What is Diabetic Retinopathy?

Diabetic retinopathy is a diabetes problem that affects the eyes. It is caused by the damage of blood vessels in the retina (this is the back of an eyeball that is sensitive to light and triggers nerve impulses) and new abnormal ones that are found that can cause some people to lose their vision.

There are no early symptoms of diabetic retinopathy, or they experience mild vision problems for some people. Symptoms can vary from blurry vision, floating spots in your image (this is when microscopic fibers in your eyes tend to clump and cast tiny shadows on your retina; these little shadows are called “floaters”), and in some cases, it can lead to blindness.

Diabetic retinopathy can happen to people who have type 1 or type 2 diabetes. People who have type 1 diabetes can develop symptoms quickly and immediately see the changes in their bodies. This type also usually develops in childhood or adolescence, unlike type 2 diabetes, symptoms won’t show immediately and may take years to build. Some people with type 2 diabetes have no symptoms and won’t discover that they have diabetes until complications arise. The longer you have no control over your blood sugar level and have diabetes, the more likely you are to have this eye complication.

4 STAGES OF DIABETIC RETINOPATHY 

Diabetic retinopathy is an eye disease that is progressive and damages the nerves in the eye. It can also turn someone completely blind. Two types and four stages classify this eye disease.

The two types are non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Non-proliferative is the early stages of the disease, while the proliferative is the advanced form of the disease.

STAGE 1: Mild Non-proliferative Diabetic Retinopathy

This is the early stage of the disease, often subtle or non-existent. There is tiny swelling in the blood vessels of the retina causes it to get weak. Slight bulges in the blood vessels or spots that are swelling are called microaneurysms.

Small amounts of fluid may leak from the retina, which triggers the macula to swell. The macula is the part of the retina at the back of the eye. Close inspection and monitoring are essential.

STAGE 2: Moderate Non-proliferative Diabetic Retinopathy

People with moderate NPDR have a 12% to 27% risk of developing proliferative diabetic retinopathy (PDR) within one year. Increased swelling in the tiny blood vessels hinders proper blood flow to the retina, preventing it from giving adequate nourishment. This causes a build-up of blood and other fluids in the macula.

STAGE 3: Severe Non-proliferative Diabetic Retinopathy

People who have developed severe NPDR are at a high risk of progression in their disease and create permanent vision loss. A more extensive section of blood vessels in the retina becomes closed, causing a significant decrease in blood flow in this area. The body starts to receive a signal that new blood vessels are growing in the retina.

STAGE 4: Proliferative diabetic retinopathy

People who had NPDR or non-proliferative diabetic retinopathy that has progressed Proliferative diabetic retinopathy. This is also an advanced stage of the disease. New blood vessels are formed in the retina. There’s a higher risk of fluid leakage since the blood vessels are often fragile. This stage also develops different eye problems such as blurriness, reduced field of vision, and blindness.

People who have developed this should immediately go to a retina specialist to do further testing and treatment.

WHAT CAUSES DIABETIC RETINOPATHY?

Diabetic retinopathy is caused by high blood sugar, also called hyperglycemia due to diabetes. Excessive sugar in your blood can affect and damage your retina- this is the nerve layer that lines the back of the eye that senses light and signals your brain.

Diabetes destroys blood vessels all over the body. The damage in your eyes starts when sugar blocks the small blood vessels that travel through your retina, causing it to bleed or leak fluid. To compose for the blocked blood vessels, your eyes start to create new blood vessels that don’t function well.

WHAT ARE THE SYMPTOMS OF DIABETIC NEUROPATHY?

Be mindful that diabetic retinopathy can damage both eyes at the same time. During the early stages of non-proliferative, symptoms don’t usually come up, and you may not know that you have one already because blood vessels don’t always leak in these stages. It doesn’t damage your eyes immediately unless you go to a doctor and get examined.

Most people don’t experience any symptoms, not until the disease progress to proliferative diabetic retinopathy.

Proliferative diabetic retinopathy symptoms are:

• Seeing an increased number of floaters or shadows and dark spots in your eyes that floats
• Distorted vision, having a vision that changes from blurry to clear
• Poor night vision
• Change in colors. Colors may seem faded or decolorized
• Fluctuating vision
• Seeing blank or empty areas in your vision
• Losing of vision

HOW IS DIABETIC RETINOPATHY DIAGNOSED BY DOCTORS?

A doctor or an ophthalmologist- these are medical doctors specializing in diagnosing eye and vision problems. A doctor examines your eyes and does an examination that involves measuring the ability of your eyes in the following procedures:

• Visual Acuity - This is the measurement of how well your eyes can distinguish different shapes and see the various details of an object at a given distance.
• Eye muscle movement - This is performed to see any weakness or other defect in your extraocular muscles (these are the six muscles that help your eyes to move) and to see if there is an uncontrolled movement in your eye.
• Peripheral vision - This tests the range of your out of the corner of your eye vision. This tests how well is the “outside” of your vision.
• Depth perception - This tests how well both of your eyes work together to see in three dimensions. This tests how is the depth of your perception and perceiving distance.
• The curvature of the cornea - In this test, a device called “Keratometer or ophthalmometer” is used to measure the reflected light that is on the surface of your cornea. It measures the curvature of the cornea and how well it can assess the abnormal curvature.

