Diabetes and Vision Complications

What is Diabetic Retinopathy?

Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may notice no changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

Diabetic retinopathy has four stages:

  1. Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.
  2. Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.
  3. Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
  4. Proliferative Retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye.

By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Who is at risk?
All people with diabetes – both Type 1 and Type 2 – are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. Between 40 to 45% of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

Symptoms
Diabetic retinopathy often has no early warning signs. Don’t wait for symptoms. Be sure to have a comprehensive dilated eye exam at least once a year.

What are the symptoms of proliferative retinopathy if bleeding occurs? At first, you will see a few flecks of blood, or spots, “floating in your vision. If spots occur, see your eye care professional as soon as possible. You may need treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.

Sometimes, without treatment, the spots clear, and you will see better. However, bleeding can reoccur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.

If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely treatment will be effective.

Treatment 
During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macula edema (when fluid leaks into the center of the macula, the part of the eye where sharp, straight ahead vision occurs). To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.

Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.

Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy to restore your sight. During this treatment, blood is removed from the center of your eye.

What can I do to protect my vision?
The National Eye Institute (NEI) urges everyone with diabetes to have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95% with timely treatment and appropriate follow-up care.

A major study has shown that better control of blood sugar levels slows the onset and progression f retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reaches the need for sight saving laser surgery.

This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

What should I ask my eye care professional?
You can protect yourself against vision loss by working in partnership with your eye care professional. Ask questions and get information you need to take care of yourself and your family.

Some questions to ask about my eye disease or disorder
What is my diagnosis?
What caused my condition?
Can my condition be treated?
How will this condition affect my vision now and in the future?
Should I watch for particular symptoms and notify you if they occur?
Should I make any lifestyle changes?

Some questions to ask about my treatment
What is the treatment for my condition?
When will the treatment start and how long will it last?
What are the benefits of this treatment and how successful is it?
What are the risks and side effects associated with this treatment?
vAre their foods, drugs, or activities I should avoid while I’m on this treatment?
If my treatment includes taking medicine, what should I do if I miss a dose?
Are other treatments available?

Other suggestions 
If you don’t understand your eye care professional’s responses, ask questions until you do understand.

Take notes or get a friend or family member to take notes for you. Or, bring a tape recorded to help you remember the discussion

Ask your eye care professional to write down his or her instructions to you.

Ask your eye care professional for printed material about your condition.

Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them too.

The foregoing information has been prepared by the U.S. Department of Health and Human Services, National Institutes of Health, National Eye Institute. www.nih.gov

 

Newton-Wellesley Hospital has written a variety of different health articles about diabetes and various other subjects. These materials are intended to provide general educational information and to help users arrange more easily for health care services. 

These articles are not an attempt to practice medicine or provide specific medical advice and should not be used to make a diagnosis or to replace or overrule a qualified health care provider's judgment. Nor should users rely upon this information if they need emergency medical treatment. We strongly encourage users to consult with a qualified health care professional for answers to personal questions.

 

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