Diabetic Retinopathy (Eye Damage)
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For anyone with either type 1 or type 2 diabetes, eye care is an important priority. By keeping your blood glucose level close to normal, you can lower your risk for some of the long-term effects of diabetes and preserve your eyesight. An eye specialist monitors changes in your eyes, especially those changes associated with diabetes. He or she then determines what those changes mean and how they should be treated. For example, changes in the tiny blood vessels that supply your retina—the part of the eye that detects light and thus visual images—could be an early sign of diabetic retinopathy. Left untreated, diabetic retinopathy can lead to blindness.
Although your diabetes care provider will look at your eyes during the course of your yearly physical examination, you also need to have them more thoroughly examined by a trained eye specialist. Your eyes need to be dilated for this exam. If you are 10 years of age or older and have type 1 diabetes, you should have a comprehensive examination 3 to 5 years after you are diagnosed with diabetes and yearly thereafter. If you are an adult with type 2 diabetes, you should have a comprehensive eye and visual exam conducted by an eye doctor when you are diagnosed and every year thereafter—even if your vision is fine. Also, if you notice any changes in your vision or you are planning a pregnancy, you should be examined.
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Type 2 diabetes commonly affects organs with small blood vessels, such as the eye. High blood sugars cause the lining of blood vessels to thicken and make it difficult for these small vessels to dilate (open up) and constrict (clamp down) appropriately. Over time, this stress causes blood vessels to become leaky and weak, leading to diabetic eye disease called diabetic retinopathy.
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Background retinopathy is a type of damage to the retina of the eye, marked by bleeding, fluid accumulation and abnormal dilation of the blood vessels. Background retinopathy is an early stage of diabetic retinopathy. It is also called simple or nonproliferative retinopathy.
Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes. There are two major types of retinopathy: nonproliferative (capillaries in the back of the eye balloon and form pouches) and proliferative (a more serious form in which the blood vessels are so damaged they close off).
The longer you've had diabetes, the more likely you are to have retinopathy. Almost everyone with type 1 diabetes will eventually have nonproliferative retinopathy. And most people with type 2 diabetes will also get it. But the retinopathy that destroys vision, proliferative retinopathy, is far less common. People who keep their blood sugar levels closer to normal are less likely to have retinopathy or to have milder forms.
The researchers in the Diabetes Control and Complications Trial found that after 10 years, intensive management reduced the risk of developing diabetic retinopathy by 76 percent. Among individuals who already had early signs of eye disease before entering the trial, intensive management slowed the progression of retinopathy by 54 percent.
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There are steps you can take to avoid eye problems if you have diabetes:
- First and most important, keep your blood sugar levels under tight control. In the Diabetes Control and Complications Trial, people on standard diabetes treatment got retinopathy four times as often as people who kept their blood sugar levels close to normal. In people who already had retinopathy, the condition progressed in the tight-control group only half as often. These impressive results show that you have a lot of control over what happens to your eyes. Also, high blood sugar levels may make your vision temporarily blurry.
- Second, bring high blood pressure under control. High blood pressure can make eye problems worse.
- Third, quit smoking.
- Fourth, see your eye care professional at least once a year for a dilated eye exam. Having your regular doctor look at your eyes is not enough. Nor is having your eyeglass prescription tested by an optician. Only optometrists and ophthalmologists can detect the signs of retinopathy. Only ophthalmologists can treat retinopathy.
- Fifth, see your eye care professional if:
- Your vision becomes blurry
- You have trouble reading signs or books
- You see double
- One or both of your eyes hurt
- Your eyes get red and stay that way
- You feel pressure in your eye
- You see spots or floaters
- Straight lines do not look straight
- You can't see things at the side as you used to
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Diabetic retinopathy, the leading cause of blindness in American adults, is caused by damage to the eyes' blood vessels. High blood sugar levels and high blood pressure associated with diabetes can cause the tiny blood vessels of the eyes to swell, weaken and leak fluid, which can lead to blurry or double vision and ultimately to partial or total blindness. In some people, abnormal blood vessels grow on the surface of the retina. Notify your doctor at the first sign of any vision problems and have eye exams yearly to minimize your own risks of diabetic retinopathy.
