Anyone who has diabetes can develop diabetic retinopathy. Risk of developing the eye condition can increase as a result of:
Duration of diabetes — the longer you have diabetes, the greater your risk of developing diabetic retinopathy
Poor control of your blood sugar level
High blood pressure
Being African-American, Hispanic or Native American
Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily. The bleeding does not cause pain and can only be detected upon examination.
You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include:
Spots or dark strings floating in your vision (floaters)
Impaired color vision
Dark or empty areas in your vision
Diabetic retinopathy usually affects both eyes.
Stages of Diabetic Retinopathy
Stage 1: Mild nonproliferative diabetic retinopathy
This is the earliest stage of diabetic retinopathy, characterized by tiny areas of swelling in the blood vessels of the retina. These areas of swelling are known as micro aneurysms.
Small amounts of fluid can leak into the retina at the stage, triggering swelling of the macula. This is an area near the center of the retina.
Stage 2: Moderate nonproliferative diabetic retinopathy
Increased swelling of tiny blood vessels starts to interfere with blood flow to the retina, preventing proper nourishment. This causes an accumulation of blood and other fluids in the macula.
Stage 3: Severe nonproliferative diabetic retinopathy
A larger section of blood vessels in the retina become blocked, causing a significant decrease in blood flow to this area. At this point, the body receives signals to start growing new blood vessels in the retina.
Stage 4: Proliferative diabetic retinopathy
This is an advanced stage of the disease, in which new blood vessels form in the retina. Since these blood vessels are often fragile, there’s a higher risk of fluid leakage. This triggers different vision problems such as blurriness, reduced field of vision, and even blindness.
At each annual eye exam, we will screen you for diabetic retinopathy. It's important to know your most recent A1C and glucose readings before your appointment.
If we find diabetic retinal findings, we will perform the following tests at your follow up:
Dilated Fundus Exam- This allows us a 3D view of the retina
Re-refraction- When your blood sugar levels are elevated, this can cause a shift in your refraction. We will want to re-check your glasses prescription when better control over blood sugar is obtained for accurate readings.
A1C and Glucose readings- It's important that we know updated readings before your follow up. We will also want contact information for your endocrinologist and/or primary care doctor to send a report.
OCT- It maybe necessary to perform an additional cross section scan to determine the exact layer of the retina the blood is located.
WHAT ARE THE TREATMENT OPTIONS FOR DIABETIC RETINOPATHY?
Early Stages: The most important part of your treatment is to keep your diabetes under control. The retina will reabsorb small micro-hemorrhages once blood glucose levels are stabilized.
Advanced Stages: For advanced diabetic retinopathy that is threatening or affecting your sight, the main treatments are:
Laser treatment – to treat the growth of new blood vessels at the back of the eye (retina) in cases of proliferative diabetic retinopathy, and to stabilize some cases of maculopathy.
Eye injections – to treat severe maculopathy that's threatening your sight.
Eye surgery – to remove blood or scar tissue from the eye if laser treatment isn't possible because retinopathy is too advanced.