Doctors also put drops in your eyes to dilate and widen them. This allows your ophthalmologist to look through a unique lens to see the inside of your vision better.

Fluorescein angiography can also diagnose diabetic retinopathy. This checks if there are any abnormal vessels that are growing or a leakage.

They will also inject a yellow dye into the vein of your arm that can travel through your blood vessels. A special camera takes an image of the dye that has been inserted that travels through your blood vessels in your retina.

PREVENTION OF DIABETIC RETINOPATHY

You can’t always prevent diabetic retinopathy; however, regular eye exams, proper control of blood sugar and blood pressure.

If you have diabetes, reduce the risk of having diabetic retinopathy by doing the following:

• Monitor your blood sugar level - If you’re ill or often stressed, you may ask your doctor how often you should check and record your blood sugar level. Keep track of your blood sugar level, and you might need to do this several times a day.

• Asking your doctor for a glycosylated hemoglobin test -  A glycosylated hemoglobin test, often called A1c, is a simple blood test used to detect prediabetes (High sugar levels that can lead to diabetes, stroke, and heart disease). This test measures the amount of sugar is in your blood. Asking your doctor for this test will help you prevent diabetes in the early stage.

• Keeping your blood pressure and cholesterol under control - Eating healthy foods such as choosing whole-grained products, skipping sugary drinks and foods, and avoiding processed meat. Losing excess weight and regular exercising.

• Proper management of your diabetes - Make healthy eating and working out a part of your daily routine. Changing your lifestyle into a healthy one can contribute a lot to putting your diabetes in control. Try to get at least 150 minutes of moderate aerobic activity such as walking, etc. You may take medications or insulin as directed by your doctor as well.

• Pay attention to changes in your vision - if you have experienced hazy, blurry, and having spots in your vision, contact your doctor right away and set an appointment.

HOW IS DIABETIC RETINOPATHY TREATED?

There are many ways to prevent and reduce the risk of having diabetic retinopathy, like monitoring your blood sugar level, keeping your blood pressure and cholesterol under control, and managing your diabetes by taking the proper medication that your doctor advised you. 

Changing your lifestyle, watching your diet, and doing more physical activities will also help.

Keeping your blood sugar within a healthy range can help slow down the progression of vision loss. Other treatments will depend on the stage and how much the disease progressed in your body. 

If caught very early before the damage of the retina occurs- blood sugar management might be the only option. Going to a doctor can help a lot to manage and to ensure the disease doesn’t progress.

Treatments for advanced diabetic retinopathy include the following:

• Laser surgery - A laser surgery called photocoagulation uses a laser to create a microscopic burn in the target tissue. This reduces the abnormal blood vessels to grow and the swelling of the retina.
• Eye medications - A steroid injection in the eye can help stop the inflammation and growing of new blood vessels, but you might also be a candidate for the anti-VEGF medication. Here are three types of anti-VEGF medicines that are used to prevent visual loss and improve vision. These are aflibercept (EyeleaTM), bevacizumab (Avastin), and ranibizumab (LucentisTM). 
• Vitrectomy - if the disease progresses to proliferative diabetic retinopathy, eye surgery might be the best way to treat it. This eye surgery is called vitrectomy. This treats various problems with the retina and vitreous, a jellylike substance in the middle of the eye. The surgery can remove scar tissue, blood or fluid, and some vitreous gel so that light rays can adequately focus on the retina. Traction in the retina or retinal detachments can also be corrected.

RISK FACTORS

• Gestational diabetes - pregnant women with gestational diabetes (high blood sugar that develops during pregnancy that usually disappears after a woman gives birth. It can happen at any stage of pregnancy but is more common after the second or third semester) have a higher risk of developing diabetic retinopathy.
• Blood pressure - High blood pressure is dangerous to the retinal blood and can cause hypertensive retinopathy (retinal vascular damage caused by hypertension). People with raised blood sugar levels and high blood pressure have a greater chance of diabetic retinopathy.
• Use of tobacco - Smokers have a greater risk of blood vessel complications. The chemicals that makeup tobacco destroy the human body itself.
• Blood sugar level - People with high blood sugar levels have a greater risk of developing diabetic retinopathy. If blood pressure is not controlled and maintained, this could lead to diabetes.
• Diabetes duration - The longer the person has diabetes, the greater risk that this person will eventually develop diabetic retinopathy. 90% of the people who have had type 1 diabetes for over ten years developed some extent of diabetic retinopathy. The number of people who have had type 2 diabetics for more than ten decades but do not take insulin is 67%, and among type 2 diabetics with a ten-year disease duration who do take insulin, the amount is 79%

WHAT OTHER PROBLEMS CAN DIABETIC RETINOPATHY CAUSE?

Diabetic retinopathy can lead to severe other eye problems:

• Diabetic macular edema (DME) - About 1 out of 15 people who have diabetes will develop DME. This accumulation of fluid in the macula leads to leakage of fluid that causes vision to get blurry.
• Neovascular glaucoma - This is a type of secondary glaucoma (an eye disease that can cause vision loss and blindness) where the angle of the eye is blocked by new and weak blood vessels.