What is Diabetic Retinopathy?
High blood sugar levels from diabetes mellitus cause damage to small blood vessels throughout the body, including in the eye. The retina is a common site of involvement. Diabetic retinopathy can be classified into two general types: nonproliferative diabetic retinopathy and proliferative diabetic retinopathy.
In the nonproliferative form, damage to small retinal blood vessels leads to microaneurysms, retinal hemorrhages, exudates, cotton wool spots, and retinal swelling (known as diabetic macular edema). Proliferative diabetic retinopathy is even more serious, and is characterized by the growth of new, abnormal blood vessels that can take over the front and back of the eye. These blood vessels are fragile and can cause large hemorrhages in the eye (vitreous hemorrhage). Scar tissue can form on the surface of the retina, leading to retinal detachment. The abnormal blood vessels can also grow on the iris and clog the drainage area of the eye, leading to high eye pressures and a serious condition known as neovascular glaucoma. If left untreated, these complications can cause blindness and even loss of the eye.
Diabetic Retinopathy Symptoms
Nonproliferative Diabetic Retinopathy (NPDR) is often initially asymptomatic. In the early stages of the disease a patient may not even know that they have any issues. This highlights the importance of regular screening eye exams. When NPDR becomes more severe, it may lead to blurred vision, decreased clarity of vision, and fluctuating vision quality.
Proliferative Diabetic Retinopathy (PDR) can cause profound visual impairment. Patients may report hazy vision, difficulties with night vision, and floaters. It may also take a long time for eyes to adjust to changes in lighting conditions (ie, going from a dark room to the bright outdoors, or vice versa). If neovascular glaucoma develops, a patient may have loss of vision, eye redness, and severe pain. Patients with a retinal detachment may experience loss of peripheral vision, blurred vision, flashing lights, and floaters.
Diabetic Retinopathy Treatment
In the early stages of NPDR, treatment measures are focused on slowing the progression of disease. Importance is placed on controlling blood sugar levels, blood pressure, cholesterol, and other vascular risk factors. Smoking cessation should be pursued, if applicable. Medical control of diabetes mellitus is very important in order to preserve vision and to prevent other systemic complications such as kidney disease, heart disease, stroke, and neuropathy. Working closely with a primary care provider is essential in meeting these health goals.
A variety of retinal treatment options are available if the diabetic retinopathy is more severe. Diabetic macular edema (swelling of the central retina) is managed with injections of medications into the eye and laser treatments. There are several injectable medications that are available. The most common medications are known as “anti-VEGF” agents, and they counteract the effects of a molecule inside the eye known as vascular endothelial growth factor. The levels of VEGF are abnormally high in diabetic retinopathy and this leads to leaky retinal capillaries, macular edema, and the growth of abnormal, fragile blood vessels. In addition to anti-VEGF medications, steroid injections can be used to treat the complications from diabetic retinopathy.
Proliferative diabetic retinopathy is initially managed with laser treatments and eye injections. Surgery may be necessary if more serious complications arise, such as vitreous hemorrhage, retinal detachment, and neovascular glaucoma.
Schedule a Consultation
If you would like to learn more about Proliferative Diabetic Retinopathy, please call (800) VRS-2500 to schedule a consultation. We have locations in Minneapolis, St. Paul, Blaine, Edina, Oakdale, Plymouth, St. Cloud and Duluth.