Understanding the Stages of Diabetic Retinopathy

When we hear medical terms like diabetic retinopathy, we can assume that the issue is you either have it or you don’t. This isn’t the case with most health conditions. Just as diabetes can vary in severity, so can diabetic retinopathy. Unlike diabetes, which affects a person’s blood sugar levels, diabetic retinopathy is a progressive condition that may not be reversible. Once you go from one stage to the next, it may not be possible to correct the damage that has been done.

As you may have guessed, diabetic retinopathy is a complication of dysregulated diabetes. When there is too much, then too little, then too much glucose in the blood, the tiny blood vessels that line the back of the eye where the retina lives sustain damage. The retina is an integral structure in the formation of eyesight. When this part of the eye is damaged, there is the potential for vision loss. A fortunate aspect of diabetic retinopathy is that this condition typically does not develop until a person has had diabetes for 3 to 5 years or more. Not every person with diabetes will develop diabetic retinopathy.

When blood sugar is well managed, eyesight is typically not threatened. In the instance of poor blood sugar regulation, diabetic retinopathy may progress through four stages: mild, moderate, severe non-proliferative retinopathy, and proliferative retinopathy.

  • Mild non-proliferative retinopathy is the earliest stage of blood vessel damage. In this stage, the tiny blood vessels develop what are called micro-aneurysms, which is swelling in the vessels.
  • Moderate non-proliferative retinopathy occurs when some of the tiny blood vessels in the retina become blocked.
  • Severe non-proliferative retinopathy has progressed farther, with a substantial blockage in several blood vessels. These blockages prevent the retina from receiving the necessary blood supply. Without sufficient circulation of blood, the retina grows new blood vessels.
  • Proliferative retinopathy occurs because the new blood vessels that are grown to feed the retina are weak and fragile. These new vessels sit near the vitreous gel at the center of the eye. Being that they do not grow normally, these blood vessels may leak blood into the eye, causing severe vision loss. Proliferative retinopathy can cause permanent blindness.

Diabetic retinopathy can progress through these stages slowly or quickly. The speed of progression depends on several factors, including the patient’s blood sugar, cholesterol, and blood pressure. If you have diabetes, you must learn to manage your blood sugar with healthy lifestyle habits and prescribed medications, if necessary. You should also see an ophthalmologist with experience diagnosing and treating diabetic retinopathy. Visits should be scheduled yearly, or more often if the doctor advises.

VitreoRetinal Surgery is proud to provide care to patients in need of a retinal specialist in Minnesota. Call (800) VRS-2500 to schedule a visit at a location near you.

Are Eye Supplements Beneficial?

We often assume that we will absorb all the nourishment the body needs by eating a well-balanced diet. Numerous factors may affect this, from poor soil conditions in farming to the body’s ability to capture nutrients through digestion. For this reason, many people consider the value of supplements. Beyond a daily multivitamin, several types of supplements can be taken, including some that are formulated specifically for the eyes. Here, we discuss why and what those supplements could do for you.

AREDS: What Is it and What Does it Mean for Eye Health?

AREDS is not a product, it is a body of research. The Age-Related Eye Disease Study was one of the most influential studies conducted in recent years. An initial study, and also a follow up, AREDS2, were sponsored by the National Eye Institute to observe the effects of two multivitamin formulations on the development and progression of cataracts and age-related macular degeneration. These common eye diseases typically affect people over the age of 55 and can be difficult to slow without consistent management. Each AREDS study determined that the risk of disease progression in high-risk patients could be reduced by approximately 25 percent through the consumption of specific supplementation.

Vitamins and Minerals for Eyes

Studies have identified a variety of nutrients that are known to have benefits for eye health. Many of them are antioxidants, chemicals that combat the cellular damage done by toxins and reactive oxygen. According to the AREDS clinical trial multivitamins, the following ingredients offer significant eye health benefits:

  • Beta-carotene. This precursor to vitamin A is in carrots, kale, beef or chicken liver, and sweet potatoes. It is an essential nutrient for night vision.
  • Vitamin C. When we eat oranges, kale, broccoli, and grapefruit, we get a dose of vitamin C. Known for its ability to ward off the average cold, vitamin C also reduces the risk of cataracts.
  • Vitamin E. Available in peanuts, almonds, and wheat germ, vitamin E is a powerful antioxidant known to act against risks for cataracts and macular degeneration.
  • Omega-3 fatty acids. Studies suggest that this nutrient, contained in many supplements, is protective against dry eye syndrome and macular degeneration.
  • Lutein and zeaxanthin. These plant pigments were incorporated into the AREDS2 study in place of beta-carotene. Found in kale, spinach, and turnip greens, lutein and zeaxanthin may be protective against cataracts and age-related macular degeneration.

