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What is diabetic retinopathy?

Diabetic retinopathy, also known as diabetic eye disease, is an eye condition that can affect people with diabetes. This condition occurs when the level of blood sugar increases, which damages the vessels in the light-sensitive tissues in the back of the eye (retina).

Diabetic retinopathy may cause no symptoms or cause only minor vision problems at the beginning, but it can eventually lead to blindness.

The condition can affect people with type 1 or type 2 diabetes. You are more likely to develop diabetic retinopathy if you do not control your blood sugar properly. 

What are the symptoms of the diabetic retina?

You may have symptoms in the early stages of diabetic retinopathy. As the condition worsens, symptoms of diabetic retinopathy may include:

  • Floating dark spots or strings in the vision (floaters)
  • Blurred vision
  • Fluctuating vision
  • Dark spots in your vision
  • Impaired color vision
  • Vision loss

What are the types of glaucoma?

Open-angle glaucoma

Open-angle glaucoma is the most common form of glaucoma. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork remains partially closed. This causes pressure inside the eye that gradually increases. This pressure damages the optic nerve. It happens slowly you may lose your vision before you even realize the scale of the problem.

Angle-closure glaucoma

Angle-closure glaucoma occurs when the iris protrudes forward to narrow or block the drainage angle formed by the cornea and iris. This prevents the fluid from circulating through the eye, and causes the pressure to increase.  Angle-closure glaucoma may occur suddenly (acute angle-closure glaucoma) or gradually (chronic angle-closure glaucoma).

Diabetic retinopathy often affects both eyes.

What are the causes of diabetic retinopathy?

High sugar levels in your blood can, over time, block the tiny blood vessels that supply the retina, cutting off its blood supply. Consequently, the eye tries to form new blood vessels, but these new blood vessels do not grow properly, and fluid can leak easily.

There are two types of diabetic retinopathy and they are:

  • Early diabetic retinopathy. In this more common type – called non-proliferative diabetic retinopathy (NPDR) – new blood vessels do not grow (proliferate).

And when you have non-proliferative diabetic retinopathy, the blood vessel walls in the retina weaken. Small bulges (microscopic aneurysms) protrude from the walls of blood vessels, from which fluid and blood sometimes leak into the retina. Larger retinal vessels begin to dilate and become irregular in diameter as well. As more blood vessels become blocked, NPDR can progress from mild to severe.

 

  • Advanced diabetic retinopathy. In this type, damaged blood vessels block, causing abnormal new blood vessels to grow in the retina, and it can leak into the clear, jelly substance that fills the center of the eye (the vitreous).

Tissue scarring stimulated by the growth of new blood vessels may eventually cause the retina to separate from the back of the eye. If the new blood vessels block the normal flow of fluid out of the eye, the pressure in the eyeball may increase. This can damage the nerve that carries images from the eye to the brain (the optic nerve), causing glaucoma.

What are the types of glaucoma?

Open-angle glaucoma

Open-angle glaucoma is the most common form of glaucoma. The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork remains partially closed. This causes pressure inside the eye that gradually increases. This pressure damages the optic nerve. It happens slowly you may lose your vision before you even realize the scale of the problem.

Angle-closure glaucoma

Angle-closure glaucoma occurs when the iris protrudes forward to narrow or block the drainage angle formed by the cornea and iris. This prevents the fluid from circulating through the eye, and causes the pressure to increase.  Angle-closure glaucoma may occur suddenly (acute angle-closure glaucoma) or gradually (chronic angle-closure glaucoma).

Diabetic retinopathy often affects both eyes.

What are the complications of the diabetic retina?

  • Vitreous hemorrhage. New blood vessels may bleed into the clear, gel-like substance that fills the center of the eye. If the amount of bleeding is small, you may only see a few dark spots (floaters). In advanced cases, blood can fill the vitreous cavity and completely block your vision.
  • Retinal detachment. The abnormal growth of blood vessels caused by diabetic retinopathy stimulates the growth of scar tissue, which may pull the cornea away from the back of the eye. This may cause floating spots in your eyes, flashes of light, or severe vision loss.
  • Glaucoma. New blood vessels may grow in the front of your eye and block the normal flow of fluid out of the eye, causing pressure to build up in the eye (cyanosis). The pressure can damage the nerve that transmits images from your eye to your brain (the optic nerve).
  • Blindness. Diabetic retinopathy, glaucoma, or both can lead ultimately to complete vision loss.

How to diagnose diabetic retinopathy?

Diabetic retinopathy is best diagnosed with a comprehensive eye exam. During this examination, drops are placed in your eyes to dilate the pupil to enable the doctor to see better inside your eyes. The drops may cause blurry vision, but this wears off after several hours.

During the examination, the ophthalmologist will look for the following:

  • Abnormal blood vessels
  • Fatty deposits, blood or swelling in the retina
  • Growth of new blood vessels and scar tissue
  • Bleeding in the clear substance that fills the center of the eye (vitreous)
  • Retinal detachment
  • Optic nerve disorders

How to treat diabetic retinopathy?

  • Early diabetic retinopathy. If your non-proliferative diabetic retinopathy is mild or moderate, you may not need to get treatment right away. However, the ophthalmologist will examine your eyes closely to determine if you need treatment.

The progression of the condition can usually be slowed with good blood sugar control if the diabetic retinopathy is mild or moderate.

  • Advanced diabetic retinopathy. If you have proliferative retinopathy or macular edema, you will need surgical treatment right away. Depending on the specific problems in the retina, options may include:
  • Photocoagulation. This laser treatment, also known as focal laser therapy, can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks of abnormal blood vessels are treated with a laser burn.

Focal laser treatment is usually performed in a single session in a doctor’s office or eye clinic. If you had blurred vision caused by macular edema before surgery, treatment may not restore vision to normal, but the chance of macular edema getting worse is likely to decrease.

  • Panretinal photocoagulation. This laser treatment can cause abnormal blood vessels to shrink. During the procedure, areas of the retina far from the macula are treated with scattered laser burns. The burns cause abnormal new blood vessels to shrink and scar.

The treatment is usually done in two or more sessions at a doctor’s office or eye clinic. Your vision will be cloudy for about one day after the procedure. Your peripheral vision or night vision may decrease to a certain degree after the procedure.

  • Vitrectomy. This procedure uses a very small incision in the eye. To remove blood from the center of the eye, as well as scar tissue that affects the retina. This procedure is performed in a surgical center or hospital, using general or local anesthesia.
  • Injecting the medicine into the eye. Your doctor may suggest that a drug be injected into the eye vitreous. These drugs, called vascular endothelial growth factor (VEGF) inhibitors, may help stop the growth of new blood vessels by blocking the effects of the growth signals the body sends to create new blood vessels.

Surgical procedures usually slow or stop the progression of diabetic retinopathy, but they are not considered a cure. Because diabetes is a lifelong condition, and it is still possible to damage the retina and lose vision in the future.

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