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Diabetic retinopathy

Retinopathy means disease of the retina, the nerve layer at the back of your eye. Diabetic retinopathy is related to prolonged high blood sugar, which damages blood vessels in the eyes. It can lead to poor vision or blindness.

Diabetic retinopathy usually gets worse over many years. People who have diabetes need regular eye exams so that this condition can be found early. Keeping your blood sugar and blood pressure under control can help protect your vision.

  • Symptoms

    What are the symptoms of diabetic retinopathy?

    There are usually no symptoms of diabetic retinopathy until it starts to change your vision. When this happens, the disease is already severe. Having your eyes checked regularly can find the disease early enough to treat it. Treatment can help prevent vision loss.

    Symptoms of diabetic retinopathy and its complications may include:

    • Blurred, double, or distorted vision or trouble reading.
    • Floaters or spots in your vision.
    • Partial or total loss of vision. Or you might have a shadow or veil across your field of vision.
    • Pain, pressure, or constant redness of the eye.

    Diabetic Retinopathy

    Diabetic retinopathy

    Diabetic retinopathy is a disease of the retina, the thin tissue that lines the back of the eye. The condition is a complication of diabetes. It is related to long-term high blood sugar levels. Over time, this leads to changes in blood vessels that interfere with oxygen delivery to the cells in the retina.

  • Causes

    What causes diabetic retinopathy?

    Diabetes damages small blood vessels throughout the body. If your blood sugar levels don't stay in your target range, it can cause damage to your blood vessels. Diabetic retinopathy happens when high blood sugar damages the blood vessels of the retina. This is the part of the eye that sends images to your brain.

  • Diagnosis

    How is diabetic retinopathy diagnosed?

    Diabetic retinopathy can be found during a dilated eye exam. This exam is done by an ophthalmologist or optometrist. An exam by your primary doctor, during which your eyes aren't dilated, isn't the same. You need a full exam done by an ophthalmologist or optometrist.

    Eye exams for people with diabetes can include:

    Visual acuity testing.

    This test measures how well the eye can focus and see details at near and far distances. It can help find vision loss and other problems.

    Ophthalmoscopy and slit lamp exam.

    These tests allow your doctor to see the back of the eye and other structures inside the eye. They may be used to find clouding of the lens (cataract), changes in the retina, and other problems.

    Tonometry.

    This test measures the pressure inside the eye. This is called intraocular pressure (IOP). The test is used to help find glaucoma. Diabetes can increase your risk of glaucoma.

    Your doctor may also do a test called an optical coherence tomography (OCT) to check for fluid in your retina. Sometimes a fluorescein angiogram is done to check for and locate leaking blood vessels in the retina. Your doctor may want you to have this test if you have symptoms, such as blurred or distorted vision, that suggest damage to or swelling of the retina.

    Fundus photography can track changes in the eye over time in people who have diabetic retinopathy and especially in those who have been treated for it. This test makes accurate pictures of the back of the eye (the fundus). An eye doctor can compare pictures taken at different times to watch the progression of the disease and find out how well treatment is working. But the photos don't take the place of a full eye exam.

    People who have diabetes are also at higher risk for other eye diseases, including glaucoma and cataracts. Regular dilated eye exams can help find these diseases early. And they can prevent or delay vision loss.

  • Treatment

    How is diabetic retinopathy treated?

    You may need treatment for diabetic retinopathy if:

    • It has affected the center (macula) of the retina.
    • Abnormal new blood vessels have started to appear. (This is called proliferative retinopathy.)
    • Your side (peripheral) vision has been severely damaged.

    There is no cure for diabetic retinopathy. But treatment works very well to prevent, delay, or reduce vision loss. The sooner the condition is found, the easier it is to treat. And it's more likely that vision will be saved.

    Controlling your blood sugar levels is always important. This is true even if you've been treated for diabetic retinopathy and your eyes are better. In fact, good blood sugar control is even more important in this case. It can help keep retinopathy from getting worse.

    Treatment options

    Treatment options include:

    Anti-VEGF (vascular endothelial growth factor) or an anti-inflammatory medicine.

    Anti-VEGF medicines slow the growth of abnormal blood vessels in the retina. This growth is triggered by a protein called vascular endothelial growth factor (VEGF). Anti-VEGF medicines block the effects of VEGF.

    • Sometimes injections of these types of medicine help to shrink new blood vessels in proliferative diabetic retinopathy.
    • An anti-VEGF medicine, such as aflibercept or ranibizumab, might be used if the macula has been damaged by macular edema.
    • Steroids may be injected into the eye. Sometimes an implant, such as Iluvien, may be placed in the eye. The implant releases a small amount of corticosteroid over time.
    Laser treatment (photocoagulation).
    • Laser treatment usually works very well to prevent vision loss if it's done before the retina has been severely damaged. It may also help with macular edema.
    • Severe proliferative retinopathy may be treated with a more aggressive laser therapy called scatter (pan-retinal) photocoagulation. It allows your doctor to limit the growth of new blood vessels across the back of your retina. Laser treatments may not always work in treating proliferative retinopathy.
    Surgical removal of the vitreous gel (vitrectomy).
    • This surgery may help improve vision if the retina hasn't been severely damaged. It's done when there is bleeding (vitreous hemorrhage) or retinal detachment. These two problems are rare in people with early-stage retinopathy.
    • This surgery is also done when severe scar tissue has formed. It can be used to treat macular edema.

    Many people with diabetic retinopathy need to be treated more than once as the condition gets worse.

  • Self-care

    How can you care for yourself when you have diabetic retinopathy?

    • Have regular eye exams. Tell your doctor about any changes in your vision.
    • Keep blood sugar in your target range.
      • Eat a variety of healthy foods, and spread carbohydrate throughout the day. You may want to have a dietitian help you plan meals.
      • If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
      • Be safe with medicines. Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
      • Check your blood sugar as often as your doctor recommends.
    • Eat a low-salt diet. This may help keep your blood pressure at a normal level. You may also need to take medicines to reach your goals.
    • Do not smoke. Smoking can make this condition worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
    • Avoid risky activities. These include things like weight lifting and some contact sports. They may trigger bleeding in the eye through impact or increased pressure.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.