Before taking new vitamins and supplements, it is important to speak with your healthcare provider. Our board-certified ophthalmologists offer comprehensive care and can provide information about clinically tested eye supplements. To learn more, call (800) VRS-2500.

What are The Risks for Macular Disease?

It has been estimated that approximately 11 million people live with age-related macular degeneration. This is only one of several macular diseases. Each of them can lead to vision loss. It is important to know what macular disease and what your risk factors may be because outside of that and routine eye exams, it is not easy to spot the early warning signs of damage to the macula. At Vitreo Retinal Surgery facilities, our experienced team offers comprehensive screenings for macular diseases. Here, we discuss details regarding risk factors and how you may protect your eyes.

Macular Diseases

The macula is the central aspect of the retina, a part of the back of the eye. When light enters the eye, it focuses on the retina. It is then transmitted to the brain via the optic nerve. Some of the conditions that can affect this part of the eye include:

  • Diabetic macular edema
  • Diabetic retinopathy
  • Age-related macular degeneration
  • Macular puckering
  • Macular holes
  • Retinal vein occlusion

Each of these macular diseases may present uniquely. However, damage to the macula typically causes symptoms such as reduced night and central vision, visual distortions such as floaters, and blurriness.

Risk Factors for Macular Diseases

Family history, genetics, and age are some of the strongest risk factors for macular conditions. However, other factors also contribute. For example, studies show that smoking increases the risk of damage to the macula. This may be because smoking can cause vascular problems and the eyes are reliant on numerous tiny blood vessels. Additionally, a diet that is high in salt, sugar, or fat may increase the risk of macular diseases. Unhealthy eating habits are associated with diabetes, and diabetes is a contributing factor for several eye diseases, including diabetic retinopathy. Finally, surgery or an eye injury may affect the vitreous, the fluid center of the eye. If the vitreous shrinks from an injury, it can tug on the back of the eye, leading to macular pucker or macular holes.

If you want to know more about your risk for macular disease, contact us. One of our experienced retina specialists can perform a comprehensive exam to help you better understand your eye health. Call (800) VRS-2500 to contact one of our conveniently located offices in Minnesota.

How Laser Treatment Benefits Diabetic Retinopathy

The National Institutes of Health report that approximately 2 out of 5 diabetics also have some degree of diabetic retinopathy. This condition, secondary to diabetes and unregulated blood sugar, can cause vision loss. Research indicates that children and adults with Type I and Type II diabetes, as well as pregnant women with gestational diabetes, are at risk of developing diabetic retinopathy. For this reason, regular dilated eye exams are advised for these patients. Several treatment options are available for this condition, including laser treatments such as photocoagulation.

How Laser Photocoagulation Helps Preserve Vision

The retina is a piece of tissue that sits at the back of the eye. Light lands on the retina and is translated into images through the optic nerve. Diabetic retinopathy involves swelling in the tiny blood vessels within the retina. Swelling causes blood and fluid to lead from the affected vessels. This can scar the retina or lead to detachment, in which the retina separates from the lining of the eye. Advanced diabetic retinopathy may involve the growth of abnormal blood vessels and excessive leakage of fluid and blood into the back of the eye.

Laser photocoagulation may be recommended as a method of stopping blood vessels from leaking. This quick procedure can also destroy abnormal blood vessels. One technique that is used is called focal photocoagulation, in which laser energy is direct to a small number of concentrated blood vessels. The heat from the laser seals off the blood vessels to prevent further leaking. Another technique, called scatter photocoagulation, may be done to destroy numerous abnormal blood vessels at once.

By destroying abnormal blood vessels and sealing those that are leaking, laser photocoagulation can slow the progression of diabetic retinopathy and vision loss. The procedure is conducted in the office. Patients are made comfortable with a local anesthetic administered as eye drops. Slight stinging may be felt or flashes of light seen as the laser works on blood vessels. The entire procedure is usually done in under an hour.

