November 28, 2022

One of the most common causes of blindness in adults is diabetic retinopathy, which is found in both Type 1 and Type 2 diabetes.  Diabetic retinopathy is caused by microvascular damage to the retina and sometimes has no outward signs.  Diabetic eye diseases include diabetic macular edema, proliferative diabetic retinopathy, cataracts, and even glaucoma.

Diabetes rates and diabetic retinopathy rates are increasing in the United States and other developed countries.  Although these numbers are steadily increasing, only about 60% of people with diabetes have yearly screenings for diabetic retinopathy.

Detecting diabetic retinopathy early is crucial to preventing loss of vision and can reduce blindness risks by up to 95%.  Diabetic retinopathy sometimes lacks early symptoms so it's important to get frequent eye exams.

Follow these suggestions to prevent vision loss from diabetic retinopathy:

  • The first five years after the onset of type 1 diabetes should be spent getting annual screenings
  • If you have Type 2 diabetes you need to have an eye examination at the time of diagnosis and every year going forward
  • Take your diabetic medication as prescribed! It's important you are consistent and accurate with your dosage.
  • Make a lifestyle change to a clean and healthy diet. Don’t smoke!
  • Studies have shown that consistent exercise and physical activity is one of the keys to controlling sugar levels.
  • Get a comprehensive, dilated eye examination once a year or more frequently based on exam findings.

One of the main causes of diabetic retinopathy is consistently high blood sugar from your diet, which damages the tiny blood vessels in the retina.

Diabetic Retinopathy can:

  • Cause blood vessels in the retina to leak fluid
  • Cause hemorrhaging of the eye
  • Distort vision or cause total loss of vision
  • Increase the risk of glaucoma or retinal detachment by causing abnormal blood vessel growth

The three stages of Diabetic Retinopathy

  • Mild nonproliferative retinopathy shows up in the beginning stages of diabetic retinopathy.  At this stage, small areas of balloon-like dilation of blood vessels, also known as microaneurysms, start to appear along with small spot hemorrhages and cotton wool spots (which represent tiny areas of poor oxygenation of the tissue also known as ischemia).
  • Moderate or severe nonproliferative retinopathy: following mild nonproliferative retinopathy, more microaneurysms, hemorrhages, and cotton wool spots emerge.  There is further damage to the retinal blood vessels that may result in reduced blood flow to the surrounding retinal tissue leading to vision loss.
  • Proliferative diabetic retinopathy: the most advanced stage of diabetic retinopathy.  Closure of blood vessels from diabetic damage causes the retina to produce new blood vessels in an attempt to enhance nourishment.  When these new blood vessels are produced, they are typically fragile and tend to break and produce bleeding. This causes floaters in the retina and vitreous cavity which, in severe cases, can lead to vision loss and in some cases permanent blindness.

Testing is the most important thing you can do! Your doctor will offer different tests based on your condition and situation.

  • Visual acuity test:
    • This is your basic eye chart test, which is used to check your vision at various distances
  • Pupil dilation:
    • This is one of the most accurate tests. A drop is placed here to widen your pupils so that your physician can examine your retina and optic nerve.
  • OCT (optical coherence tomography):
    • This technique captures images of internal tissues with light waves rather than sound waves
  • Fluorescein angiogram:
    • This is performed to look for leaky or damaged blood vessels if diabetic retinopathy or DME is suspected. During the test, a fluorescent dye is injected into the bloodstream through a vein in the arm.

Prevention and Treatment

  • In the event that a diabetic woman becomes pregnant, she should have a comprehensive dilated eye examination as soon as possible, as well as additional exams throughout the pregnancy.
  • Diabetic macular edema is treated with laser or anti-VEGF injections or steroid injections.
  • With proliferative diabetic retinopathy, laser surgery or anti-VEGF treatment may be recommended to shrink abnormal blood vessels.
  • Surgically removing the vitreous gel in the eye's center is sometimes necessary to treat severe bleeding into the vitreous.
  • Controlling your sugar levels is known to slow down the onset or worsening of diabetic retinopathy.
  • Diabetic retinopathy should be treated by a qualified retinal specialist.

In addition to standard-of-care treatments, Island Retina participates in the National Eye Institute, which is sponsored by the Diabetic Retinopathy Clinical Research Network. Island Retina also participates in other National & International protocols to offer our patients the most advanced treatments available.

You should receive a thorough eye exam every year if you have diabetes since you have a high risk of developing diabetic retinopathy.  If you have been diagnosed with diabetic retinopathy or are worried that you could have this disease, call the Island Retina team now to schedule an appointment.