Diabetic Retinopathy
Diabetic Retinopathy (DR) is one of the more common complications of diabetes. It is among the leading causes of blindness in people of working age, affecting both men and women. People with type 1 diabetes can show signs of diabetic retinopathy as early as five years after the beginning of their diabetes, and almost all patients will show different levels of retinopathy 20 years after their diabetes begins.
Research has shown that several factors can contribute to diabetic retinopathy, including hyperglycemia (elevated blood sugar). This and other factors can lead to damage to blood vessels, including the many small blood vessels supplying blood to the retina at the back of the eye, which can lead to reduced oxygen. As the retina requires a high level of oxygen to function properly, this leads to further complications.
There are several stages in the development of diabetic retinopathy:
Background retinopathy
This first stage occurs when the blood vessels begin leaking abnormally and also begin to expand abnormally, sometimes leading to ruptures. You may not notice any effect on your vision when this occurs, but this can lead to more serious later stages which can affect your vision.
Maculopathy
This is a disease of the macula, which is the part of the retina which helps us to see fine details and is important when performing tasks such as reading and other close work. Maculopathy can occur at any stage of diabetic retinopathy and is caused by fluid collecting in the macula, which can lead to severe vision loss.
Proliferative retinopathy
The retina starts getting damaged due to the reduction in oxygen, and this leads to the formation of numerous new blood vessels in an attempt to gain more oxygen. The formation of new blood vessels can lead to more problems as they can break and leak into the vitreous, which is the clear, jelly-like substance that fills the centre of the eye. The vitreous can become clouded due to the presence of blood, and this can lead to an increased chance of blindness. In addition, scar tissue can form in the retina which can lead to its detachment from the back of the eye, also leading to blindness if untreated.
Advanced eye disease
This stage represents the advanced retinal damage that can develop without intervention, and leads to blindness. All of the conditions described previously become more pronounced, leading to a painful blind eye.
Treatment and Management of Diabetic Retinopathy
Comprehensive eye evaluations are recommended as part of routine care for people with type 1 diabetes within 3 to 5 years of disease onset, and immediately following diagnosis for people with type 2 diabetes. If you have diabetes but have no vision problems, you should have eye examinations every year to detect it when it first develops. If you have already developed some visual complications, then it is necessary to have more frequent eye examinations to determine when is best to begin therapy.
Eye examinations can be conducted by your family doctor, a health worker, an optometrist or an ophthalmologist (eye doctor). As a first step, you should visit your family doctor who may refer you to an ophthalmologist if vision threatening changes are detected.
There are several treatment options for diabetic retinopathy including laser treatment which can target specific parts of the eye affected by the disease, surgery of the retina and/or vitreous, and medications or pharmaceuticals. Your ophthalmologist and/or doctor will discuss such options with you, and work out the best course of action for you.