Diabetic retinopathy, also known as diabetic eye disease, is the most common cause of vision loss among people with diabetes. The condition affects the retina, a small patch of tissue at the back of the eye. The retina turns rays of light into signals for the brain, which allows us to see. A healthy retina is essential to good vision — any amount of retinal damage can cause irreversible vision loss.
There are four stages of diabetic retinopathy:
Mild non-proliferative retinopathy: This is the early stage of diabetic retinopathy. Small blood vessels in the retina begin to swell, which may cause fluid leakage. Most patients don’t experience symptoms of vision loss at this stage of the disease.
Moderate non-proliferative retinopathy: As the disease progresses, blood vessels continue to swell and leak. The vessels may lose their ability to transport blood to the retina, which causes swelling in the macula, the region of the retina responsible for sharp central vision. In patients with diabetes, buildup of fluid in the macula is called diabetic macular edema (DME).
Severe non-proliferative retinopathy: More blood vessels are blocked, halting the passage of blood to areas of the retina. This process sends a signal to the retina to grow new blood vessels.
Proliferative diabetic retinopathy (PDR): This is the most advanced stage of diabetic eye disease. The retina has grown new, unstable blood vessels to replace the blocked ones. The new blood vessels are fragile and likely to leak and bleed even more. Accompanying scar tissue can also cause the retina to contract, which increases the risk for retinal detachment. PDR can result in severe central and peripheral vision loss, or worse, permanent blindness.
What causes diabetic retinopathy?
High blood sugar levels cause damage to the tiny blood vessels in the retina of diabetic patients. Over time, the blood vessels start to swell and leak blood into the eye, which causes blind spots and blurry vision. The blood vessels can also close completely, which blocks the passage of blood to parts of the eye.
What are the symptoms?
Diabetic retinopathy is not detectable in its early stages, as there are typically no symptoms. In most cases, the eye disease will progress unnoticed by the patient until they experience blurry vision or “floaters,” which appear as dark spots in your line of sight. A comprehensive eye exam is required in order to examine the blood vessels of the retina and diagnose diabetic retinopathy. If vision has already been affected by the leakage of fluid in the retina, prompt treatment is required in order to prevent permanent vision loss.
Can you prevent diabetic retinopathy?
Anyone with type 1 or type 2 diabetes is at risk of developing diabetic retinopathy. 45 percent of diabetic Americans experience some stage of diabetic retinopathy, while only half of those people are aware they have the disease.
If you have diabetes, the best way to reduce your risk of diabetic retinopathy is to control your blood sugar levels, take medications as prescribed, stay active, and eat healthy. People with diabetes should also visit an eye doctor for a comprehensive dilated eye exam at least once a year. Early detection and treatment of diabetic retinopathy can help protect against long-term eye problems and vision loss.
Diabetic Retinopathy Treatment Options
In most cases, vision loss due to diabetic retinopathy is irreversible. The swelling of blood vessels in the retina can, however, be treated a number of different ways. Treatment for diabetic macular edema and PDR includes:
Anti-VEGF Injection Therapy: Vascular endothelial growth factor (VEGF) is a protein that causes abnormal blood vessels to grow and leak fluid. Blocking VEGF can reverse this process and reduce the amount of fluid in the retina. Anti-VEGF drugs include Avastin, Lucentis, and Eylea. Lucentis and Eylea are approved by the FDA for the treatment of diabetic macular edema.
Laser Surgery: Focal/grid macular laser surgery involves an application of laser energy to control the leakage of fluid from blood vessels in the retina and reduce swelling inside the eye.
Corticosteroids: Corticosteroids can be injected or implanted into the eye to suppress swelling caused by diabetic macular edema. Since corticosteroids can increase the risk of cataracts and glaucoma, it’s important for patients with DME to be monitored for changes in eye pressure levels.
Vitrectomy: A vitrectomy is a surgical procedure that involves the removal of the vitreous gel, located in the center of the eye. The procedure is only recommended for patients who experience severe bleeding in the vitreous as a result of diabetic retinopathy. During surgery, the vitreous gel is removed and replaced with a clear salt solution.
What is diabetic retinopathy?
