Diabetic Retinopathy

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Editors
Puneet Singh Arora, MBBS, MS, FACE


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What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes where high blood glucose causes damage to the blood vessels in the light-sensitive part of the retina (the back part of the eye). The retina plays an important role in vision, it records the images the eye takes in and converts them into electrical signals sent to the brain. The brain then interprets the electrical signals, so you understand what you’re seeing. Diabetes is a major cause of retinopathy. More than 80% of people who have had diabetes 20 years or longer develop diabetic retinopathy.

Diabetic retinopathy occurs in both type 1 and type 2 diabetes; the likelihood of developing the condition increases with duration of disease and is higher in people with uncontrolled blood glucose levels. Retinopathy means “diseases of the retina.” It is an broad term describing several conditions. The most common are:

  • Non-proliferative retinopathy an early stage sign of retinopathy where blood vessels swell or become blocked
  • Macular edema is when fluid leaks into the macula (center of the retina) causing vision to blur
  • Proliferative retinopathy is damage to the blood vessels depriving the retina of oxygen

Damage to the retina can occur without symptoms and can eventually cause vision problems that can not be corrected by eyeglasses or contact lenses. That’s why it’s critical for people with diabetes to get regular eye exams by an eye doctor. 

Diabetic Retinopathy Image

Understanding Complications and Treatment

Treatment depends on the type of retinopathy you have. Controlling blood pressure and blood sugar can prevent eye problems. The appearance of diabetic retinopathy is associated with the rapid increase of a protein called vascular endothelial growth factor (VEGF) in the retina. VEGF stimulates the production of new blood vessels in the retina to bring more oxygen to the tissue but because blood circulation is prevented due to diabetes. Blood vessel leakage from diabetic retinopathy can cause fluid to accumulate in the center if the retina, which is the most sensitive part of the retina that is responsible for vision. If macular edema is present, or complications have progressed to proliferative retinopathy the following treatment is most commonly used are: 

  • Anti-VEGF, injection which help reduce the production of protein in the retina
  • Corticosteroids, medicine to reduce swelling or the amount of fluid present in the retina
  • Focal/grid macular laser surgery, laser treatment that helps to repair damage to the eye tissue by sealing the vessels that are leaking or eliminating damaged blood vessels all together

Terms you should know:

Cataracts - A condition in which the eye’s lens becomes cloudy and blocks light.

Complication - A disease or health condition brought on by another disease or health condition.

Glaucoma - An excess of pressure in the eye, which causes damage to the retina and optic nerve.

Macula - A part of the retina that controls fine detail perception.

Non-proliferative retinopathy - The early stages of retinopathy where the blood vessels at the back of the eye swell up and form pouches.

Proliferative retinopathy - The later, more dangerous stage of retinopathy, in which blood vessels are so damaged that they shut off, and new, weaker blood vessels grow in the retina.

Retina - The back part of the eye, which is responsible for changing images the eye sees into electrical signals that are sent to the brain.

Retinopathy - Damage to the retina.

Vitreous fluid - The fluid in the eye’s middle.

Vitrectomy - A surgical procedure in which cloudy fluid and scar tissue is removed from inside the eye.

Preventing eye problems

  • Smoking can increase chances of developing retinopathy. Talk with your doctor about ways to help you stop smoking
  • Control your blood sugar, blood pressure, and blood fats (triglycerides)
  • Be physically active for at least 30 minutes a day
  • Maintain a healthy weight
  • Limit carbohydrates and sugar, eat foods high in fiber, healthy fats and protein

Questions to ask your doctor?

  1. Am I at risk for diabetic eye problems?
  2. How do I control my blood glucose levels, what is my target range?
  3. How can I prevent or delay the beginning of diabetic eye problems?
  4. How often should I be seen for eye exams by an eye care professional?
  5. What are my treatment options?

Edited April 2018