Diabetic Retinopathy

I. What is Diabetic Retinopathy?
Diabetic retinopathy is an eye disease, which results from damage of blood vessels in the back of the eye from high blood sugar. The small blood vessels in the retina become weak and break down or become blocked. They can leak fluid or bleed. The retina may swell. Within the leaking fluid, there may be protein and fat, which deposit as exudates as the water component is absorbed. This form of diabetic retinopathy is nonproliferative or Background Diabetic Retinopathy.

Background Diabetic Retinopathy (fluorescein angiogram photo) Click to Enlarge

Background Diabetic Retinopathy (fundus photo - same patient) Click to Enlarge

The leading cause of legal blindness in people with diabetes is macular edema. This is fluid accumulation within the center of the retina, or macula, which we use for central vision, reading vision, fine detailed vision, and color vision.

Proliferative Diabetic Retinopathy is a potential cause of severe vision loss. New, fragile blood vessels grow along the surface of the retina onto the vitreous gel in the middle of the eye. These blood vessels may bleed into the vitreous causing clouded vision. These blood vessels may bring scar tissue, which pulls the retina away from the back of the eye, causing a retinal detachment.

Proliferative Diabetic Retinopathy (fluorescein angiogram photo) Click to Enlarge

Proliferative Diabetic Retinopathy (fundus photo - same patient) Click to Enlarge

New blood vessels may grow on the iris, or the colored part of the front of the eye. This can lead to a painful glaucoma.


II. Who is at risk for Diabetic Retinopathy?
Diabetic retinopathy is one of the complications associated with the circulatory problems of people with diabetes.

The longer a person has diabetes, the greater the risk of retinopathy. More than 80 percent of those who have diabetes for 15 or more years have some blood vessel damage. And some of these people develop the most serious result of the disease: severe vision loss or blindness.

However, the disease does not affect only people who have had diabetes for many years. It can appear within the first year or two after the onset of the disease. For some people, retinopathy is one of the first signs that they have diabetes.


III. How do I know if I have Diabetic Retinopathy?
Sometimes, there are visual symptoms of blur, floaters, strings and cobwebs, or parts of vision missing. Sometimes, you may have no symptoms, especially in early diabetic retinopathy.

Your eye doctor is best equipped to tell you if you have changes in the retina from diabetes with an ophthalmoscope and slit-lamp microscope. The best way to be examined is with a dilated pupil.


IV. How is Diabetic Retinopathy evaluated?
The most important part of evaluation for diabetic retinopathy is a regular eye exam. You will be dilated so be prepared to have difficulty with near vision for several hours. It is best to have someone else drive you to your visit. If leakage or new blood vessel growth is seen, you may need Fluorescein Angiography. This is a photographic study of the back of the eye while a dye is injected in a vein of the arm. The dye circulates through the body into the eye to show where leaky vessels are present, or where treatment is needed.


V. How is Diabetic Retinopathy treated?
Diabetic retinopathy does not always require treatment. Good control of your diabetes with intensive management and control of your blood sugar will delay, and possibly prevent, both the development and progression of diabetic retinopathy.

Laser Photocoagulation is one of the most common treatments for diabetic retinopathy. In this kind of surgery, brief spots of bright light are directed at the retina to seal leaking blood vessels. The laser beam spots can also be scattered through the sides of the retina to reduce abnormal blood vessel growth (neovascularization) and help seal the retina to the back of the eye. This can help prevent bleeding and retinal detachment.

Laser surgery can usually be done in the ophthalmologist's office or outpatient surgery center setting. Occasionally it is done at the hospital. Numbing eye drops will be put in your eyes to reduce any discomfort during the procedure. You may also have an injection of local anesthesia to numb the entire area around the eye. Often, topical or local anesthesia is all that's needed, but you and your surgeon may decide you need some sedation-medication to make you less anxious as well. There is little recuperation needed after laser surgery for diabetic retinopathy. Laser surgery may require more than one treatment to be effective.

Vitrectomy is recommended if you have very advanced proliferative diabetic retinopathy or retinal detachment. In vitrectomy, the surgeon removes the blood-filled vitreous and replaces it with clear salt water. If the retina is detached, a gas bubble may be placed in the eye to assist the reattachment of the retina. The gas bubble will leave the eye by itself over time.

Vitrectomy is performed in the hospital or outpatient surgery center under local or general anesthesia. You may need to stay in the hospital overnight. The surgeon will use a special microscope to look into your eye, and will perform the procedure using microsurgical instruments.

After vitrectomy surgery, you may experience some discomfort. Your ophthalmologist can give you medication to alleviate this. Most people wear an eye patch for about a week after surgery to protect the eye. Your surgeon may suggest that you refrain from some activities, and when you can resume your normal activities.

The type of retinopathy you have, your general health and eye structure will determine the kind of treatment (if any) you need for your condition, and the kind of anesthesia you will have.

As with all surgery, there are risks associated with surgery for diabetic eye conditions. Complications are unusual, but can include: infection, bleeding, elevated pressure in the eye, which can lead to glaucoma, retinal detachment or scarring, or even loss of vision. All these are stated not to scare anyone away form surgery but to make one aware that any time we do anything there are always potential complications.


VI. How can I prevent vision loss from Diabetic Retinopathy?
The longer a person has diabetes, the higher the likelihood they will develop diabetic retinopathy. It may not always be possible to prevent vision loss by good control of diabetes alone. Sometimes early intervention with laser is necessary to reduce the risk of vision loss, even while vision is good.

Taking good care of yourself significantly reduces your risk of diabetic eye disease, as well as many of the other complications associated with diabetes. You should keep your blood sugar under best possible control, maintain a healthy diet, and exercise regularly. Control blood pressure, and avoid cigarette smoking. Yearly dilated eye exams by an ophthalmologist are the best way to preserve your vision. Early detection of diabetic eye disease is essential in preventing vision loss.

Retinal Disorders

Diabetic Retinopathy
Age-Related Macular Degeneration
Retinal Vein and Artery Occlusions
Macular Hole
Macular Pucker
Retinal Tears and Detachments
What is Fluorescein Angiography?
What is Photodynamic Therapy?
What is ICG Angiography?
What is optical coherence tomography?

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