Diabetic retinopathy, an eye condition caused by diabetes, is the leading cause of new cases of blindness in adults aged 18-64.
All diabetic patients, despite their type of disease, are at risk of retinopathy. Risk of retinopathy increases with the duration of the disease and poorly controlled HbA1c levels. Cases of diabetic retinopathy are predicted to increase by almost 50% to more than 11 million people by 2030. Delaying diagnosis or treatment of retinopathy can result in permanent vision loss, but early diagnosis with prompt treatment can prevent vision loss.
What is diabetic retinopathy?
Diabetic retinopathy occurs when elevated blood sugar damages blood vessels in the retina. The retina is sensitive nerve tissue in the back of the eye that sends images to the patient’s brain through the optic nerve. Healthy retinal tissue is a critically important part of the visual system. Weakened retinal blood vessels cause bleeding and swelling into the retinal tissue and can disrupt normal visual function.
Diabetic retinopathy may present with or without symptoms. Asymptomatic retinopathy highlights the importance of annual comprehensive eye examinations. Common symptoms of retinopathy are blurred vision, fluctuating vision, and/or new floaters. Retinopathy is diagnosed when an eye doctor evaluates the retinal tissue through a comprehensive dilated eye examination. Patients with no retinopathy are encouraged to return on an annual basis. Patients with retinopathy are educated on the severity of their presentation and are referred to a retinal specialist when treatment is required.
Severity of diabetic retinopathy
Retinopathy is categorized as either non-proliferative or proliferative. Non-proliferative retinopathy can further be categorized as mild, moderate, severe, or very severe. Each category has its own definition and can be identified by the amount of bleeding in the retina. Milder presentations of non-proliferative disease are usually monitored without treatment. Those patients are still encouraged to improve their diabetic control. Proliferative disease is the most severe form of diabetic retinopathy and always requires prompt treatment to preserve vision. All categories of retinopathy may or may not include macular edema. The macula is the central part of the retina and controls central vision. Patients with macular edema usually present with blurred central vision and are referred for treatment.
Retinopathy treatment options
Treatment for more severe forms of retinopathy often involves injections into the vitreous cavity of the eye and/or laser treatment to the retina. Injections are given to prevent leakage from retinal blood vessels. Laser is performed to reduce the risk of dangerous blood vessel growth and is also used to prevent leakage from retinal blood vessels.
Diabetic patients should schedule an annual comprehensive dilated eye exam and inform their doctor if they are experiencing any new visual symptoms. Family members should support their diabetic relatives by encouraging them to comply with their appointments and recommended medical care. Eye doctors should encourage control of patient’s blood sugar, refer the patient when treatment is necessary, and communicate the results of the diabetic eye examination to the patient’s physicians. Although diabetic retinopathy can be visually significant, most sight threatening cases of retinopathy are preventable with prompt diagnosis and treatment.