Diabetic Retinopathy
Diabetic retinopathy is an eye-related diabetes complication. It is caused by damage to the blood vessels of the light-sensitive retinal tissue.
Initially, diabetic retinopathy may produce no symptoms or only mild vision issues. However, it can cause blindness.
Individuals with type 1 or type 2 diabetes can develop the condition. The longer you have diabetes and the less your blood sugar is controlled, the greater your risk of developing this eye complication.
Types of Diabetic Retinopathy
Early diabetic retinal disease
Early diabetic retinal disease In this more prevalent form of diabetic retinopathy, known as nonproliferative diabetic retinopathy (NPDR), new blood vessels do not grow (proliferate).
When you have NPDR, the walls of your retina’s blood vessels become weakened. Tiny protrusions protrude from the walls of the smaller vessels, causing fluid and blood to occasionally leak into the retina. Additionally, larger retinal vessels can dilate and become irregular in diameter. As more blood vessels become blocked, NPDR can intensify from mild to severe.
Occasionally, damage to retinal blood vessels results in an accumulation of fluid (edema) in the macula of the retina. If macular edema impairs vision, treatment is necessary to prevent irreversible loss of vision.
Advanced diabetic retinal disease
Advanced diabetic retinal disease is more severe form of diabetic retinopathy is known as proliferative diabetic retinopathy. In this form, the retina develops new, abnormal blood vessels as a result of the closure of damaged blood vessels. These new blood vessels are fragile and may leak into the clear, gelatinous substance that fills your eye’s center (vitreous).
Scar tissue from the development of new blood vessels can eventually cause the retina to detach from the back of the eye. If the new blood vessels impede the normal outflow of fluid from the eye, eyeball pressure can increase. This accumulation can cause damage to the nerve that transmits images from the eye to the brain (optic nerve), leading to glaucoma.
Causes of Diabetic Retinopathy
In the early stages of diabetic retinopathy, you may not exhibit any symptoms. As the condition worsens, you may experience:
- Floating spots or dark strings in your vision (floaters).
- impaired vision
- Vision with fluctuating clarity
- blind spots or voids in your visual field
- Vision loss
Symptoms of Diabetic Retinopathy
In its initial stages, diabetic retinopathy often goes unnoticed because it typically lacks obvious symptoms until it reaches an advanced stage. Nevertheless, the early signs of this condition can be detected through eye photographs taken during diabetic eye screening.
If you encounter any of the following symptoms, it’s crucial to promptly get in touch with a ophtalmologist or diabetes specialist:
- Gradually deteriorating vision
- Sudden loss of vision
- Seeing floating shapes in your field of vision (floaters)
- Vision becoming blurred or patchy
- Experiencing eye pain or redness
- Difficulty seeing in low-light conditions
Complications of Diabetic Retinopathy
In diabetic retinopathy, abnormal blood vessels develop in the retina. Complications can result in severe vision issues:
Vitreous bleeding
New blood vessels may bleed into the transparent, gelatinous substance that fills the center of your eye. If the amount of bleeding is minimal, only a few dark spots (floaters) may be visible. In severe cases, blood can completely obstruct vision by filling the vitreous cavity.
Typically, vitreous hemorrhage does not result in permanent vision loss. Blood typically clears from the eye within weeks or months. Unless the retina is damaged, the clarity of your vision will likely return to normal.
Retinal detachment.The abnormal blood vessels associated with diabetic retinopathy stimulate scar tissue growth, which can pull the retina away from the back of the eye. This can result in floating spots, flashes of light, and severe vision loss.
Glaucoma. New blood vessels can grow in the iris, interfering with the normal flow of fluid out of the eye and causing the intraocular pressure to rise. This pressure can damage the optic nerve, which transmits images from the eye to the brain.
Blindness. Inadequate management of diabetic retinopathy, macular edema, glaucoma, or a combination of these conditions can result in total vision loss.
Diagnostics of Diabetic Retinopathy
Diabetic retinopathy is most effectively diagnosed with a thorough dilated eye exam. For this examination, drops placed in your eyes dilate (enlarge) your pupils to provide your doctor with a clearer view of the interior of your eyes. The drops can blur your close vision for several hours until they wear off.
During the exam, your eye doctor will examine the interior and exterior of your eyes for abnormalities.
Angiography with fluorescein. Following the dilation of your pupils, a dye is injected into a vein in your arm. Then, photographs are taken as the dye circulates through the blood vessels of your eyes. The images can identify closed, broken, or leaking blood vessels.
OCT (optical coherence tomography). This examination provides cross-sectional images of the retina that reveal the retina’s thickness. This will aid in determining whether fluid has leaked into retinal tissue. Later, OCT exams can be used to assess the efficacy of the treatment.
Treatment of Diabetic Retinopathy
The treatment for diabetic retinopathy, which largely depends on the type and severity of the disease, aims to slow or stop its progression.
Early diabetic retinal disease
If your nonproliferative diabetic retinopathy is mild or moderate, you may not need treatment immediately. However, your ophthalmologist will closely monitor your eyes to determine if treatment is necessary.
Work with your diabetes doctor (endocrinologist) to determine whether your diabetes management can be improved. When the severity of diabetic retinopathy is mild or moderate, good blood sugar control can typically slow its progression.
Progression of diabetic retinopathy
If you have proliferative diabetic retinopathy or macular edema, prompt treatment is required. Depending on the specific issues with your retina, the following options may be available:
Medications injected into the eye. These drugs, known as inhibitors of vascular endothelial growth factor, are injected into the vitreous of the eye. They inhibit the development of new blood vessels and reduce fluid accumulation.
The U.S. Food and Drug Administration (FDA) has approved three medications for the treatment of diabetic macular edema: faricimab-svoa (Vabysmo), ranibizumab (Lucentis), and aflibercept (Eylea). Bevacizumab (Avastin), a fourth drug, can be used off-label to treat diabetic macular edema.
These medications are injected while under topical anesthesia. Injections can cause mild discomfort, such as burning, tearing, or pain, for up to twenty-four hours after administration. Eye pressure buildup and infection are among the potential adverse effects.
These injections will require repetition. Occasionally, the medication is used in conjunction with photocoagulation.
Photocoagulation. This laser treatment, also known as focal laser treatment, can stop or slow blood and fluid leakage in the eye. Laser burns are used to treat abnormal blood vessel leaks during the procedure.
Typically, focal laser treatment is administered in a single session at your doctor’s office or eye clinic. If you had blurred vision due to macular edema prior to surgery, the treatment may not restore normal vision, but it will likely reduce the likelihood of the condition worsening.
Photocoagulation of the panretinal area. This laser therapy, also known as scatter laser therapy, can reduce the size of abnormal blood vessels. During the procedure, scattered laser burns are applied to areas of the retina outside of the macula. The burns shrink and scar the abnormal new blood vessels.
It is typically performed in a doctor’s office or eye clinic over the course of two or more visits. After the procedure, your vision will be blurry for approximately one day. After the procedure, some loss of peripheral vision or night vision is possible.
Vitrectomy. This procedure uses a tiny incision to remove blood from the middle of the eye (vitreous) and scar tissue that is pulling on the retina. It is performed in a hospital or surgery center under local or general anesthesia.
