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Diabetic Retinopathy
People with diabetes are unfortunately at a higher risk for numerous diabetic eye diseases, which can lead to severe vision loss and sometimes even blindness.

Diabetic retinopathy is the most common eye disease that damages the blood vessels in the retina.  It usually affects both eyes and occurs in people with Type I and Type II diabetes.
 

Diabetes causes damage to vessels throughout the body.  Vision loss due to diabetic blood vessel damage can occur in two major ways.  Both ways affect the retina, the nerve tissue that lines the back wall of the eye.  In the first way blood vessels that are normally present can be damaged so that they begin to leak fluid into the retina causing it to swell and malfunction.  This is called diabetic macular edema.  In the second way, damaged blood vessels are unable to bring the necessary nutrients and oxygen to the retina nerve tissue.  The eye then signals the body to produce new vessels (neovascularization) within the eye to overcome this problem.  However, while important in the heart, kidney, and brain, abnormal vessels growing in the eye have detrimental effects leading to bleeding, retinal detachment, glaucoma, and ultimately, loss of the eye.  This is known as proliferative diabetic retinopathy.   Both of these complications (retinal edema and new vessel growth) from diabetes can be treated with laser therapy by an experienced retinal specialist.
 

There are no common symptoms present during the early stages of diabetic retinopathy. If you experience blurred vision or "floating" spots, contact your ophthalmologist as soon as possible.

When an eye exam should be scheduled?

  • If you have any blurriness, floaters, or distortion in your vision, an exam should be scheduled as soon as possible with your ophthalmologist.
  • If you were diagnosed with diabetes at 30 years old or younger, you should have your first eye exam no later than five years after diagnosis.
  • If you were diagnosed with diabetes after the age of 30, you should have an exam within a few months of diagnosis.
  • If you are pregnant and have diabetes, an exam should be scheduled during the first trimester.
  • If you have high-risk conditions (diabetes for more than 20 years, kidney failure, high risk for vision loss), an eye exam should be scheduled immediately.
Illustration showing abnormal vessel growth and bleeding
associated with diabetic retinopathy

How is diabetic retinopathy diagnosed?

An ophthalmologist can diagnose diabetic retinopathy by looking into the eyes with a table-top microscope and a special lens.  Other evaluation techniques may be used, including fluorescein angiography and optical coherence tomography.
  • Optical Coherence Tomography uses light rays to obtain a cross-sectional image of the retina.  It is extremely sensitive and may be used to measure the degree and extent of swelling in the macula
  • Fluorescein angiography is obtained by involves injecting a small amount of a non-iodine based yellow dye into the vein of the arm.  Photographs are taken as the dye travels through and "highlights" the retinal vessels.  Abnormal areas glow to help guide treatment options.   
  • Ultrasonography is used when the physician cannot adequately see the retina because of a severe amount of blood in the eye (vitreous hemorrhage) or other opacity such as a cataract.  Sound waves are then used to acquire a picture of the posterior segment of the eye to grossly determine the condition of the retina.

How is diabetic retinopathy treated?
  • Laser Surgery can be used to shrink abnormal new vessels and reduce macular swelling.  Major studies have shown this intervention can help reduce the chance of severe vision loss from diabetic retinopathy.  
  • Eye Injections are sometimes used to help reduce swelling in the macula and possibly treat abnormal blood vessel growth.
How can diabetic retinopathy be prevented?

People with diabetes can help prevent the development of diabetic retinopathy by carefully managing their blood sugar level, blood pressure level, and cholesterol level.  Smoking cessation is also strongly encouraged.  If a person is in the final stage of diabetic retinopathy (Proliferative Retinopathy), laser treatments are available to help shrink the fragile blood vessels, which can ultimately preserve sight.  Some eyes require surgery (Vitrectomy) to undo the damage caused by abnormal blood vessel growth.  In some cases vitrectomy is used in an effort to relieve macular swelling when it doesn't respond to laser or injections.
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