Diabetic Retinopathy : Types, Symptoms, and Treatment

Overview

What is Diabetes retinopathy?

Diabetes retinopathy is a progressive eye disorder that can cause retinal damage, leading to blurred vision and blindness in people with diabetes. The retina is the name of the tissue layer at the back of the eye that receives the images we see and transfers them to our brains through the optic nerve.¹Overview| Researched based study from Cancer.gov People with both type 1 and type 2 diabetes are at risk of developing this disease and should get their eyes checked regularly as it is the most common eye disease among them.

This article discusses various stages of diabetic retinopathy, its causes, symptoms, complications, prevention, diagnosis, and management.

Symptoms

Symptoms of Diabetic retinopathy

Most patients do not notice signs of diabetes-related retinopathy in the early stages. However, some people experience periodic abnormalities in their eyesight that could be the first sign of diabetic retinopathy:

• Trouble reading.
• Trouble seeing faraway objects.²Symptoms| Researched based study from Nei.nih.gov

As the condition progresses, you might develop:

• Poor night vision.
• Blurred or distorted vision.
• Seeing faded colors as color blindness starts.³Symptoms| Researched based study from Clevelandclinic.org
• Seeing dark floating strings or spots.
• Dark areas in the vision.
• Blindness.

Types

Types of Diabetes retinopathy

There are two types of diabetic retinopathy

• Non-proliferative type
• Proliferative type

Non-proliferative diabetic retinopathy (NPDR)

• This type is also called early diabetic retinopathy.
• It is a more common type where new blood vessels are not forming.⁴Types| Researched based study from Mayoclinic.org

Proliferative diabetic retinopathy (PDR)

• Also called advanced diabetic retinopathy develops when weakened blood vessels block, forming new, abnormal blood vessels in the retina. ³Types| Researched based study from Clevelandclinic.org

Stages

Diabetic retinopathy stages

Four stages may include

• Stage 1 – Mild non-proliferative stage
• Stage 2 – Moderate non-proliferative
• Stage 3 – Severe non-proliferative stage
• Stage 4 – Proliferative diabetic retinopathy

Stage 1 – Mild non-proliferative diabetic retinopathy

• Micro aneurysms, or tiny patches of bulging in the blood vessels of the retina, are seen in the early stages of diabetic retinopathy.
• At this stage, tiny amounts of fluid might leak into the retina and cause the macula to enlarge.

Stage 2 – Moderate non-proliferative diabetic retinopathy

• These tiny swellings on the blood vessels begin to grow in size and obstruct blood flow, causing the blood and other fluid to be clogged in the macula.

Stage 3 – Severe non-proliferative diabetic retinopathy

• Blood flow to the retina is significantly reduced as a more significant portion of blood vessels are blocked.
• The body now receives instructions to develop new retina blood vessels.

Stage 4 – Proliferative diabetic retinopathy

• New blood vessels begin forming in the retina at this progressed stage of the disease.
• There is a greater chance of fluid leakage since these blood arteries are frequently weak and may cause various vision problems like blurriness, a smaller field of vision, and even blindness.⁵Stages| Researched based study from Drsnyder.org

Causes & Risk

Diabetic retinopathy causes and Risk factors

Main causes of Diabetic retinopathy are:

• Diabetes-related elevated blood sugar levels are what lead to diabetic retinopathy.⁶Causes| Researched based study from Nlm.nih.gov
• Blood sugar levels that are excessively high can harm blood vessels throughout the body, including the eyes.
• The retinal blood vessels can get blocked, and the eyes develop new blood vessels that don’t function properly and can rupture or bleed easily to compensate for these obstructions. ²Causes| Researched based study from Nei.nih.gov

Risk factors of Diabetic retinopathy are:

Diabetic retinopathy can occur in anyone with diabetes. The risk, however, may be raised by the following elements :

• Poor blood sugar control
• Being a diabetic for a long time
• Going through puberty
• Being pregnant ⁷Risk factors| Researched based study from Nlm.nih.gov
• Having high blood pressure ⁸Risk factors| Researched based study from Nlm.nih.gov
• Having high levels of cholesterol
• Having kidneys that do not work well
• Having vitamin D deficiency.⁹Risk factors| Researched based study from Nlm.nih.gov
• Being overweight
• Being a smoker

Diagnosis

Diagnosis of Diabetes retinopathy

Regular checks

An ophthalmologist is an eye doctor who can diagnose diabetic retinopathy during regular examinations by checking the following :

• Pupil response to light
• Pressure within the eye
• Eye movements
• Visual acuity
• Depth perception
• Peripheral vision

Also, the doctor may take a closer look at the eye’s lens and retina by dilating the eyes with drops to check for the following:

• Red spots on the retina – diabetic retinopathy’s first sign.
• Retinal swelling
• Abnormal blood vessels
• Bleeding in the center of the eyes

Additional test:

• Retinal imaging techniques such as tomography or photography to record the retina’s present condition.
• Fluorescein angiography is used to assess atypical blood vessel development.¹⁰Diagnosis| Researched based study from Aoa.org

Treatment

Treatment of Diabetic retinopathy

Treatment depends on a person’s symptoms, age, general health, and how severe the condition is and may include:

Treatment in early stages of Diabetic retinopathy

It might not require any therapy but requires close monitoring of the eyes by an eye doctor.

