Diabetic retinopathy (DR) is a common microvascular complication of diabetes. Diabetic retinopathy is a condition which is characterised by a change in the retina’s blood vessels of the eye. The retina is a thin layer of tissue that lines the back of the eye on the inside and is located near the optic nerve. It senses light and sends images to your brain for visual recognition. The abnormal blood vessel is caused by an increase in blood glucose which can harm the blood vessels. When these blood vessels thicken, they can develop leaks, which can then lead to vision loss. New blood vessels may also grow causing further damage. Many people who have diabetes have some form of diabetic retinopathy.

There are four stages of diabetic retinopathy, ranging from mild to severe. At the initial stages of diabetic retinopathy, your sight loss may not be noticeable or detected. It is only during the late stage would the vision be affected, by which the damage to the retina may be irreversible.

• Stage 1: Mild non-proliferative retinopathy
  At this stage, tiny blood vessels swell in the retina. Some early leakage may take place.

• Stage 2: Moderate non-proliferative retinopathy
  Some of the blood vessels that feed the retina become blocked. Leaky blood vessels are more likely.

• Stage 3: Severe non-proliferative retinopathy
  More blood vessels are being blocked resulting in other areas of the retina not being nourished leading to areas of the retina not receiving adequate blood flow. Without proper blood flow, the retina cannot grow new blood vessels to replace the damaged ones. Signals are then sent to the body to grow new blood vessels.

• Stage 4: Proliferative retinopathy
  This is when sight loss can occur quickly. This is the advanced stage of the disease. Additional new blood vessels will begin to grow in the retina, but they will be fragile and abnormal, causing blurred vision, severe sight loss or blindness.

The advanced stages of diabetic retinopathy can also increase your vulnerability to developing other eye conditions such as a detached retina, which requires surgery, or glaucoma.

Anyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics will be affected. In the early stages of diabetes, you may not notice any change in your vision. But by the time you notice vision change; your eyes may already be damaged by the disease.

Risk of developing the eye condition can increase as a result of:

• Duration of diabetes — the longer you have diabetes, the greater your risk of developing diabetic retinopathy
• Poor control of your blood sugar level
• High blood pressure
• High cholesterol
• Pregnancy
• Tobacco use

Diabetic eye disease is a leading cause of blindness and vision loss. Because of the high risk for eye disease, all those who are diagnosed with diabetes at age 30 and older should receive an annual dilated eye exam. For people with diabetes younger than 30, an annual dilated exam is recommended after they have had diabetes for 5 years.

Do not wait for symptoms! When left untreated, diabetic retinopathy damages your retina. You might not have symptoms in the early stages of diabetic retinopathy. Once symptoms develop, it may be too late to save the vision. As the condition progresses, symptoms of diabetic retinopathy may include:

• Spots or dark strings floating in your vision (floaters)
• Blurred vision
• Fluctuating vision
• Impaired colour vision
• Dark or empty areas in your vision
• Vision loss

“Diabetic retinopathy usually affects both eyes”

An eye doctor can usually tell if you have diabetic retinopathy during an eye exam. The best way to diagnose diabetic retinopathy is a dilated eye exam. During this exam, the physician places drops in the eyes to make the pupils dilate (open widely) to allow a better view of the inside of the eye, especially the retinal tissue.

Your eye doctor will look for:

• Swelling in the retina that threatens vision (diabetic macular edema)
• Evidence of poor retina blood vessel circulation (retinal ischemia)
• Abnormal blood vessels that may predict an increased risk of developing new blood vessels
• New blood vessels or scar tissue on the surface of the retina (proliferative diabetic retinopathy)

Regular dilated eye exams by an ophthalmologist are important, especially for those who are at a higher risk for diabetic retinopathy or diabetes. If you are over age 50, an exam every 1 to 2 years is a good idea so the physician can look for signs of diabetes or diabetic retinopathy before any vision loss has occurred. In addition to checking for signs of diabetic eye disease, a comprehensive dilated eye exam will evaluate your vision need for corrective lenses, eye pressure (looking for glaucoma), the “front” of the eye (eyelids, cornea, checking for dry eyes), lens (looking for cataracts), as well as a complete exam of the retina and vitreous.

Treatments such as scatter photocoagulation, focal photocoagulation, and vitrectomy prevent blindness in most people. The sooner retinopathy is diagnosed; the more likely these treatments will be successful. The best results occur when sight is normal.

At your comprehensive eye exam, the ophthalmologist will carefully view the retina through your dilated pupil. The doctor will look for any currently leaking blood vessels or evidence of past vessel leakage. These problems are often seen before you notice any visual symptoms. Early detection and treatment are critical to preventing vision loss.

People with nonproliferative diabetic retinopathy may not need treatment. However, they should be closely followed-up by an eye doctor.

For patients with proliferative diabetic retinopathy, treatment may be recommended and though treatment usually does not reverse damage that has already occurred, it can help keep the disease from getting worse. Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.

