Diabetic Retinopathy: What You Can Do To Protect Your Vision

Diabetic retinopathy is a potential complication of diabetes that damages the eye's retina. It affects half of all Americans diagnosed with diabetes. Anyone with diabetes is at riskthose with type 1 diabetes (formerly known as juvenile onset) and those with type 2 diabetes (formerly known as adult onset). Diabetic retinopathy may also be a problem for women with diabetes who become pregnant.

What happens?

Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. The retina is a light-sensitive tissue at the back of the eye. As light enters the eye, the retina changes the light into nerve signals.

The retina then sends these signals along the optic nerve to the brain. Without a retina, the eye cannot communicate with the brain, making vision impossible. In the early stages, most people do not notice any changes in their vision.

In the earlier stages of the disease, macular edema occurs when damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, blurring vision, making it hard to do things like read and drive. In some cases, vision will get better or worse during the day.

As the diabetic retinopathy progresses, it enters its advanced, or proliferative, stage. Fragile, new blood vessels grow along the retina and in the clear, gel-like vitreous that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina.

Other Diabetic Eye Diseases

Besides diabetic retinopathy, which causes damage to the blood vessels in the retina and is the most common diabetic eye disease, other eye diseases that people with diabetes may develop as a result of complications from this disease include:

Cataract: a clouding of the eyes lens. Studies show that a person with diabetes is twice as likely to get a cataract as a person who does not have the disease, and they develop at an earlier age.
Glaucoma: an increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. Studies show that a person with diabetes is also twice as likely to develop glaucoma as other adults, and the longer you have had diabetes, the greater your risk.

As new blood vessels form at the back of the eye, they can bleed (hemorrhage) and blur vision. The first time this happens it may not be very severe. In most cases, it will leave just a few specks of blood, or spots, floating in your vision. They often go away after a few hours.

These spots are often followed within a few days or weeks by a much greater leakage of blood. The blood will blur your vision. In extreme cases, a person will only be able to tell light from dark in that eye. It may take the blood anywhere from a few days to months or even years to clear from inside of your eye. In some cases, the blood will not clear. You should be aware that large hemorrhages tend to happen more than once, often during sleep.

How is it detected?

Your ophthalmologist will look at your retina for early signs of the disease, such as: (1) leaking blood vessels, (2) retinal swelling, such as macular edema, (3) pale, fatty deposits on the retinasigns of leaking blood vessels, (4) damaged nerve tissue, and (5) any changes in the blood vessels.

Should your doctor suspect that you need treatment for macular edema, he or she may ask you to have a test called fluorescein angiography. In this test, a special dye is injected into your arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This test allows your doctor to find the leaking blood vessels.

How is it treated?

There are two treatments for diabetic retinopathy, both are very effective in reducing vision loss.

Laser Surgery

Macular Edema: During the surgery, a laser is aimed directly onto the damaged blood vessels. This is called focal laser treatment. This seals the vessels and stops them from leaking. Generally, laser surgery is used to stabilize vision, not necessarily to improve it.

Medical Records Checklist: Diabetic Retinopathy

If you have diabetic retinopathy, include the following information in your PersonalMD medical records:

Name, address, and telephone number of your ophthalmologist
Date of your last visit to your ophthalmologist
Results of your eye examination and any tests that were performed
Treatment plan and/or recommendations
Date of your next eye appointment, or when you need to schedule another examination
Also, use your medical record to record any changes you are experiencing in your vision, for example if your vision is becoming cloudy or you are seeing spots or floaters. Also note when these changes occur. This information will be very helpful to your doctor

Proliferative Retinopathy: In treating advanced diabetic retinopathy, doctors use the laser to destroy the abnormal blood vessels that form at the back of the eye. Once you have proliferative retinopathy, you will always be at risk for new bleeding. This means you may need treatment more than once to protect your sight.

Vitrectomy

Instead of laser surgery, you may need an eye operation called a vitrectomy to restore your sight. A vitrectomy is performed if you have a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a salt solution. The doctor makes a tiny incision in the sclera, or white of the eye.

Next, a small instrument is placed into the eye. It removes the vitreous and inserts the salt solution into the eye. Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous.

Early vitrectomy is especially effective in people with insulin-dependent diabetes, who may be at greater risk of blindness from a hemorrhage into the eye.

What can you do to protect your vision?

Diabetic retinopathy has no early warning symptoms. It can be detected only by a comprehensive eye examination in which the pupils are dilated. The most important step people with diabetes can take to prevent blindness is to have a dilated eye exam at least once a year to find out if there are any changes that could lead to vision loss.

If you have more serious retinopathy, you may need to have a dilated eye examination more often. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.

Better control of blood sugar levels slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

Most people with diabetes do not have to expect blindness as a natural progression of their disease.

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