Diabetic retinopathy is a form of eye disease caused by chronically high or variable blood sugar that is associated with diabetes. If left untreated, diabetic retinopathy can lead to vision loss and blindness. The condition develops slowly throughout many years; therefore, it is essential to undergo regular eye tests when you have Diabetes. Retinopathy is basically impaired blood vessels in the retina which is the thin inner light-sensitive layer situated in the back of the eyes. In some cases, these vessels will swell up (macular oedema) and leak fluid into the rear of the eye. In other cases, abnormal blood vessels will grow on the surface of the retina.
Diabetic retinopathy occurs in three stages:
- Background retinopathy - Background retinopathy is said to occur if you have developed microaneurysms on your retina. Microaneurysms are when there is a swelling of the capillaries (very small blood vessels) that feed the retina. It is an early warning sign that your diabetes has lead to some damage of the small blood vessels of your retina.
- Diabetic maculopathy - The macula is the part of the eye that helps to provide us with our central vision. Diabetic maculopathy is when the macula sustains some form of damage. One such cause of macular damage is from diabetic macular oedema whereby blood vessels near to the macula leak fluid or protein onto the macula.
- Proliferative retinopathy - If a significant number of blood vessels on the retina become damaged, your body will respond by releasing a growth hormone known as Vascular Endothelial Cell Growth Factor (VEGF). The growth hormone stimulates the growth of new blood vessels. However, these new blood vessels are particularly weak and prone to leaking. Proliferative retinopathy is the body’s attempt to save its retina but it can often lead scarring of the retina and can cause the retina to detach, leading to blindness.
Symptoms
You might not have any signs of diabetic retinopathy until it becomes serious. When you do have symptoms, you might notice:
- Loss of central vision, which is used when you read or drive
- Not being able to see colors
- Blurry vision
- Holes or black spots in your vision
- Floaters, or small spots in your vision caused by bleeding
- Poor night vision
Risk factors
Anyone who has diabetes can develop diabetic retinopathy. 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
- Being African-American, Hispanic or Native American
Detection and diagnosis of diabetic retinopathy
Diabetic retinopathy can be detected by undergoing a comprehensive eye examination that emphasizes on the evaluation of specifically the retina and macula. Such a test may include:
- Visual acuity measurements – measuring a patient’s ability to see at different distances.
- Patient history – to determine the presence of diabetes, vision impairments and other general health issues that may affect vision.
- Tonometry – Measuring pressure within the eye.
- Refraction – to establish whether a prescription for new glasses is required.
- Pupil dilation – evaluation of eye structures, including assessment of the retina and optic nerve through a dilated pupil.
Supplementary testing may be required which include:
- Retinal tomography or photography – In this test retina’s current status is documented.
- Fluorescein angiography test - During this test, your doctor will inject a dye into your arm, allowing them to track how the blood flows in your eye. They’ll take pictures of the dye circulating inside of your eye to determine which vessels are blocked, leaking, or broken.
- An optical coherence tomography (OCT) exam - It is an imaging test that uses light waves to produce images of the retina. These images allow your doctor to determine your retina’s thickness. OCT exams help determine how much fluid, if any, has accumulated in the retina.
Treatment
Treatment of diabetic retinopathy depends on the extent of the disease.
- Eye Injections - Eye Medications called vascular endothelial growth factor (VEGF) inhibitors can be used to help stop the growth of new blood vessels and improve vision. Most people who receive these injections will need to get them for at least three months. Over time, some people may need to get them less often or may no longer need them at all, but others will need to continue in order to protect their vision.
- Focal laser surgery - This surgery attempts to stop or reduce the leaking of blood or fluid into the eye by burning and sealing the damaged blood vessels.
- Photocoagulation - This is usually done in your doctor’s office as an outpatient procedure during a single session. The procedure may or may not restore your vision to normal, but it should prevent your condition from worsening.
- Scatter laser surgery - This surgery uses lasers to burn the damaged blood vessels so that they shrink. This procedure may require more than one application, and your vision may be blurry for a day or more after each session. You may also experience loss of peripheral vision or night vision after the procedure.
- Vitrectomy - This surgery is done under general anesthesia and involves making a tiny incision in the eye to remove blood from the vitreous fluid, as well as any scar tissue that may cause retinal detachment.
Complications
Diabetic retinopathy involves the abnormal growth of blood vessels in the retina. Complications can lead to serious vision problems:
- Vitreous hemorrhage - The new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision. Vitreous hemorrhage by itself usually doesn't cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision may return to its previous clarity.
- Retinal detachment - The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss.
- Glaucoma - New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).
- Blindness - Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.
How can I reduce my risk of Retinopathy?
You can reduce your risk of developing diabetic retinopathy, or help prevent it getting worse, by:
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