Know the Signs of Diabetic Retinopathy

Anyone who has been diagnosed with diabetes should be aware of the effects their condition could have on their eyes. Routine eye exams are vital, as is continued blood sugar management. Signs of diabetic retinopathy include:

  • Blurry vision
  • Difficulty reading
  • “Cobwebs” in vision
  • Black spots or floaters in vision
  • “Holes” in vision
  • Not seeing well when driving
  • Difficulty seeing colors or becoming colorblind

When diabetic retinopathy is diagnosed early, conservative treatment using prescription medication may slow or halt the progress of blood vessel damage in the eyes.

If you have signs of diabetic retinopathy, schedule a comprehensive eye exam with us. Call 800) VRS-2500.

What Causes Macular Edema?

There are certain eye conditions that we hear about relatively often. Cataracts, for example, or even glaucoma. As retinal specialists, we diagnose and treat more obscure problems, such as macular edema. Here, we discuss what this condition is, what causes it, and what we may do to protect eye health.

The macula is the central part of the retina, the thin layer of tissue that sits at the back of the eye. When light enters the front of the eye, it passes through the lens and the vitreous and lands on the retina. The retina processes light and delivers signals to the brain via the optic nerve. The brain processes these signals and forms an image. As the center of the retina, the macula processes finer vision, that which we use to read, write, and perform up-close tasks. Macular edema is the thickening or swelling of the macula that requires treatment so that vision is not disrupted or lost.

Why Macular Edema Develops

Macular edema results from damaged blood vessels the retina. Damaged blood vessels can leak blood, fluids, and small amounts of fat. These can accumulate on the macula, causing thickening or swelling. Studies suggest that damaged blood vessels are a common side effect of diabetes. Macular edema is often considered a complication of diabetic retinopathy. However, other factors may contribute to this condition, including:

  • Age-related macular degeneration
  • Blockages in the small veins in the retina
  • Inflammation of the uvea, a middle-eye structure
  • Genetic disorders such as retinitis pigmentosa
  • Side effects of certain medications

A history of eye surgery is not considered a direct cause of macular edema but it could be a factor that increases a person’s risk of blood vessel damage in the retina. For example, the blood vessels in the retina may be more sensitive after cataract surgery, increasing the risk of fluid leakage onto the macula.

Treatments for Macular Edema

At this time, macular edema is not a curable condition. Doctors provide care to manage swelling in the macula and protect long-term vision. A retinal specialist may reduce the thickness of the macula by injecting medication into this part of the eye. Alternatively, laser treatment may be administered to seal off leaking blood vessels. Treatments for macular edema to not reverse vision loss that has occurred. However, they can stabilize the condition to prevent worsening.

If you are experiencing symptoms of a retinal disorder, it is important to consult with a specialist. We are proud to serve physicians and patients in Edina, Minneapolis, St. Cloud, and various other Minnesota cities. To locate an office near you, call (800) VRS-2500.

What is Macular Pucker and What Would One Do About This Condition?

Here is an interesting detail about being a retinal specialist: you diagnose and treat conditions that many people have never heard of. If you’ve heard the term “macular pucker” before, you are among a very, very small group. For the most part, one only becomes familiar with this problem if they or someone they love is diagnosed with it. Here, we discuss what macular pucker is, who may develop it, and what we do about it when we find it.

Macular pucker is an eye disease that develops in the macula. The macula is the central part of the retina, which sits at the back of the eye. The macula is responsible for forming central vision. A macular pucker, as it may sound, involves bulging or wrinkling in this part of the retina. Normally, the macula lies flat. This position is necessary for normal function. A wrinkle or bulge will interrupt the clarity of central vision. People with macular pucker may experience cloudiness, a graying of their central field of vision, or blank spots in central vision. In some cases, no symptoms develop. Macular pucker may affect any person. However, studies indicate that there are certain people who have a higher risk of developing this condition.

People with Retinal Conditions

Eye conditions that affect the retina may increase the risk for macular pucker. Common retinal conditions include:

  • A torn or detached retina
  • Posterior vitreous detachment
  • Damaged or abnormal blood vessels in the retina
  • Swelling in the eye, increased intraocular pressure
  • Injury to the eye
  • Inflammation in the eye

Older Adults

Macular pucker is more commonly found in older adults. This could be because, as we age, the vitreous fluid that fills the center of the eye shrinks. The vitreous is normally gel-like and viscous. With age, it becomes more fluid, which could cause it to separate from the retina. Tiny fibers in the vitreous can tug on the retina, resulting in tears or other damage. Where there is damage, there will be scar tissue, and scar tissue could lead to macular pucker. The American Society of Retina Specialists reports that 2% of adults aged 50 and over show signs of macular pucker. Approximately 20% of adults aged 75 and older show signs of the condition.

