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Diabetic retinopathy is damage to the eye's retina that occurs with long-term diabetes.
Retinopathy - diabetic; Photocoagulation - retina
Diabetic retinopathy is caused by damage to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. It changes light and images that enter the eye into nerve signals that are sent to the brain.
There are two types, or stages of retinopathy: non-proliferative or proliferative.
Other problems that may develop are:
Having more severe diabetes for a longer period of time increases the chance of getting retinopathy. Retinopathy is also more likely to occur earlier and be more severe if your diabetes has been poorly controlled. Almost everyone who has had diabetes for more than 30 years will show signs of diabetic retinopathy.
Most often, diabetic retinopathy has no symptoms until the damage to your eyes is severe.
Symptoms of diabetic retinopathy include:
Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.
In nearly all cases, the health care provider can diagnose diabetic retinopathy by dilating the pupils with eye drops and then carefully examining the retina. A retinal photography or fluorescein angiography test may also be used.
The following are very important for preventing diabetic retinopathy:
People with nonproliferative diabetic retinopathy may not need treatment. However, they should be closely followed-up by an eye doctor trained to treat diabetic retinopathy.
Treatment usually does not reverse damage that has already occurred, but it can help keep the disease from getting worse. Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.
Several procedures or surgeries are the main treatment for diabetic retinopathy.
Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels.
A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may also be used to repair retinal detachment.
Drugs that prevent abnormal blood vessels from growing, and corticosteroids injected into the eyeball are being investigated as new treatments for diabetic retinopathy.
If you cannot see well:
American Diabetes Association - www.diabetes.org
National Diabetes Information Clearinghouse - www.diabetes.niddk.nih.gov
Prevent Blindness America - www.preventblindness.org
You can improve your outcome by keeping good control of your blood sugar and blood pressure.
Both treatments are effective at reducing vision loss. They do not cure diabetic retinopathy or reverse the changes that have already occurred.
Once proliferative retinopathy occurs, there is always a risk for bleeding. You will need ongoing monitoring, and you may need more treatment.
Call for an appointment with an eye doctor (ophthalmologist) if you have diabetes and you have not seen an ophthalmologist in the past year.
Call your doctor if any of the following symptoms are new or are becoming worse:
Tight control of blood sugar, blood pressure, and cholesterol is very important for preventing diabetic retinopathy.
Do not smoke. If you need help quitting, ask your doctor or nurse.
You may not know there is any damage to your eyes until the problem is very bad. Your doctor can catch problems early if you get regular exams. You will need to see an eye doctor who is trained to treat diabetic retinopathy.
Begin having eye examinations as follows:
If you are beginning a new exercise program or are planning to get pregnant, have your eyes examined. Avoid resistance or high-impact exercises, which can strain already weakened blood vessels in the eyes.
Rosenblatt RJ, Benson WJ. Diabetic Retinopathy. In: Yanoff M, ed. Opthalmology. 2nd ed. St. Louis, MO: Mosby; 2004;877-887.
American Diabetes Association (ADA). Standards of Medical Care in Diabetes: 2009. Diabetes Care. 2009;32:S13-S61.
O'Doherty M, Dooley I, Hickey-Dwyer M. Interventions for diabetic macular oedema: a systematic review of the literature. Br J Opthalmol. 2008;92:1581-1590.
Diabetic Retinopathy Clinical Research Network (DRCR.net), Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009;127:245-251.