Diabetic Eye Disease and Retinopathy
What is diabetic retinopathy?
Diabetic retinopathy is the most common eye disease in people with diabetes. It is a leading cause of blindness in American adults. Changes in the blood vessels of the retina, the light sensitive layer of tissue at the back of the inner eye, can lead to this condition. In some people, retinal blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.
According to Cesar Espiritu MD, PIH Health Family Medicine physician, “While you can’t completely prevent diabetic retinopathy, you can reduce your risk of getting it. Controlling your blood sugar slows the start of retinopathy. It also keeps it from getting worse. And, it lessens the need for laser surgery for severe retinopathy”.
Diabetic eye disease refers to a group of eye problems that people with diabetes may face. All can cause severe vision loss or even blindness. Fortunately, diabetic eye disease often can be treated before vision loss occurs. All people with diabetes need a dilated eye exam at least once a year.
What causes diabetic retinopathy?
Changes in the blood vessels of the retina cause diabetic retinopathy. In some people with diabetic retinopathy, the blood vessels in the retina may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.
Who is at risk for diabetic retinopathy?
Anyone with diabetes is at risk for diabetic retinopathy. The longer you have diabetes, the more likely you are to develop diabetic retinopathy. Your risk rises if you have diabetes and you smoke, have high blood pressure, or are pregnant.
What are the symptoms of diabetic retinopathy?
In the early stages of diabetic retinopathy, you may have no symptoms. Vision may not change until the disease gets worse. Then you may have blurry or double vision, dark or floating spots, pain or pressure in one or both eyes, rings, flashing lights, or blank spots in your vision.
A condition called macular edema may occur from diabetic retinopathy. It happens when the macula, a part of the retina, swells from the leaking fluid and causes blurred vision. When new vessels grow on the surface of the retina, they can bleed into the eye. This may decrease vision.
How is diabetic retinopathy diagnosed?
Along with a complete health history and eye exam, your eye care professional may do these tests to diagnose diabetic retinopathy:
- Visual acuity test. This is the common eye chart test. It measures vision ability at various distances.
- Tonometry. This standard test is done to check the pressure (intraocular pressure, or IOP) inside the eye.
- Pupil dilation. For a close up exam of the eye’s lens and retina, your pupil is widened with eye drops.
- Ophthalmoscopy. This is a test where a doctor looks very closely at the retina using a special magnifying glass.
- Fluorescein angiography. In this test, a dye is injected into the bloodstream. The dye helps the blood vessels in the eye show up while pictures are taken with a special camera. This test lets the doctor see if the blood vessels are leaking.
- Optical coherence tomography. In this test, light waves are used to make detailed images of the retina.
How is diabetic retinopathy treated?
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
Even people with advanced retinopathy have a good chance of keeping their vision if they are treated before the retina becomes severely damaged. Treatment for diabetic retinopathy may include:
- Laser surgery. This is often used to treat macular edema and proliferative retinopathy. It involves shrinking the abnormal blood vessels, or sealing the leaking ones.
- Vitrectomy. Vitrectomy is a procedure that involves removing the cloudy, jelly-like substance (vitreous) that fills the center of the eye. The vitreous is replaced with a saline solution.
- Injections. Certain chemicals can be injected into the eye to slow the growth of the abnormal vessels of the retina.
Can diabetic retinopathy be prevented?
Although you can't prevent diabetic retinopathy, you can reduce the risk of developing it by:
- Having a dilated eye exam once a year. An eye exam does not prevent retinopathy. But it can help diagnose eye problems that can then be treated. An eye exam can also alert you and your healthcare provider if the diabetes needs to be better controlled.
- If you're a women with diabetes, have an eye exam before pregnancy or in the first trimester. Continue to be monitored every trimester and for 1 year after birth depending on how severe the retinopathy is.
Following your diabetes management plan by:
- Taking medicines as directed
- Using insulin as directed, if needed
- Eating to manage blood sugar level
- Exercising to lower and help the body use blood sugar
- Testing blood-sugar levels regularly
- Testing urine for ketone levels regularly
- Regular healthcare follow-up to evaluate diabetes control and rule out or treat other risk factors, such as high blood pressure
Better control of blood sugar slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.
For more information about diabetes and its complications, visit your primary care physician (PCP). If you don’t have a PCP, contact Dr. Espiritu’s office at 562.789.5420 or visit PIHHealth.org/Find-a-Doctor.
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