VitreoRetinal Surgery, PA provides services to diagnose and treat conditions like macular pucker, macular holes, and several other problems. We are honored to accept referrals from physicians in our area and are committed to helping each patient address their eye health needs. To schedule a visit with us, call (800) VRS-2500.

Common Retinal Conditions that Can be Misdiagnosed

Medical misdiagnoses are difficult to understand. Doctors do their best to arrive at accurate conclusions about patients’ health based on available data. However, because there are innumerable medical conditions, and many of them mimic one another, even highly trained and experienced healthcare providers and sophisticated diagnostic equipment could overlook the correct issue. One of the best ways we have of reducing misdiagnoses in medicine at large and, for us, within the field of retina care, is to educate patients. The team at VitreoRetinal Surgery, PA is consistently armed with the most up-to-date information regarding retinal conditions. We share this information with patients to ensure they can make confident decisions about their care.

Three Commonly Misdiagnosed Retinal Conditions

Macular Hole

We receive numerous referrals from other doctors and appreciate the opportunity to provide advanced care for their patients. Sometimes, patients come to us believing they have a macular hole. This misdiagnosis isn’t too far off-base. What we often find is that a macular hole diagnosis is actually a lamellar macular hole. The difference relates to severity, with the lamellar macular hole being less severe.

A macular hole affects all layers of the retina, while a lamellar macular hole affects only one or a few.

A macular hole must be surgically corrected, while a lamellar macular hole typically does not require surgical intervention.

Central Retinal Vein Occlusion

Central retinal vein occlusion is a condition in which small blot hemorrhages may be scattered throughout all four quadrants of the eye. This same clinical data characterizes diabetic retinopathy. Additionally, both conditions can cause macular edema that is visually significant during an eye exam. A retina specialist may differentiate the two by the presence of disc edema and venous tortuosity (twisting of one or more veins) in the eye, which indicates the occlusion of the central retinal vein.


Like central retinal vein occlusion, peripheral retinoschisis shares similar indications with another condition. In this instance, it is that peripheral retinoschisis gets misdiagnosed as retinal detachment. In either condition, the retina may be elevated. A specialist looks for finite details such as white dots on the retina and a particular shape and thickness of this part of the eye to reach an accurate diagnosis. The distinction is critical because retinal detachment requires prompt surgical intervention to prevent vision loss, whereas peripheral retinoschisis does not.

The differences between retinal conditions often come down to the tiniest details. The objective of any comprehensive eye exam is not to create doubt in a patient’s mind that their referring doctor “got it wrong.” Our goal is to continue providing second-opinions as requested by referring physicians so patients receive the best possible care.

We proudly serve areas in and around Minneapolis, St. Cloud, Hermantown, Edina, St. Paul, and more. To locate an office near you, call (800) VRS-2500.

Frequently Asked Questions about Eye Floaters

When we reach a certain age, we may begin to notice objects drifting across our field of vision. These are phenomena called floaters. If you have noticed these objects and have attempted to look at them, you know they cannot be pinned down visually. Trying to look at a floater is the fastest way to get it to disappear, it seems. Because floaters are a common symptom experienced by most adults, we receive a lot of questions about this visual disturbance. Here, we answer some of the most common.

What is an eye floater?

Floaters are not imaginary objects floating through vision. They are small clumps of protein that have formed inside the eye. As light passes through the eye, these clumps may cast shadows on the retina. These appear as small blobs, cobwebs, hair, black dots, or worm-like shapes. As the eyes shift around, floaters move. They are most obvious when you are observing a uniform background such as the sky.

Why do floaters occur?

We get floaters as we get older because the vitreous humor, the gel-like fluid that fills the center of the eye, loses density. The liquid becomes watery and clumps of protein float through it. Protein clumps become visible as they cast shadows on the back of the eye. While age is the most common factor that contributes to floaters, they may also stem from inflammation, infection, an eye injury, or a retinal tear.

Should I be concerned about eye floaters?

Most people over the age of 40 will experience the occasional object floating around their field of vision. The change in the vitreous humor is a natural occurrence that is usually not a cause for concern. However, floaters are sometimes indicative of a retinal tear, a condition that can be very serious. A retinal tear may occur if the shrinking vitreous tugs on the retina so much that this structure begins to separate from the back of the eye. If the retina tears and begins to detach, floaters may coincide with shadowing coming over vision as well as streaks of light passing through the field of vision. These symptoms require prompt medical attention.

