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What is diabetic retinopathy? | Types | Complications | Symptoms | Treatment | Prevention

What is diabetic retinopathy?

Diabetic retinopathy, a complication of diabetes, is an eye disease affecting the blood vessels in the retina . It damages blood vessels in the eye, causing them to either become weak and break down, or to become blocked .

Diabetic retinopathy is the leading cause of blindness among working-age Americans. The longer a person has diabetes, the greater his or her chance of developing diabetic retinopathy. Fifty percent of the people who have diabetes will have some vessel damage due to diabetic retinopathy. Twenty years after the onset of the disease, more than ninety percent of diabetics have some degree of retinopathy. Although diabetic retinopathy usually develops after a person has had diabetes for several years, it can occur when a person first develops diabetes. In fact, diabetic retinopathy can be one of the first signs of diabetes.

Types

There are two main types of diabetic retinopathy. In nonproliferative or background retinopathy, blood vessels damaged by high blood sugar leak fluid or blood causing the retina to swell and form deposits called exudates. If the swelling occurs in the area of the macula, sight may be diminished significantly. This condition can lead to more serious forms of retinopathy that affect vision.

In proliferative retinopathy, fragile blood vessels develop and grow on the surface of the retina. This process is also called neovascularization. If these vessels break and bleed, it can cause serious vision problems. The vitreous becomes cloudy preventing light from passing to the retina, blurring or distorting vision.

Complications

Several additional complications can occur as a result of diabetic retinopathy. Macular edema is caused when fluid collects in the macula, the part of the retina that allows us to see fine details. This condition makes it hard for the patient to read or do close work.

The growth of new blood vessels can lead to scar tissue and cause the retina to pull away from the back of the eye. If untreated, this condition, called retinal detachment, can lead to blindness. Abnormal blood vessels can also grow on the iris causing glaucoma.

Symptoms

There may be no noticeable symptoms in the early stages of diabetic retinopathy. A patient with non-proliferative retinopathy may experience a gradual blurring of his or her vision and have difficulty doing close work. Blurred vision also occurs because of macula edema. In this condition, the macula (the part of the retina that provides center vision) swells because of leaking fluid. In proliferative retinopathy, new vessels growing on the surface of the retina break down causing the vision of the person to become spotty, hazy or disappear completely. People with diabetes should have their eyes checked at least annually.

If you are experiencing some of the symptoms described here, it does not necessarily mean you have diabetic retinopathy. However, if you experience one or more of these symptoms, you should contact your eye doctor for a complete exam. Click here for information on emergency or immediate care.

Treatment

The best treatment for diabetic retinopathy is prevention. Good control of diabetes through the management and control of blood sugar may delay or prevent the progress of diabetic retinopathy.

If diabetic retinopathy does develop, laser photocoagulation is one of the most common treatments. This process uses a laser beam to seal leaking blood vessels in the retina.

Laser photocoagulation can also be used to treat proliferative retinopathy by destroying abnormal blood vessels growing in the back of the eye. In a process called scatter laser treatment, the eye professional will make hundreds of small laser burns away from the center of the retina. Although the patient will lose some peripheral vision, the center vision will be saved.

In the case of retinal detachment, lasers are used to seal the retina to the back of the eye. Laser surgery can reduce the risk of severe vision loss by ninety percent.

In the case of macular edema, laser surgery may also be used. However, vision that has been lost cannot be restored.

Vitrectomy is used with very advanced cases of proliferative diabetic retinopathy when a lot of blood is found in the vitreous. In this procedure, the surgeon removes the blood-filled vitreous and replaces it with clear salt solution which allows light to pass through to the retina. Vitrectomy is done under local anesthesia. After a tiny incision is made in the sclera, a small instrument is placed in the eye and is used to remove the vitreous and replace it with salt water. After surgery, the patient will need to wear an eyepatch for a few days or weeks and use medicated eyedrops. The earlier a person has a vitrectomy after a hemorrhage, the more likely it is their vision can be saved.

Prevention

Diabetic retinopathy cannot be prevented completely, but good control of blood sugar can reduce the risk. Both the onset and progression of diabetic retinopathy can be slowed though good control of blood sugar.

Diabetics are also at risk for other eye diseases such as cataracts and glaucoma. A diabetic is twice as likely to get a cataract (and at an earlier age) than a non-diabetic. They are also twice as likely to develop glaucoma.

Diabetic pregnant women are at a higher risk for diabetic retinopathy. To protect their eyes, they should have eye exams every trimester.