• Laser eye surgery, called photocoagulation. Your ophthalmologist makes tiny burns on the retina with a special laser. These burns seal the blood vessels and stop them from growing and leaking. In scatter photocoagulation (also called panretinal photocoagulation), your ophthalmologist makes hundreds of burns in a polka-dot pattern on two or more occasions. Scatter coagulation reduces the risk of blindness from vitreous hemorrhage or detachment of the retina – but it only works before bleeding or detachment has progressed very far. This treatment is also used for some kinds of glaucoma. Side effects of scatter photocoagulation are usually minor.

• Focal laser photocoagulation Your ophthalmologist aims the laser precisely at leaking blood vessels in the macula. This procedure does not cure blurry vision caused by macular edema. But it does keep it from getting worse. When the retina has already detached or a lot of blood has leaked into the eye, photocoagulation is no longer useful.

• Scatter laser treatment or panretinal photocoagulation treats a large area of your retina. This treatment can shrink the abnormal blood vessels. During the procedure, if severe bleeding is found inside the eye (vitreous haemorrhage) is severe, laser may not be possible.

• Vitrectomy is a surgical procedure required to clear the bleeding in the eye. This procedure is performed by a vitreo-retinal surgeon, a highly trained ophthalmologist.

In diabetic eye disease, abnormal blood vessels develop that can break, bleed, and leak fluid. If left untreated, these damaged blood vessels can result in a rapid and severe loss of vision. The most effective treatments to date for this blood vessel damage are the anti-angiogenic drugs injections such as Avastin (bevacizumab), Accentrix (ranibizumab), Eylea (aflibercept) or Ozurdex (dexamethasone implant). These drugs are given as injections in the eye.

Patients with diabetes frequently ask, “Is there anything I can do to keep from getting diabetic retinopathy or to prevent or treat vision loss once it occurs?”

You cannot always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.

If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:

• Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Try to get at least 150 minutes of moderate aerobic activity, such as walking, each week. Take oral diabetes medications or insulin as directed.

• Monitor your blood sugar level. You may need to check and record your blood sugar level several times a day — more frequent measurements may be required if you’re ill or under stress. Ask your doctor how often you need to test your blood sugar.

• Ask your doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test, or hemoglobin A1C test, reflects your average blood sugar level for the two- to three-month period before the test.

• Keep your blood pressure and cholesterol under control. Eating healthy food, exercising regularly and losing excess weight can help. Sometimes, medication is needed too.

• If you smoke or use other types of tobacco, it is advisable that you quit. Smoking increases your risk of various diabetes complications, including diabetic retinopathy.

• Pay attention to vision changes. Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.

Remember, diabetes does not necessarily lead to vision loss. Taking an active role in diabetes management can go a long way toward preventing complications.

If you develop retinopathy, the eye doctors at Island Hospital will know when and how to treat the damage to your eyes.

People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. Risk also increases with age.

Many people without diabetes develop cataracts, but people with diabetes are 60% more likely to develop this eye condition. People with diabetes also tend to develop cataracts at a younger age and have them progress faster. Diabetic retinopathy is a general term for all disorders of the retina caused by diabetes.

Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Pregnancy may worsen diabetic retinopathy, so if you are pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy.

If you have any risk factors or are experiencing any of the common symptoms for diabetic retinopathy, see an eye doctor right away. Eye doctors can check your eyes and determine if you are at risk for diabetic retinopathy using any one of six diagnostic tests:

• Visual acuity test is an eye exam that checks how well you see the details of a letter or symbol from a specific distance.

• Dilated eye exam During the exam, each eye is closely inspected for signs of common vision problems and eye diseases, many of which have no early warning signs.

• Tonometry is a test to measure the pressure inside your eyes.

• Optical coherence tomography (OCT) is a noninvasive imaging technology for your ophthalmologistto see each of the retina’s distinctive layers to map and measure their thickness.

• Fundus photography is a specialized low power microscope with camera to photograph the interior surface of the eye, including the retina, retinal vasculature, optic disc, macula, and posterior pole

• Fluorescein angiogram is when your ophthalmologist uses a special camera to take pictures of your retina. These pictures help your ophthalmologist get a better look at the blood vessels and other structures in the back of the eye.

Sight lost from diabetic retinopathy cannot be restored, but with early detection, treatment is often very successful and can prevent your sight from getting worse.

It is extremely important for diabetic patients to maintain the eye examination schedule put in place by the retina specialist. How often an examination is needed depends on the severity of your disease. Through early detection, the ophthalmologist can begin a treatment regime to help prevent vision loss in almost all patients and preserve the activities you most enjoy.

In Island Hospital, we are committed to provide advanced, attentive, professional and convenient care. We bring world-class care to you, delivered with expertise and compassion. Learn more about our leading-edge therapies, innovative treatments, and exceptional specialty eye care.