Floaters may go away on their own over time. However, it is wise to schedule a retinal exam if floaters develop to ensure that this important part of the eye is healthy and intact. VitreoRetinal Surgery, PA is proud to serve patients in several Minnesota cities, including St. Cloud, Minneapolis, and Duluth. To find an office near you, call (800) VRS-2500.

Macula | Blaine, MN

How Age-Related Macular Edema Affects Vision

Age-related macular degeneration (AMD) describes the damage that occurs in the macula, the part of the eye in which central vision is formed. This common condition is the leading cause of vision loss in older adults. Although total blindness is not typically caused by AMD, people with this condition may suffer a diminished quality of life. For this reason, it is important to know how age-related macular edema may appear and what to do if it does.

What Is the Macula?

The macula is a part of the retina that is positioned at the center of the back of the eye. It is the part of the retina where, when light lands, transports electrical messages to the brain to form central vision, that which is straight ahead of the eyes. When the macula is damaged, light processing in this area is interrupted, causing the decrease or loss of central vision.

Symptoms of AMD

Damage to the macula does not cause vision loss right away. Milder symptoms often occur first. These include:

  • Sensitivity to glare
  • Fuzzy, blurry, or shadowing in the central vision
  • Difficulty seeing or reading in low-light
  • Distortion or blurring of straight lines

As the disease worsens, symptoms become more noticeable. When the disease reaches an advanced stage, everyday tasks can become a challenge due to the marked decrease in the central area of vision. Sufferers have a difficult time reading road signs, seeing objects up close, watching television, driving, and performing work or chores. Being able to see clearly only in peripheral vision, sufferers can become limited in how they engage in life.

Treating AMD

A board-certified ophthalmologist can diagnose AMD during a comprehensive eye exam and discussion of visual symptoms. The early diagnosis of age-related macular edema is imperative to the most successful management of the condition. Doctors use medications or laser therapy to slow the progression of this disease but cannot correct the damage that has occurred.

If you exhibit symptoms of macular degeneration, a thorough eye exam is needed to discover the cause of visual impairment. Our specialists have years of experience treating age-related macular degeneration and can administer care to help preserve your vision for the foreseeable future.

VitreoRetinal Surgery, PA proudly serves patients in several Minnesota cities. To locate an office near you, call (800) VRS-2500.

Vitreo Retinal Surgery

Causes of Blurry Peripheral Vision

Our peripheral vision is our ability to see objects that are to the side of the face without turning our head. It is an expansion of our central vision and necessary for us to engage in life as fully and safely as possible. Sudden peripheral vision loss may feel like tunnel vision, where everything to the side is dark and everything in the central field is quite clear. There are reasons why peripheral vision loss may occur. With prompt attention for this visual disruption, a retinal specialist can identify the cause and, optimally, administer treatment that might restore at least some degree of visual clarity.

Retinal Detachment and Tears

Blurry side vision is one of the primary symptoms of a torn or detached retina. Additional symptoms include sudden spots, flashes, floaters, or a shadow obscuring part of the field of vision. Retinal detachment requires prompt treatment to prevent complete vision loss.


This progressive eye disease involves elevated pressure within the eye. Persistent pressure on the optic nerve can lead to irreversible damage and vision loss. Because damage occurs slowly, patients have a chance to receive care that can preserve as much visual clarity as possible.

Retinitis Pigmentosa

Retinitis pigmentosa affects the light-sensitivity of the retina, the part of the eye that transfers light to the brain via the optic nerve. The intense sensitivity of the retina leads to gradual degeneration of this part of the eye. Retinitis pigmentosa is a rare eye disorder that cannot be cured but may be managed with appropriate care from a retina specialist.

A Note About Peripheral Vision Loss

Peripheral vision loss may occur suddenly or gradually. People with glaucoma, for instance, are more likely to notice very subtle changes over time. Regardless of the speed of darkening in the peripheral view, it is beneficial to schedule a comprehensive eye exam right away. A board-certified ophthalmologist or retina specialist can determine the cause of visual changes and provide appropriate care.
In the case of sudden peripheral vision loss, floaters, or flashes, emergency medical attention is needed right away.

Contact Our Retinal Care Specialists

We are proud to serve patients from multiple Minnesota cities, including St. Cloud, St. Paul, Minnesota, and more. To locate an office near you, call (800) VRS-2500.