5 Things to Understand about Diabetic Retinopathy | Diabetic Eye Disease Month

Diabetes is a chronic condition that affects millions of people around the country and world. Unfortunately, people who have diabetes are also at risk for other health conditions, including eye disease.

Diabetic retinopathy is the most common type of diabetic eye disease. It's a serious eye condition that can lead to blindness if not detected and treated early.
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The retina (implicated in diabetic retinopathy) plays a key role in vision. It receives light that comes into our eye and sends signals to our brain so that we can see. In people who have diabetes and even pre-diabetes, high blood sugar levels can cause the small blood vessels in the retina to leak fluid or bleed. This can affect and impair vision. For some with diabetes, abnormal blood vessels in the retina can increase in number, leading to scarring and vision loss.
 
If you have diabetes or pre-diabetes, having a better understanding of diabetic retinopathy may help you prevent the condition and protect your vision. Below are five important facts you should know about diabetic retinopathy.
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1. Diabetic Retinopathy Occurs in 4 Stages

Diabetic retinopathy is usually classified into four stages. The first stage is considered mild nonproliferative retinopathy. During this stage, swelling occurs in the tiny blood vessels in the retina. Symptoms are typically not present. Someone in this early stage of the disease may not notice any changes. Regular eye exams are necessary to detect the beginning signs of diabetic retinopathy. 
 
The second stage is considered moderate nonproliferative retinopathy. Some of the blood vessels in the retina may become blocked, which decreases nutrients and oxygen to the retina. Symptoms may still not occur, and vision may not be affected. Again, regular eye exams are necessary to detect the signs of advancing diabetic retinopathy.
 
If the condition progresses, severe nonproliferative retinopathy will develop. As more blood vessels become blocked, new abnormal blood vessels develop. These may leak fluid, which can cause the macula to swell and thicken. This swelling and thickening interferes with vision, making symptoms of diabetic retinopathy noticeable.
 
The last and most severe stage of diabetic retinopathy is called proliferative retinopathy. In this fourth stage, an increasing number of blood vessels are blocked, and more abnormal blood vessels form, which may lead to bleeding to the center of the eye. Additional complications, such as macular edema (swelling of the macula, responsible for fine vision), retinal detachment, and vitreous hemorrhage (swelling into the vitreous), can occur in this stage. These changes can lead to more severe vision abnormalities, including blurred vision, flashes of light in the central vision, and black spots.
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2. Diabetic Retinopathy May Not Have Symptoms at First

The early stages of diabetic retinopathy are often symptomless, making regular eye exams critical. If you have diabetes or pre-diabetes, even if you do not have any symptoms of retinopathy, you should schedule a yearly eye exam with an ophthalmologist who specializes in diabetic eye disease. An ophthalmologist who is an expert in diabetic eye disease will perform special tests to detect diabetic retinopathy in the early stages, before symptoms start. 
 
In many cases, symptoms of diabetic retinopathy don’t appear until the condition has progressed to stage three or four. According to the Mayo Clinic, as the disease progresses, symptoms may include the following:

• Blurry vision
• Sudden loss of vision
• Double vision
• Eye floaters or spots in your field of vision
• Dark areas in your field of vision

• Poor night vision
• Any type of changes in vision

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3. Early Detection May Decrease Vision Loss

Early detection of diabetic retinopathy is essential to preserve vision. Symptoms can continue to get worse if not treated when detected. Eventually, severe vision loss or total blindness can occur. With early detection and treatment, vision loss may be prevented.
 
To detect diabetic retinopathy early, a comprehensive eye exam should be performed annually, or more frequently if any vision changes develop. During a comprehensive exam, your ophthalmologist will typically perform the following tests to determine the health of your vision and your eyes:  

1. A visual acuity test, to evaluate your vision.
2. A dilated eye exam, which allows your ophthalmologist to get a better view of the inside of your eye, including the retina.
3. Tonometry, a test that measures the pressure inside your eye.
4. A fluorescein angiogram, a test helps your ophthalmologist view the blood vessels in your eye to help diagnose retinal conditions.
5. Optical coherence tomography (OCT), which is used to assess your macula.

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4. Treatment for Diabetic Retinopathy Is Available

While diabetes and all of this information about diabetic retinopathy can sound scary and be overwhelming, there’s good news. Treatment for diabetic retinopathy is available and may prevent vision loss, particularly when the condition is caught early.
 
Treatment will often include lifestyle changes and treatments to control blood sugar levels, blood pressure, and cholesterol, which may help prevent the progression of the disease. However, according to the National Eye Institute (NEI), in more advanced cases of diabetic retinopathy, additional treatment, such as injection therapy, may be recommended. When injected into the eye, a category of drugs called Anti-VEGF can be used to block the hormone that stimulates blood vessel growth, helping to prevent or slow progression of the disease.
 
Laser treatment may also be an option in advanced stages of diabetic retinopathy. The procedure uses a special laser to destroy damaged structures in the retina, thereby sealing the leaky blood vessels and preventing formation of the chemicals that cause abnormal blood vessels to develop.
 
In some cases like vitreous hemorrhage, laser treatment may not be possible, and surgery may be recommended. In such cases, a procedure called a vitrectomy may be performed. The surgery involves removing the blood-filled vitreous gel from the center of the eye to restore vision.
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5. Controlling Key 'Numbers' & Making Important Lifestyle Choices Are Vital to Preventing Diabetic Retinopathy

The best ways to decrease your chances of developing diabetic retinopathy are managing your diabetes effectively and controlling your blood sugar levels, blood pressure, and cholesterol. High sugar levels circulating in the blood can damage the retina. High blood pressure and cholesterol can be harmful to eyes as well. Remember, both people with type 1 diabetes and type 2 diabetes are at risk for diabetic retinopathy.
 
Efficiently managing your diabetes involves several factors. Talk to your doctor to determine how often you should check your blood sugar. It may also be helpful to ask your doctor about doing an A1C test, which shows your average blood sugar level over the past three months.
 
It’s also important to know your other health indicators or numbers. Develop a plan with your healthcare team to maintain a healthy weight, blood pressure, and cholesterol level. It’s also critical to follow your diabetes meal plan, exercise regularly, and take your medication as prescribed.
 
If you smoke, try to quit. Smoking increases your chances of developing diabetic retinopathy. Medications, nicotine patches, and smoking cessation classes are available, which may help you break the habit.
 
Fortunately, if detected early, you can slow the progression of diabetic retinopathy. To learn more about diabetic eye disease, including additional information about stages / progression, symptoms, testing, and treatment, please visit our Diabetic Eye Disease page.
 
If you have any questions about diabetic eye disease, need an eye exam, or would like to meet with one of our ophthalmologists who specializes in diabetic eye disease to discuss your condition, please call our office at 508-746-8600 to schedule an appointment with one of the following:

• Eddie F. Kadrmas, MD, PhD

• Lawrence I. Rand, MD

 
That wraps our discussion of "5 Things to Understand about Diabetic Retinopathy". Check back with us soon as we continue with Diabetic Eye Disease Month. Next up, "Managing Blood Sugar During the Holidays"!