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Retinopathy is a diabetic eye disease that results in damage to the small blood vessels in the retina, the light-sensitive layer of tissue that lines the back of the eye. Loss of vision may result. A dilated eye exam in which the pupil (the black center) of the eye is temporarily enlarged with eyedrops allows an eye care specialist to see the inside of the eye more easily. There are two types of retinopathy:
- nonproliferative retinopathy: damage to the retina marked by bleeding, fluid buildup, and abnormal dilation of the blood vessels. It is an early stage of diabetic retinopathy.
- proliferative retinopathy: a condition in which fragile new blood vessels grow along the retina and in the clear gel that lies behind the eye's lens and in front of the retina.
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Changes to the eye caused by diabetes are collectively known as diabetic retinopathy. Diabetes affects the eye in two ways:
- The changing blood sugar levels affect the lens of the eye and blood vessels in the retina
- Changes in the lens cause vision to blur with the changing blood sugar levels. The same fluctuations cause blood vessels to leak, including those in the eye.
Diabetes can affect many organs, and an annual examination of the retina is important because it is a good indicator of overall vascular status. Patients with insulin dependent or type 1 onset diabetes don't exhibit hemorrhages and exudates in the retina as early as patients with type 2. Early abnormalities in the center of the retina (macula) or in the peripheral blood vessels may be corrected with laser or other therapies.
Fluctuating vision caused by the change of sugar in the lens of the eye may be the first sign of diabetes along with extreme thirst and frequent urination. Insurance companies require primary care doctors to forward annual information, which includes an eye examination. Therefore, ophthalmologists are required to perform an annual eye care exam for diabetics. Many diabetics can actually improve through diet and exercise, of which both regulate their blood sugar and may require less medication. Diabetes represents a condition where there needs to be a strong partnership between patients and health care providers. It is often avoidable and manageable,and therefore it is important to recognize and treat it before profound complications such as diabetic retinopathy occur.
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Diabetic retinopathy can appear in three forms, macular edema, background retinopathy (BDR), and proliferative diabetic retinopathy (PDR). Macular edema is swelling in the center of the retina without involvement of the periphery. BDR is leakage of blood vessels around the macula and the optic nerve in an irregular scattered fashion. It tends to be slow but may be a forerunner of either macular edema or proliferative changes.
PDR is characterized by sprout of new blood vessels growing from the surface of the retina or optic nerve directly into the fluid vitreous cavity. This new blood vessel formation is called neovascularization and can also grow from areas in the peripheral retina. The consequences are the same; the blood vessels grow along with scar tissue, which may contract and pull off the retina (retinal detachment). Therefore PDR is the most serious diabetic complication in the eye.
PDR is associated with:
- Increased severity of disease
- Increased duration of disease
- Elevated HbA1c
- Protein in the urine
- Men
- Increased diastolic blood pressure (the lower number)
- Family history
Blurred vision may not be recognized immediately but if the fragile new blood vessels bleed, blurred vision is sudden. And if the retina becomes torn and pulled off, a curtain comes down across the vision. Therefore, annual dilated eye exams are imperative for diabetics so that complications such as BDR and PDR can be detected early. The standard treatment for PDR without bleeding is pan retinal photocoagulation (PRP) laser. The basis for making a concentric series of small laser burns all around the periphery of the retina is to kill off enough cells to extinguish the low oxygen supply to them. By removing the low oxygen stimulus surprisingly these new blood vessels disappear and even background changes may fade. The laser light is absorbed by either the pigment under the retina or the blood cells in the blood vessels enabling the focal scar to occur. The peripheral location of the scars does not affect central vision but does reduce the peripheral visual field and night vision (adaptation to the dark). Given the choice of progressive deterioration in vision and destruction of the retina, PRP has much more benefit than risk. The treatments may be done in one or several sessions and are approximately 55% immediately successful. In many instances, the success rate is much higher when performed by
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Diabetes is a systemic disease and one of the leading causes of visual loss. Diabetes may be associated with leakage of blood vessels in the eye and development of new, abnormal types of circulation within the retina. Over the past 30 years ophthalmologists have developed accurate staging and treatment protocols for the various stages of diabetic eye disease. Vision loss can be significantly reduced and sometimes prevented through careful screening and evaluation by an ophthalmologist. Typically we work closely with internal medicine, family practice physicians and endocrinologists to coordinate the care of our patients. As ophthalmologists we are often able to detect the earliest stages of diabetes in our patients and impact overall impact of this disease on our patients.
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During the first three stages of diabetic retinopathy, no treatment is needed unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions are usually required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision. Scatter laser treatment works better before the fragile new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may be possible, depending on the amount of bleeding. If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.
This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.
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