Diabetic Retinopathy

What Is Diabetic Retinopathy?

People with diabetes can develop an eye condition called diabetic retinopathy. This is when high blood sugar levels cause damage to the blood vessels in the retina. These blood vessels can swell and leak, or they can close, stopping blood from passing through. All of these changes can result in vision loss.

Diabetic retinopathy typically develops without early warning signs. The damage to the eye can occur slowly and is hard to detect without regular and accurate monitoring.

What are the Symptoms of Diabetic Retinopathy?

Since diabetic retinopathy rarely has symptoms in its early stages, it is possible to have diabetic retinopathy and not even know it. As the condition worsens, you may experience:

• Blurry vision
• Seeing spots or floaters
• Impaired night vision
• Noticing colors appear faded or washed out
• Dark or empty spots in vision
• Vision loss

Symptoms typically affect both eyes. Because of a lack of early symptoms, it is important that if you have diabetes, you have an annual comprehensive eye exam. Your sight depends on it! The longer diabetic retinopathy goes undiagnosed, the higher the chances become that you will experience permanent vision impairment.

What are the Stages of Diabetic Retinopathy?

There are two main stages of diabetic eye disease:

Non-Proliferative Diabetic Retinopathy (NPDR)

This is the early stage of diabetic eye disease, and many people with diabetes have it. With NPDR, the weakened blood vessels can begin to leak fluid and blood. When the macula swells, it is called macular edema. This is the most common reason why people with diabetes lose their vision. Also with NPDR, blood vessels in the retina can close off, keeping blood from reaching the macula. This is referred to as macular ischemia, and can cause significant vision loss.

Proliferative Diabetic Retinopathy (PDR)

PDR is the more advanced stage of diabetic eye disease. In PDR, the lack of blood flow due to the number of damaged blood vessels is great enough to cause the eye to grow new blood vessels to try and help itself, a process called neovascularization. Unfortunately, these new blood vessels do not help. These fragile vessels can easily burst with minor trauma like a forceful sneeze or cough, causing the eye to fill with blood. These abnormal vessels also result in scar tissue formation that may cause the retina to detach from the back of the eye. PDR is very serious, as it can steal both your central and peripheral vision.

How is Diabetic Retinopathy Treated?

Treatment depends on the extent of the disease and can include:

Medical Management

Certain medications (injections) may help to relieve inflammation or reduce swelling of the macula, thereby slowing vision loss and perhaps improving vision.

Anti-Vascular Endothelial Growth Factor (Anti-VEGF)

This treatment is an injection that can help with two problems. It can reduce the number of abnormal blood vessels in the retina and can also decrease fluid. We may recommend anti-VEGF treatment in both cases of NPDR and PDR.

Focal or Grid Laser

In certain instances, laser surgery is used to seal a blood vessel that is leaking or to stimulate the cells under the retina to absorb the leaked fluid. In some cases, more than one treatment is needed.

Panretinal Photocoagulation (PRP) Laser

In the case of the more serious PDR where abnormal blood vessels have developed, we may recommend a laser procedure called panretinal photocoagulation (PRP). By using a laser to make tiny burns in the peripheral retina, we reduce the signals for the growth of the abnormal blood vessels and cause these vessels to shrink. In some cases, more than one treatment is needed.

Vitrectomy

For more severe cases of diabetic retinopathy when the eye is filled with blood or if a retinal detachment is present, vitrectomy surgery is used. Vitrectomy is a surgical procedure that removes vitreous gel, blood and scar tissue in the back of the eye. It is also used to repair retinal detachments that result from scar tissue and abnormal blood vessel growth in advanced diabetic eye disease. By removing the vitreous hemorrhage and reattaching the retina, light rays are again able to focus correctly on the retina.

If you are concerned about any diabetes-related eye problems, our experienced retina specialist, Dr. Mohsenin, will be happy to discuss potential solutions and develop an individual treatment plan for you.