Mostly it is treated by treating the underlying cause like:

• The proper diet and medications regulate blood sugar since stable blood sugar levels can repair retinal damage and halt vision loss.
• To maintain the health of the blood vessels in the eyes, patients should also take medications to regulate their blood pressure.

Treatment in advanced stages of Diabetic retinopathy

Medicines injected in the eye

• Anti-VEGF drugs – such as Avastin, Eylea, and Lucentis- can minimize macula swelling, slowing vision loss and improving eyesight. ¹¹Treatment| Researched based study from Aao.org
• Steroid medication is an additional choice for lowering macular swelling and reducing the development of abnormal retinal blood vessels.

Surgical methods

Surgical methods may include Vitrectomy or Laser surgery.

Vitrectomy

• A vitrectomy is a technique that includes removing the blood and scar tissue that is pulling on the retina from the middle of the eye.
• It is also possible to remove the vitreous, which resembles jelly, and replace it with a balanced solution.

Laser surgery

• Used to treat macular swelling and occasionally proliferative retinopathy.
• It entails either closing blood vessels that are leaking or shrinking aberrant blood vessels.¹²Treatment| Researched based study from Hopkinsmedicine.org

Prevention

Prevention of Diabetes retinopathy

One cannot always avoid diabetic retinopathy. However, the following actions can be taken to lessen the possibility of diabetic patients acquiring retinopathy and prevent vision loss:

• Obtain routine eye checkups. Pay attention to vision problems and contact an eye doctor immediately if your eyesight changes suddenly and gets blurry or hazy.
• It is advised to exercise frequently or try to take walks for up to thirty minutes every day.
• To determine whether blood sugar levels are controlled, check them daily and keep track of them.¹³Prevention| Researched based study from Aoa.org
• Get a glycosylated hemoglobin test regularly to check the mean blood sugar level for the last two to three months.
• One can control cholesterol and blood pressure by eating correctly, exercising frequently, and losing weight.
• Take all prescription medications for cholesterol, blood pressure, and blood sugar without skipping a dosage.
• Smokers should try to kick the habit or get assistance because it increases their risk of developing diabetes problems, including diabetic retinopathy.⁴Prevention| Researched based study from Mayoclinic.org

Complications

Complications associated with Diabetes retinopathy

Diabetic retinopathy can cause several severe other eye problems like:

• Diabetic macular edema (DME)
• Vitreous hemorrhage
• Glaucoma
• Retinal detachment
• Blindness

Diabetic macular edema (DME)

• It occurs when the macula or the retina’s center swells, making a person’s eyesight blur. ²Complications| Researched based study from Nei.nih.gov

Vitreous hemorrhage

• The newly formed blood vessels have the potential to spill into the jelly-like material that occupies the center of the eye.
• Minor bleeding may cause spots in the vision or, in more severe cases, may ultimately impair vision until the blood is stopped.¹⁴Complications| Researched based study from Nlm.nih.gov

Glaucoma

• New blood vessels that are formed may obstruct the flow of the normal fluid out of the eye, increasing pressure inside the eye.
• This can cause harm to the nerve that transmits everything the eye sees to the brain²Complications| Researched based study from Nei.nih.gov

Retinal detachment

• This leads to the formation of scarring in the back of the eye, which may cause the retina to separate away, resulting in severe eyesight loss.²Complications| Researched based study from Nei.nih.gov

Blindness

• Complete vision loss may result from diabetic retinopathy alone or in combination with its complications like macular edema, glaucoma, and retinal detachment, mainly if the conditions are not adequately controlled.⁴Complications| Researched based study from Mayoclinic.org

Prognosis

Prognosis of Diabetes retinopathy

Diabetic retinopathy can be reversed in its early stages by controlling blood sugar levels and managing elevated cholesterol and blood pressure levels. In addition, prompt medical care may avoid vision loss and slow the progression of retinopathy. Without treatment, it can make a person blind. People with diabetes should visit an eye doctor if they experience any new changes in their vision, as early detection and management can benefit their eyesight. People will have the best chance of a successful outcome following treatment if they maintain tightly regulated blood sugar and blood pressure levels.