Damage and weakening of the blood vessels can result in swelling and leakage in the retina. Sometimes the blood vessels can close and limit blood flow to the retina. Abnormal new blood vessels can also grow and bleed or form scar tissue. These changes from diabetes can result in vision loss.
There are two main distinctions of diabetic eye disease. The first, Non-Proliferative Diabetic Retinopathy, or NPDR: This is the stage of diabetic eye disease where there are changes evident in the retina.
Many people with diabetes have it and it may or may not be associated with vision changes. At any stage of disease, vision loss can occur when the central retina swells.
Swelling of the central retina is called macular edema. It is the most common reason for blurry vision and vision loss with diabetes.
These images show macular edema, evidenced by an OCT scan (Optical Coherence Tomography). Macular edema is the most common cause of vision loss in diabetes, also referred to as Diabetic Macular Edema or DME.
In advanced/severe NPDR, blood vessels in the retina can close off and restrict blood flow to the retina. This is called macular ischemia, and it can result in blurry vision. If you have NPDR, your vision may be blurry, depending on the severity of the eye disease.
Proliferative Diabetic Retinopathy, or PDR: PDR is the most advanced and severe stage of diabetic eye disease. As a result of poor blood flow to the retina, new blood vessels start to grow. This is called neovascularization.
The fragile new vessels grow in the wrong places and often bleed into the eye and can cause floaters or completely block the vision. The new blood vessels can also form scar tissue as they grow. This scar tissue can cause severe problems from traction or pulling on the retina and result in a retinal detachment.
PDR is very serious and can result in permanent irreversible vision loss.
Therefore, it is important to have regular eye exams. As the severity diabetic retinopathy progresses, symptoms may include:
Diabetic retinopathy usually affects both eyes, but sometimes one eye may be worse than the other. Fluctuating blood sugar levels could also affect your vision.
Your ophthalmologist will use special lenses and bright lights will be used to look into your eyes. Special blood flow pictures, called Fluorescein Angiography (FA), are sometimes used to evaluate the damage from diabetes to your retina.
For an FA, yellow dye (called fluorescein) is injected into a vein, usually in your arm or hand. The dye travels throughout your blood vessels and a special camera images the blood vessels in the eye. These pictures will show if any blood vessels are blocked or leaking fluid, and can also show if abnormal blood vessels are growing.
Optical coherence tomography (OCT) is another way to look closely at the retina to obtain a virtual, non-invasive biopsy. This detailed image of the retina allows your doctor to see the retina at a microscopic level and detect swelling in the retina.
Treatment options may include:
Medical control. Controlling your blood sugar and blood pressure can help to stop the progression of vision loss. A balanced diet recommended by your nutritionist can aid in blood sugar control. It is also important to take the medicines prescribed by your diabetes doctor. Sometimes, blood sugar control can help to restore some of your vision.
Medicine. The main type of local medication for the eye is "anti-VEGF" medication. This helps to reduce the leakage and bleeding of blood vessels in the eye and decrease the swelling of the macula. This can result in slowing vision loss and often improving vision. This drug is given by injections (shots) into the white part of the eye. Another type of medicine that can be used to reduce swelling and macular edema is “steroid” medications. This is also given as injections into the white part of the eye. These injections often need to be repeated over time and each person is different in how their disease responds.
Laser surgery. Laser surgery, or focal laser, is sometimes used to help seal off leaking blood vessels from macular edema. Laser surgery, or panretinal photocoagulation, can also help shrink blood vessels and prevent them from growing again. Sometimes more than one treatment is needed.
Vitrectomy. If you have advanced PDR with bleeding, scar tissue, or retinal detachment, your ophthalmologist may recommend surgery called vitrectomy. In this surgery, the vitreous gel along with any blood is removed from inside your eye. Scar tissue may also need to be removed to repair a retinal detachment.
If you have diabetes, it is important to work with your primary care doctor in controlling your blood sugar and blood pressure. Persistent high blood sugar damages retinal blood vessels and leads to vision loss from diabetic retinopathy.
High blood pressure, high cholesterol, and kidney problems can contribute to blood vessel damage from diabetes. Ask your doctor about ways to manage and treat these problems.
See your ophthalmologist regularly for dilated eye exams. Advanced severity requires more frequent visits. Diabetic retinopathy may be present without any vision problems and the first noticeable symptoms may only occur during advanced stages of disease.
If you notice vision changes in one or both eyes, call your ophthalmologist right away. Early detection and treatment of diabetic retinopathy is the best way to prevent vision loss.
High blood sugar levels can affect the blood vessels in the eye and lead to vision loss.
This is called diabetic retinopathy. In its earliest stages, there may be little to no symptoms. However, with progressing disease, there is eye damage that can lead to blindness.
Early detection and treatment for diabetic retinopathy is key. Treatment may include medication, eye injections, and surgery.
See your ophthalmologist regularly to check for eye damage from diabetic retinopathy.
Retina: Layer of nerve cells lining the back wall inside the eye. This layer senses light and sends signals to the brain so you can see.
Vitreous: Jelly-like substance that fills the middle of the eye.
Floaters: Tiny clumps of cells or other material inside the vitreous. These look like small specks, strings or clouds moving in your field of vision.
Diabetic Eye Disease
Laser Surgery for Macular Edema
Medication Injection for Macular Edema
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