Diabetes is a chronic health condition that affects millions of Americans. The condition occurs when the body stops producing a sufficient amount of insulin, which is responsible for controlling blood sugar levels as your body breaks food down and uses it for energy. When too much sugar builds up in the bloodstream, it can eventually start to damage blood vessels throughout the body.
When blood vessel damage from diabetes occurs in the retina, it is known as diabetic retinopathy. As the retinal blood vessels become damaged, they begin to bleed or leak fluid into the retina. Over time, damaged retinal blood vessels can also start developing scar tissue, which can cause a wide range of visual impairments, including floaters, blurred vision, and distortion. In severely advanced cases of diabetic retinopathy, permanent vision loss can happen.
Because diabetes has become an increasingly prevalent health issue in the US, cases of diabetic retinopathy are also on the rise. Diabetic retinopathy is one of the most common causes of blindness in adults with Type 1 or Type 2 diabetes. However, if detected early on and managed properly, patients with diabetic retinopathy have a good chance of preserving their vision.
Types of Diabetic Retinopathy
Diabetic retinopathy is a progressive disease that occurs in stages. The earliest stage is referred to as non-proliferative or background diabetic retinopathy (NPDR). If left untreated, NPDR can transition into proliferative diabetic retinopathy (PDR).
Non-Proliferative or Background Diabetic Retinopathy (NPDR)
In the earliest stages of NPDR, many patients do not experience any symptoms. At this point, the retinal blood vessels have only started to leak and bleed into the retina. As the fluid continues to accumulate, the blood vessels and retina begin to swell. When swelling and fluid accumulation occurs close to the center of the retina, it can lead to blurred, distorted, or dull vision. This is known as diabetic macular edema.
Proliferative Diabetic Retinopathy (PDR)
Proliferative diabetic retinopathy is the severe, more advanced stage of this disease. Damage caused by high blood sugar levels leads to a lack of sufficient blood flow and oxygen. In an attempt to combat this, the retina tries to grow new blood vessels to replace those that have been damaged, a process known as neovascularization. However, these new blood vessels do not grow normally – they break, bleed (vitreous hemorrhage), form scar tissue, and in extreme cases can even lead to retinal detachment. For some patients, the new/abnormal blood vessels can grow in front of the eye which will cause heavy pressure known as neovascular glaucoma.
Diabetic Retinopathy Diagnosis
In the early stages of the condition, symptoms may not be present or noticable to patients. It’s crucial for patients to be aware of their risk as well as what symptoms are possible because early detection offers patients the best chance at preserving optimal vision. All diabetic patients are advised to complete a diabetic eye exam with their ophthalmologist at least once a year. The earlier your doctor can detect abnormalities in the retina and make a diagnosis, the sooner you can receive treatment and improve your chances of maintaining healthy vision.
Diabetic Retinopathy Treatment
The type of treatment recommended for diabetic retinopathy depends on the condition’s severity. Prevention is the most advised goal for patients with diabetes, so taking proactive steps to ensure the long-term health of your vision is always recommended. It’s important that patients with diabetes keep a close eye on their blood sugar levels, consume a healthy diet, and engage in physical activity on a daily basis. Your doctor can provide diet and exercise advice that is specific to your unique situation. By being mindful of these lifestyle habits, patients with diabetes can greatly reduce the risk of developing diabetic retinopathy.
Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Injections
One of the most common treatments for diabetic retinopathy is intraocular injections of anti-vascular endothelial growth factor (anti-VEGF) medications. VEGF is a type of protein that promotes the growth of new blood vessels. By inhibiting these proteins, anti-VEGF medications help to stop the process of neovascularization, in which abnormal blood vessels form, leak, and bleed in the retina. Anti-VEGF medications are delivered directly into the vitreous using a very fine needle. The procedure is performed in our retina offices and requires local or topical anesthesia.
Laser photocoagulation is a procedure in which laser beams are used to weld-seal leaky blood vessels. Photocoagulation can also help reduce macular edema swelling as well as blood vessel growth. can be used to correct parts of the retina that have been damaged. This is often performed as an in-office procedure using local or topical anesthesia using This treatment is normally performed in-office with local or topical anesthesia. For most patients, multiple rounds of laser therapy will be needed.
In severe cases of PDR, bleeding inside the vitreous cavity can occur. When this happens, vitrectomy surgery may be necessary to remove the blood and any scar tissue that has formed from within the eye’s center, while also providing treatment for any abnormal blood vessels that have formed. Photocoagulation may also be used in conjunction with vitrectomy in order to seal leaking blood vessels. These procedures may also be used in cases of diabetes-related retinal detachment, in which heavy scar tissue has formed on the retina.