Dealing with Diabetic Retinopathy

Your vision is a little blurry. You already have diabetes. It is like you have “floaters” in your line of vision. You could have diabetic retinopathy.

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

There are four stages of diabetic retinopathy:

1.     Mild nonproliferative retinopathy. At this earliest stage microaneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels.

2.     Moderate nonproliferative retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked.

3.     Severe nonproliferative retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

4.     Proliferative retinopathy. At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

In a small segment of patients, the swelling and exudates (retina deposits) become more severe resulting in macular edema. Macula edema is the swelling of the macula, a small 1mm area in the center of the retina. The macula is needed to see fine details and is also needed for color vision. Vision loss occurs with macula edema and may be mild to severe. You can develop both proliferative retinopathy and macula edema and still see fine. But you are at high risk for vision loss.

The best treatment for diabetic retinopathy is prevention. Strict control of your blood sugar will significantly reduce the risk of vision loss from diabetic retinopathy. Most patients with diabetic retinopathy don’t require treatment.

Some studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as preserve your vision.

People with proliferative retinopathy are treated with laser surgery. The procedure is called scatter laser surgery. Scatter therapy helps shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are required, two or more sessions are usually required to complete treatment. Although you may notice some loss of side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed.  This is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatments may still be possible depending on the amount of bleeding.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye. A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.

Anyone with diabetes should get a comprehensive dilated eye exam at least once a year. These exams can detect the earliest eye changes associated with diabetic retinopathy. Regular eye care, good blood sugar control, and other measures can help preserve your vision.