Diabetic Retinopathy

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Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that affects the retina's blood vessels. Persistently high blood sugar levels can damage these vessels, leading to vision impairment and increasing the risk of developing glaucoma, cataracts, retinal detachment, or even blindness. Both individuals with type 1 and type 2 diabetes can develop diabetic retinopathy. However, those with type 1 diabetes are at a higher risk compared to individuals with type 2 diabetes.

Stages of Diabetic Retinopathy

Diabetic retinopathy consists of four stages, each increasing in severity:

• Mild non-proliferative diabetic retinopathy (NPDR): In this early stage of diabetic retinopathy, small bulges called microaneurysms begin to form in retinal blood vessels. You're unlikely to experience noticeable symptoms at this stage.
• Moderate non-proliferative diabetic retinopathy (NPDR): At this stage, some blood vessels may become blocked, reducing the supply of nutrients and oxygen to certain areas of the retina.
• Severe non-proliferative diabetic retinopathy (NPDR): As the condition worsens, the blood vessels become increasingly blocked. Scar tissue forms, and the retina begins to generate new, abnormal blood vessels. Symptoms such as blurry vision and dark spots start to appear.
• Proliferative diabetic retinopathy (PDR): This is the most advanced stage of diabetic retinopathy. Abnormal blood vessels grow, bleed, and form additional scar tissue, which can pull the retina out of position. Retinal detachment is considered a medical emergency and, if left untreated, can result in permanent vision loss.

Diabetic Macular Edema

Diabetic macular edema (DME) is a serious complication of diabetic retinopathy. It occurs when fluid leaks into the macula, the small central part of the retina, causing swelling. DME can develop at any stage of diabetic retinopathy, but the risk increases with disease severity. You can't see swelling in your retina, but your eye care specialist can detect it during a thorough eye examination. If left untreated, DME can result in permanent vision loss.

Diabetic Retinopathy Symptoms

Most individuals with diabetic retinopathy don't experience noticeable symptoms in its early stages. However, as the condition progresses, symptoms may include:

• Blurry vision
• Difficulty seeing at night
• Floaters
• Objects appearing wavy or uneven
• Blind spots

In advanced stages of diabetic retinopathy, severe complications can arise, including eye pain, vision loss, vitreous hemorrhage (bleeding in the eye), and even complete blindness.

Diabetic Retinopathy Causes and Risk Factors

Diabetic retinopathy occurs when high blood sugar levels damage the retina's blood vessels. The key risk factors for developing this condition include the duration of diabetes — meaning the longer you have diabetes, the higher your risk — as well as poor blood sugar control. Additional health conditions, such as high blood pressure, high cholesterol, and obesity, can increase the risk. Lifestyle habits, including smoking, can further contribute. Furthermore, pregnant individuals with diabetes may face an increased risk of developing diabetic retinopathy.

Is Diabetic Retinopathy Preventable?

While diabetic retinopathy isn't completely preventable, you can reduce your risk and minimize progression through diligent diabetes management and regular eye exams. Important preventive strategies include controlling blood sugar, blood pressure, and cholesterol levels, as well as maintaining a healthy diet, engaging in regular exercise, and avoiding smoking. Annual dilated eye exams are crucial for early detection and treatment.

Diagnosing Diabetic Retinopathy

Retina specialists diagnose diabetic retinopathy through a comprehensive eye exam, during which they check for signs of swelling, abnormal blood vessels, and leakage. Diagnostic methods include:

• Eye dilation: During an eye exam, your doctor will use special drops to widen your pupil, allowing for a better examination of the retina.
• Ophthalmoscopy: A retina specialist may use an ophthalmoscope to shine a light into the eye and examine the retina.
• Optical coherence tomography (OCT): This non-invasive technique uses infrared light waves to capture detailed images of the retina.
• Fundus photography: This diagnostic and monitoring tool utilizes a specialized camera to capture detailed images of the retina, optic nerve, and blood vessels at the back of the eye.
• Fluorescein angiography: In this test, a retina specialist injects colored dye into the bloodstream. This dye travels to the blood vessels in the eye, and a special camera captures images to identify any abnormalities in the retina.

Treating Diabetic Retinopathy

Diabetic retinopathy treatment varies based on the severity of the condition. If your case is mild or moderate, adjusting your diabetes management plan can help control high blood sugar levels. For more advanced cases of diabetic retinopathy, additional treatments include:

• Focal laser treatment: Also known as photocoagulation, this procedure utilizes a high-energy laser to close abnormal blood vessels, preventing further leakage.
• Anti-vascular endothelial growth factor (anti-VEGF) medications: Anti-VEGF medications are a group of drugs used to inhibit the growth of blood vessels and leakage in the eye. Examples of anti-VEGF medications include Vabysmo, Eylea, Eylea HD, Cimerli, Lucentis, and Pavblu, which are administered via injection directly into the eye. These medications can also help manage macular edema, a condition where fluid builds up in the macula.
• Panretinal Photocoagulation (PRP): PRP is a laser treatment used on the peripheral retina to inhibit the growth of abnormal blood vessels in the eye. In many cases, this treatment can significantly reduce the risk of severe vision loss.
• Vitrectomy: This surgical procedure involves removing the vitreous humor from the eye, enabling the retina specialist to repair the retina. Vitrectomies can also be combined with PRP therapy to treat vitreous hemorrhage.

Diabetic Retinopathy Prognosis

The prognosis for diabetic retinopathy varies depending on the stage of the condition and factors such as blood sugar control. Early stages of diabetic retinopathy can be reversible, while advanced stages may lead to permanent vision loss. Many patients with this condition can maintain their vision quality by effectively managing their diabetes and regularly visiting a retina specialist for treatment and monitoring.