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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If you are an adult, have a thorough eye exam at the time of diabetes diagnosis and yearly thereafter.
If you are over 10 and have had diabetes for at least 3 years, you also need a comprehensive exam once a year.
- After the initial exam, see an eye doctor familiar with retinopathy and other diabetes complications of the eyes once a year for a dilated exam.
- Call your diabetes care provider if you notice changes in your vision, but don’t panic. Highs and lows in your blood glucose level may cause temporary blurring in your vision.
- Keep your blood glucose levels close to normal. You will help prevent damage to the small blood vessels that run through your retina.
- Have regular blood pressure checks, and work to keep your blood pressure on target.
- Discuss your exercise program with your eye doctor. Some activities can raise the pressure inside your eyes and lead to bleeding in the retina.
- If you have retinopathy, avoid taking birth control pills because they may affect the clotting of your blood or increase your blood pressure.
- Get early treatment for eye problems! Early intervention, such as laser treatment for retinopathy, cuts the risk of blindness by 90 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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For adults with type 1 diabetes: You need to have a dilated eye exam within five years of being diagnosed and every year after that.
For adults with type 2 diabetes: You need to have a dilated exam soon after you have found out you have diabetes. About 1 in 5 people with type 2 diabetes have some eye problems when they find out they have diabetes. That's why it's important to have an eye exam soon after you find out you have diabetes.
After the first eye exam, all adults with diabetes need a dilated eye exam every year. Exams may be needed more often if you have eye problems.
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As diabetes retina problems get worse, new blood vessels grow. These new blood vessels are weak. They break easily and leak blood into the vitreous of your eye. The leaking blood keeps light from reaching the retina.
You may see floating spots or almost total darkness. Sometimes, the blood will clear out by itself. But, you might need surgery to remove it.
Over the years, swollen and weak blood vessels can form scar tissues and pull the retina away from the back of the eye. If the retina becomes detached, you may see floating spots or flashing lights.
You may feel as if a curtain has been pulled over part of what you are looking at. A detached retina can cause loss of sight or blindness if you don't take care of it right away.
Call your eye care professional right away if you are having any vision problems or if you have had a sudden change in your vision.
This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.
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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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A new treatment for proliferative diabetic retinopathy uses drugs that block VEGF, originally developed for cancer chemotherapy, to prevent new blood vessels from growing. Two such medications are available: Avastin (generic name bevacizumab) and Lucentis (generic name ranibizumab). These medications are normally injected directly into the eye tissues, though there are ongoing studies to determine if they will work if given intravenously.
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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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