Type 1 and Type 2 diabetes can cause a host of vision-related complications for patients, especially if blood sugar is not well controlled. As we introduced in a previous post here on the blog, the most common of these diabetic eye diseases is diabetic retinopathy—up to 45% of Americans with diabetes have some stage of diabetic retinopathy, which can lead to significant vision loss or blindness over time.
While these facts may paint a gloomy picture, the good news is that diabetic retinopathy can be treated and even prevented with routine vision care, which includes a comprehensive dilated eye exam at least once per year. Today’s post offers a closer look at what diabetic retinopathy is and how our caring vision experts at Campus Eye Center can help you manage and treat all varieties of diabetic eye disease.
What is Diabetic Retinopathy?
In short, diabetic retinopathy is a diabetes complication that damages the blood vessels within the retinas, which are the light-sensitive tissues at the back of the eyes. Diabetic retinopathy usually affects both eyes simultaneously.
Diabetic retinopathy may cause different changes in different individuals. For some patients, the retinal blood vessels might swell and leak fluid. This is the most common problem and usually associated with what is known as non-proliferative diabetic retinopathy (NPDR). In other people, abnormal blood vessels grow on the surface of the retina. This more advanced type of disease is known as proliferative diabetic retinopathy, so-called because new blood vessels are proliferating (growing) in the eyes.
What causes it to develop?
When blood sugar is too high on a regular basis, retinal blood vessels can become blocked, which causes swelling and the eventual closing off of damaged vessels. The body may try to replace these closed off blood vessels, which leads to the proliferative form of diabetic retinopathy. Careful management of your diabetes will help blood sugar stay below dangerous levels and protect these tiny blood vessels.
The main risk factor for developing diabetic retinopathy is having diabetes. Both Type 1 and Type 2 diabetes patients are vulnerable. Of course, several other health factors increase risk. These include:
- Poor control of your blood sugar level
- High blood pressure
- High cholesterol
- Tobacco use
Additionally, patients of African-American, Hispanic, or Native American descent have a slightly higher chance of developing diabetic retinopathy. Your risk also elevates as you age with diabetes over time—the longer you have diabetes, the more likely it is that you will develop diabetic retinopathy.
What are the first signs or symptoms of Diabetic Retinopathy?
If you have diabetic retinopathy, you might not notice changes to your vision at first. This is why it is vital to keep up with yearly eye exams, as your professional eye care team can detect the disease in its earliest stages before you even notice symptoms. These symptoms include:
- The appearance of floaters (spots or dark strings in your field of vision)
- Blurred and/or fluctuating vision
- Impaired color vision
- Dark or empty areas in your field of vision
- Vision loss
What happens as the disease progresses?
Without treatment, diabetic retinopathy can eventually lead to complete, permanent vision loss as a result of retinal detachment or glaucoma. Diabetic retinopathy also sometimes causes vitreous hemorrhage, which is when the abnormal blood vessels forming in a patient’s eyes bleed into the clear, jelly-like substance that fills the center of the eye (the vitreous). Vitreous hemorrhage does not usually lead to permanent blindness, but it causes dramatic vision loss for weeks or months at a time.
The 4 stages of diabetic retinopathy
Diabetic retinopathy typically progresses through four distinct phases if not well managed by a patient’s eye care team. These include three severity levels of non-proliferative diabetic retinopathy (NPDR) and finally, PDR as the fourth stage.
1. Mild NPDR
Microaneurysms, or small areas of balloon-like swelling in the retina’s tiny blood vessels that can leak fluid into the retina, occur at the earliest stage of the disease.
2. Moderate NPDR
Blood vessels that nourish the retina may swell and become distorted as diabetic retinopathy progresses. The blood vessels also lose their ability to transport blood at this stage.
3. Severe NPDR
Many blood vessels become blocked, which cuts off blood supply to areas of the retina. These areas then may secrete growth factors that signal the retina to grow new blood vessels.
4. Proliferative diabetic retinopathy (PDR)
New blood vessels are actively growing in the retina, but they are abnormal and tend to leak into the vitreous of the eyes.
More about Proliferative Diabetic Retinopathy (PDR)
The National Eye Institute (NEI) of the National Institutes of Health (NIH) describes PDR in this way:
“At this advanced stage, growth factors secreted by the retina trigger the proliferation of new blood vessels, which grow along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye. The new blood vessels are fragile, which makes them more likely to leak and bleed. Accompanying scar tissue can contract and cause retinal detachment—the pulling away of the retina from the underlying tissue, like wallpaper peeling away from a wall. Retinal detachment can lead to permanent vision loss.”
PDR is a significant threat to patients’ vision, but there are effective treatments that can often preserve central vision.
What Treatments Are Available?
PDR is most often treated with laser surgery known as panretinal laser surgery, panretinal photocoagulation, or (more simply) scatter laser surgery. These procedures work best before new, fragile blood vessels have started to bleed.
NPDR is often managed with lifestyle and dietary changes, regular monitoring by experienced eye care specialists, and careful blood sugar and cholesterol level control by the patient. The goal is to keep NPDR from progressing in severity and eventually developing into PDR, which requires surgery to correct, as mentioned above.
How to Prevent Diabetic Retinopathy
The best way to prevent diabetic retinopathy is to work with your diabetes care team to personalize a blood sugar control and disease management plan that’s right for you. Also be sure to visit your eye doctor for a comprehensive dilated eye exam at least once per year.
Campus Eye Center Can Help You Prevent or Manage Diabetic Retinopathy
In the Lancaster, PA area, Campus Eye Center is recognized as one of the best resources for helping patients live better by seeing better. If you have been diagnosed with diabetic retinopathy or are concerned about your risk of developing any type of diabetic eye disease (including cataracts or glaucoma), our experienced doctors want to work with you.
Please contact us to make an appointment at one of our two convenient locations today!