If you have diabetes mellitus, your body does not use and store glucose properly.

Diabetic Retinopathy & Eye Disease for Houston & Galveston from The Eye Clinic of Texas

Diabetic retinopathy and diabetic eye disease are unfortunate effects of diabetes for many Houston patients. Over time, diabetes can damage blood vessels in the retina, which the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy.

Diabetic retinopathy (DR) is a process where the retina is damaged due to complications of diabetes, which can eventually lead to blindness. Approximately 80% of all patients that have diabetes for more than 10 years will get retinopathy. Blood glucose control plays a very important role in this process.

What are the symptoms?

Diabetic retinopathy has no early warnings signs. Sometimes, in macula edema, patients may get blurred vision. In most cases, blood glucose fluctuation will cause vision fluctuation.

What are the risk factors?

Of course, all patients with DM (Type I and II) are at risk for DR. The longer a person has DM, the higher the risk for DR.

Also pregnancy can pose an additional risk to women who already have DM.

Nonproliferative Diabetic Retinopathy

Nonproliferative diabetic retinopathy (NPDR), commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates.

Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema or macular ischemia, or both.

Macular edema is swelling or thickening of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from retinal blood vessels. It is the most common cause of visual loss in diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral (side) vision continues to function. Laser treatment can be used to help control vision loss from macular edema. Newer treatments are being investigated such as injection of medication into the vitreous cavity.

Macular ischemia occurs when small blood vessels (capillaries) close. Vision blurs because the macula no longer receives sufficient blood supply to work properly. Unfortunately, there are no effective treatments for macular ischemia.

Proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy (PDR) is a more serious complication of diabetes caused by changes in the blood vessels of the eye. In PDR, the retinal blood vessels are so damaged they close off. In response, the retina grows new, fragile blood vessels. Unfortunately, these new blood vessels are abnormal and grow on the surface of the retina, so they do not resupply the retina with blood.

Occasionally, these new blood vessels bleed and cause a vitreous hemorrhage. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception.

The new blood vessels can also cause scar tissue to grow. The scar tissue shrinks, wrinkling and pulling on the retina and distorting vision. If the pulling is severe, the macula may detach from its normal position and cause vision loss.

What are the treatments?

There are 3 main treatments for Diabetic Retinopathy:

• Laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding. The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months, or even years.
• If the vitreous hemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, an operation called a vitrectomy can be performed. During a vitrectomy, the doctor removes the hemorrhage and any scar tissue that has developed, and performs laser treatment to prevent new abnormal vessel growth.
• Injection of steroid into the vitreous cavity can prevent further macula swelling. The medication can last up to 3-4 months and reinjection sometimes is necessary.

These treatments are very successful to prevent further vision loss. However, they don’t cure retinopathy.

How do you prevent DR?

A medical eye examination is the only way to discover any changes inside your eye. If your ophthalmologist finds diabetic retinopathy, he or she may order color photographs of the retina, a special test called fluorescein angiography, or optical coherence tomography (OCT) to find out if you need treatment.

If you have diabetes, early detection of diabetic retinopathy is the best protection against loss of vision. You can significantly lower your risk of vision loss by maintaining strict control of your blood glucose and visiting your ophthalmologist regularly. People with diabetes should schedule examinations at least once a year. Pregnant women with diabetes should schedule an appointment in their first trimester, because retinopathy can progress quickly during pregnancy. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy.

There is considerable evidence to suggest that rigorous control of blood sugar decreases the chance of developing serious proliferative diabetic retinopathy.