Diabetic Retinopathy

What Is Diabetic Retinopathy?

The highly skilled ophthalmologists at The Center for Retinal and Macular Diseases and Surgery at University Hospitals Eye Institute offer expert diagnosis and treatment of diabetic retinopathy – the most common eye disease in people with diabetes.

Diabetic retinopathy can’t be entirely prevented, but managing blood sugar slows the start of the condition and its progression. Controlling blood sugar can also reduce the need for laser surgery for severe retinopathy.

What Causes Diabetic Retinopathy?

Over time, excess sugar in the blood can block the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye will grow new blood vessels that don’t develop properly and can leak easily.

Two Stages of Diabetic Retinopathy

There are two stages of diabetic retinopathy:

• Nonproliferative retinopathy: The early stage when the blood vessels in the retina swell and leak. Changes in vision are common at this stage, including macular edema (swelling of the retina), which can lead to mild but treatable vision loss.
• Proliferative retinopathy: Characterized by the abnormal growth of new blood vessels on the surface of the retina, this is the advanced stage of the disease. The new vessels often break and bleed into the vitreous humor (the clear watery gel that fills the eye), which can lead to severe vision loss. Proliferative retinopathy generally requires urgent treatment.

Diabetic Retinopathy Symptoms

Some people in the early stages of diabetic retinopathy don’t have symptoms. As the disease progresses, symptoms may include:

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

Who Is at Risk for Diabetic Retinopathy?

Anyone with type 1 or type 2 diabetes is at risk for diabetic retinopathy. The longer you have diabetes, the higher your risk of developing diabetic retinopathy. Other factors that increase this risk include:

• High blood pressure
• High cholesterol
• Sleep apnea
• Smoking and other tobacco usage
• Pregnancy
• Ethnicity: Black, Hispanic and Native American people are at higher risk than other groups

How Is Diabetic Retinopathy Diagnosed?

In addition to performing an eye exam and reviewing your health history, your provider may do additional testing to diagnose diabetic retinopathy, including:

• Visual acuity test: The common eye chart test to measure your vision ability at various distances.
• Pupil dilation: Using eye drops, your pupil is widened (dilated) so that your eye doctor can perform a close-up exam of the eye’s lens and retina.
• Ophthalmoscopy: Your doctor looks very closely at the retina with the aid of a magnifying glass.
• Tonometry: The standard test to check the pressure (intraocular pressure) inside the eye.
• Fluorescein angiography: A dye is injected into the bloodstream to visualize the blood vessels in the eye and check if they’re leaking.
• Retinal photography: Photos are taken of the retina without pupil dilation to diagnose and follow the progression of diabetic retinopathy.
• Optical coherence tomography: An imaging technique in which light waves are used to make detailed images of the retina.

Diabetic Retinopathy Treatment

Your symptoms, age, general health and the progression of the diabetic retinopathy will determine your treatment options. Getting treated as early as possible is important to preserve vision before the damage to the retina is too severe.

Diabetic retinopathy treatment may include one or more of the following:

• Laser surgery: Treats proliferative retinopathy and sometimes macular edema. Laser surgery is used to shrink the abnormal blood vessels or seal ones that leak.
• Vitrectomy: The surgical removal of the vitreous humor and replacement with a balanced saline solution.
• Injections: To slow the growth of the abnormal vessels in the retina and treat macular edema, you doctor may recommend certain medications that are injected into the eye.

Can Diabetic Retinopathy Be Prevented?

Diabetic retinopathy can’t always be prevented. However, regular eye exams, good control of blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.

If you have diabetes, you can lower your risk of diabetic retinopathy:

• Get regular dilated eye exams: While eye exams can’t prevent diabetic retinopathy, they help diagnose eye problems that can then be treated. An eye exam can also let your healthcare provider know if your diabetes needs to be better controlled.
• Manage your diabetes: Engage in healthy eating and regular exercise as part of your daily routine. Take your oral diabetes medications or insulin as directed by your doctor.
• Monitor your blood sugar level: Follow your doctor’s direction on how often to test your blood sugar.
• Keep your blood pressure and cholesterol under control: Healthy eating, regular exercise and losing excess weight can help keep you blood pressure and cholesterol under control. Sometimes medication is needed.
• Avoid smoking and other types of tobacco usage: Ask your doctor to help you quit smoking, which raises your risk for diabetic retinopathy and other diabetes complications.
• Pay attention to vision changes: Contact your eye doctor immediately if your vision suddenly changes or becomes blurry, hazy or spotty.

Diabetes doesn’t necessarily lead to vision loss. Actively managing your diabetes can help prevent complications and preserve your vision.