular follow-ups with your doctor to assess your diabetes management and to rule out or treat any other risk factors, such as high blood pressure.
Improved blood sugar management delays the onset and progression of retinopathy and reduces the need for laser surgery or other invasive treatments for severe retinopathy.