Diabetic Retinopathy

Diabetic retinopathy is a problem caused by diabetes that damages the eyes. It is caused by damage to the blood vessels in the retina.

Diabetic Retinopathy
Diabetic retinopathy is a problem caused by diabetes that damages the eyes. It is caused by damage to the blood vessels in the retina.

Diabetic retinopathy is likely to have no symptoms or only mild vision problems at the onset. Over time, it can lead to vision loss.

People with type 1 or type 2 diabetes can suffer from this disease. In general, the longer you have had diabetes or, the less time you have had blood sugar control, the greater the likelihood of developing this condition in the eyes.

Causes of Diabetic Retinopathy

Over time, excess sugar in the blood can cause the small blood vessels that supply the retina to become blocked, reducing blood supply. As a result, the eye tries to form new blood vessels. However, the new blood vessels do not form correctly and can bleed easily.

There are two types of diabetic retinopathy:

  • Precocious diabetic retinopathy is the most common type, known as "non-proliferative diabetic retinopathy," new blood vessels do notgrow.The walls of the blood vessels in the retina weaken. Microaneurysms (small dilations) protrude from the smallest vessels' walls and, in some cases, leak fluid and blood into the retina. The largest vessels in the retina may also begin to dilate and become more irregular in diameter. Early diabetic retinopathy can range from mild to severe as blood vessels become blocked.The nerve fibers in the retina are likely to start to swell. The macula, the central part of the retina, becomes inflamed, causing macular edema, a disease that requires treatment.

  • Advanced diabetic retinopathy, also known as "proliferative diabetic retinopathy," is the most serious type. Damaged blood vessels close, causing defective vessels to form in the retina, causing blood loss in the clear gelatinous substance that occupies the vitreous. If the new defective vessels impede normal flow, they could lead to nerve damage and glaucoma production.

Symptoms of Diabetic Retinopathy

You may not have symptoms in the early stages of diabetic retinopathy. As the disease progresses, some of the following symptoms may occur: 

  • Dark spots or strands that float in view (floaters) 

  • Blurry vision 

  • Altered color vision 

  • Variable vision 

  • Loss of vision or dark or empty areas 

In most cases, diabetic retinopathy affects both eyes.

Risk factor's of Diabetic Retinopathy

Anyone with diabetes can develop diabetic retinopathy. Risk factors can increase as a consequence of the following:

Diabetic Retinopathy Diagnosis

The specialist in Ophthalmology will be in charge of treating diabetic retinopathy, perform an eye exam with a dilated pupil, and ask a series of questions related to your symptoms, lifestyle, and medical history.

During the eye exam with the dilated pupil, the ophthalmologist will place a few drops in the eyes, which will allow the pupils to dilate, allowing the doctor to look into the eyes. The drops may cause near vision to be blurred until they wear off after several hours.

During the exam, the ophthalmologist will look at the following:

  • Optic nerve abnormalities

  • Detect evidence of cataracts

  • Retinal detachment

  • Abnormal blood vessels

  • Swelling, blood, or fatty deposits in the retina

  • Growth of scar tissue and new blood vessels

  • Bleeding into the clear jelly-like substance that fills the center of the eye (vitreous humor)

  • Measure vision

  • Measure eye pressure as a test for glaucoma

Following are the most common tests to perform to diagnose diabetic retinopathy.

  • Fluorescein angiography allows the ophthalmologist to detect blood vessels that are closed, broken, or leaking fluid.

  • Optical coherence tomography allows us to detect if any liquid has leaked into the retinal tissue.

Treatment of a Diabetic Retinopathy

Treatment varies depending on the type of diabetic retinopathy you present and the severity of it. It mainly focuses on slowing or stopping the progression of the disease. 

Early stage diabetic retinopathy. 

If you have mild to moderate non-proliferative diabetic retinopathy, you may not need treatment right away. However, the ophthalmologist will determine if a treatment is necessary. 

If diabetic retinopathy is mild, having good blood sugar control may be able to slow its progression. 

Advanced diabetic retinopathy 

In case of presenting advanced diabetic retinopathy, it will be necessary to receive immediate surgical treatment. 

Depending on the specific retinal problems, the most common treatment options include: 

  • Photocoagulation. Laser treatment can stop or decrease the leakage of blood and fluid into the eye. Leaks from damaged blood vessels are treated with laser burns. Usually this treatment is done in a single session. If you have had blurred vision due to macular edema before surgery, it is likely that the treatment will not allow you to regain normal vision, however it could reduce the worsening of the macular edema. 

  • Panretinal photocoagulation. Also known as scattered laser treatment, it can reduce the size of defective blood vessels. Areas of the retina away from the macula are treated with scattered laser treatment burns. Burns cause new defective blood vessels to heal and shrink. This procedure is usually done in two or more sessions. You will likely have blurred vision for a day after the procedure, and notice a partial loss of peripheral vision or night vision after the procedure. 

  • Intravitreal injection, medications are given into the eye, they can help stop the growth of abnormal new blood vessels. 

  • Vitrectomy, a small cut is made in the eye to remove the blood from the vitreous (center of the eye), as well as the scar tissue that pulls on the retina. 

Surgery generally manages to slow or stop the progression of diabetic retinopathy, however it does not represent a cure, since diabetes is a life-long disease.

Living with Diabetic Retinopathy

When you have already been diagnosed with diabetic retinopathy, follow the treatment provided by your ophthalmologist. 

Some things to consider that could help improve the quality of life are: 

  • Attend your regular review appointments 

  • Take the medications provided by your doctor 

  • Find a support group or talk to a therapist 

If you have lost your sight, ask your doctor about low vision products, such as magnifying glasses, and services that can make your daily life easier.

When do you have to see a doctor?

Make your appointment with your doctor in case of presenting some of the aforementioned symptoms or in case of detecting another abnormal symptom.

The Ophthalmologist is in charge of treating diabetic retinopathy; He will be responsible for making a diagnosis to identify the cause of the symptoms and identify the severity of the condition.

At the time of the consultation, try to keep a record and description of your symptoms, duration, and what you think triggered them. Also, mention any medications you are taking.

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