In fact, it is the leading cause of legal blindness in working-aged adults worldwide.
The link between diabetes and diabetic retinopathy.
Diabetes is a severe systemic disease that affects the way in which the body processes blood sugar.
There are different types of diabetes, but they all share the common problem of having too much glucose in one’s bloodstream. This results in damage to blood vessels throughout the body, including the blood vessels at the back of the eye. This is known as diabetic retinopathy.
All diabetics should visit their ophthalmologist for regular screening to check for any symptoms of diabetic retinopathy before any permanent damage is done.
Why check-ups are critical:
According to Dr Olivia Read, it is unusual to see clinical diabetic retinopathy in diabetic patients before 10 years after onset of diabetes.
However, many people may live with diabetes for several years before being accurately diagnosed. This is why it’s important for ALL diabetics to visit an eye specialist after diagnosis.
Women who develop diabetes during pregnancy should also be checked for diabetic retinopathy.
What are the symptoms of diabetic retinopathy?
The initial symptoms of diabetic retinopathy may be very mild, but as it progresses, the symptoms become more severe. Look out for:
- Spots or dark floaters
- Fluctuating vision
- Blind spots
- Loss of vision
What are the stages of diabetic retinopathy?
From a few mild symptoms to potential permanent loss of vision, diabetic retinopathy has two key stages. The best time to diagnose the disease is in the early parts of stage one. This is why regular check-ups with your ophthalmologist are important.
2 Stages of diabetic retinopathy
Early diabetic retinopathy – nonproliferative diabetic retinopathy (NPDR):
Your eye specialist may detect early changes in the blood vessels at the back of your eye. They may see a few small bleeds or leakage of the blood vessels. In most instances, your vision will not be affected.
Advanced – proliferative diabetic retinopathy (PDR):
In diabetic people, the blood vessels in the eye may be damaged. This may affect the blood supply in the retina, which becomes ischaemic (insufficient blood flow to an organ).
- Abnormal blood vessels are then formed and they leak and bleed, and cause scarring within the eye. Eventually the retina is pulled off (retinal detachment).
- Sometimes, the abnormal blood vessels bleed into the jelly-like substance at the back of the eye (vitreous haemorrhage).
- New blood vessels can also grow in the angle of the eye where fluid drains out. These vessels obstruct the normal flow of fluid out of the eye, resulting in an increase in pressure (glaucoma), and ultimately irreversible damage to the optic nerve. When the nerve is damaged, the patient will experience permanent vision loss.
- The damaged vessels may leak into the clear fluid in the central portion of the retina (macula oedema) and cause visual loss.
How can diabetic retinopathy be prevented?
Loss of vision, and the other serious effects of diabetes can be controlled and prevented through management of the patient’s blood glucose levels. This involves medication, a strict diet, and a healthy lifestyle. Exercise is highly recommended for anyone suffering from diabetes.
If you’re at risk for developing diabetes, or it runs in your family, it is highly recommended that you visit your GP and your ophthalmologist on a regular basis to check for any symptoms of the disease.
How is diabetic retinopathy treated?
After a thorough examination, your ophthalmologist will recommend a treatment plan which may include medication, laser treatment, or even surgery.
Medication:
- Anti-VEGF medication can be injected into the eye by your eye specialist. It helps to reduce swelling in the macula as well as dry up any new vessels. However, they are only effective for a short amount of time, and patients may require monthly injections until the eye is stabilised.
- Steroids can also be injected into the eye to help to reduce macula swelling.
Laser therapy:
- Laser treatment helps to shrink new blood vessels, seal them off and prevent them from growing further. This is a key treatment option for Proliferative Diabetic Retinopathy (PDR) and, in some cases, macula oedema.
Surgery:
- If you have advanced retinopathy with severe bleeding or retinal detachment your ophthalmologist may recommend surgery. The surgeon will usually perform a vitrectomy where the vitreous gel, blood, and scar tissue is removed, and laser therapy is performed.
