Diabetic retinopathy

Diabetes mellitus can be accompanied by eye damage – diabetic retinopathy. High blood sugar level damages the blood vessels of the retina, which swell and leak or become clogged and blocked for blood flow. Sometimes new, abnormal blood vessels appear in the retina. All these processes lead to visual impairment.

Diabetic retinopathy

Diabetes mellitus can be accompanied by eye damage – diabetic retinopathy. High blood sugar level damages the blood vessels of the retina, which swell and leak or become clogged and blocked for blood flow. Sometimes new, abnormal blood vessels appear in the retina. All these processes lead to visual impairment.

Stages of diabetic eye damage

Diabetic eye disease has two main stages.

BDR (background diabetic retinopathy) is the initial stage of diabetic eye damage, which occurs in many diabetic patients.

BDR is accompanied by fluid leakage from blood vessels and retinal oedema. If the macula swells up, it is called macular oedema. This is the most common cause of blindness among people with diabetes mellitus.

In addition, BDR may be accompanied by blocking the retinal vessels, with an insufficient amount of blood enters the macula, and macular ischaemia develops. Sometimes small particles form in the retina – exudates, which also impair vision.

BDR is accompanied by blurred vision.

Terms

Retina is a layer of nerve cells, located on the inner surface of the eye. The retina senses light and sends signals to the brain, with images formed out of these signals in the brain.

Macula is a small but very important area in the centre of the retina. Macula is needed to clearly see the small details of objects.

Macular oedema is swelling of the macula due to fluid leakage from the blood vessels. Macular oedema leads to blurred vision.

Vitreous is a transparent gel which fills the eye cavity from the inside.

Spots in front of the eyes are small clumps of cells or certain substances in the vitreous which appear as small moving dots, lines, or clouds in the field of vision.

Macular oedema is the most common cause of visual impairment in diabetic patients.

PDR (proliferative diabetic retinopathy) is the next stage of diabetic eye damage, when new abnormal blood vessels grow in the retina. This process is called neovascularization. New vessels are very fragile, so they often become a source of vitreous haemorrhage. If the haemorrhage is small, only a few dark spots may appear in the field of vision. Extensive haemorrhage can completely obscure the entire field of vision.

New blood vessels can form scar tissue which detaches the retina or damages the macula.

PDRD is a very serious illness which can lead to loss of both central and peripheral vision.

 What are the symptoms of diabetic retinopathy?

Patients may not be aware that they have diabetic retinopathy, since in the early stages it does not have any symptoms. As diabetic retinopathy progresses, such symptoms may appear as:

  • an increased number of spots in front of the eyes;
  • blurred vision;
  • sometimes blurred vision disappears and objects become clearer;
  • dark areas in the field of vision;
  • poor vision at night or faded colours;
  • deterioration of vision.

Diabetic retinopathy usually affects both eyes.

How is diabetic retinopathy diagnosed?

The ophthalmologist will examine the retina with a special lens, after dilating the pupil with eye drops, to find changes in the retina and macula.

To identify newly formed pathological vessels, blocked vessels, as well as leakage of fluid from the vessels in the retina, doctors use the method of fluorescent angiography, when a yellow dye (fluorescein) is injected into a vein of the arm. The blood vessels supply the dye to the retina, and at this time it is photographed with a special camera.

Another method of examining the retina is optical coherence tomography (OCT). A special device scans the retina and forms detailed images of the retina and macula, and enables to measure the thickness of the retina and identify macular oedema.

 How is diabetic retinopathy treated?

Treatment depends on the abnormalities the ophthalmologist found during examination.

Control of background diseases. By controlling your blood pressure and blood sugar level, vision deterioration can be stopped. Follow the recommended diet carefully. Take prescribed diabetes medications. In some cases, strict control of the blood sugar level can even recover vision a bit. Blood pressure control helps keep the blood vessels in the eye in a proper condition.

Are you a diabetic and have an appointment with an ophthalmologist?

Fluctuations in blood sugar levels affect vision, so you should carefully monitor your blood sugar level for at least a week before seeing an ophthalmologist. Then the ophthalmologist will choose the proper glasses for you.

  • Intravitreal injection. Various medications are used to treat diabetic retinopathy. The so-called vascular endothelial growth factor (VEGF) inhibitors reduce macular oedema, slow down vision impairment, and sometimes even improve vision. The medication is injected into the eye cavity with a very thin needle.

Steroids are another group of medications for relieving macular oedema, which are also injected into the eye cavity. The doctor will tell you how many times the medications should be injected.

  • Laser procedure. The laser beam is used to cauterize the blood vessels from which the fluid leaks, and thus reduce the retinal oedema. In addition, the laser blocks blood vessels and prevents their further growth. In some cases, laser surgery should be repeated.
  • Vitrectomy. If you have a severe form of PDR, the ophthalmologist may suggest a surgery (vitrectomy). During the surgery, the ophthalmologist removes the vitreous, as well as the blood which has flowed out of the pathological blood vessels into the eye cavity. As a result, the light rays will again properly reach the retina. In addition, during the surgery, scar tissue can be removed from the surface of the retina.

Prevention of visual impairment in diabetic retinopathy

  • If you have diabetes, consult your family doctor on blood sugar level control. High sugar levels damage the blood vessels in the retina and impair vision.
  • Do you have high blood pressure or kidney problems? Consult your doctor on the treatment of these disorders.
  • See your ophthalmologist regularly for fundus examinations. It is possible to diagnose diabetic retinopathy even before you notice any of its symptoms.
  • If you notice that vision in one or both eyes has changed, see your ophthalmologist immediately.
  • Treatment for diabetic retinopathy should be started as early as possible. This is the best way to prevent visual impairment.

Summary

High blood sugar level damages the retina and macula and impairs visual acuity. This disorder is called diabetic retinopathy. In the early stages, diabetic retinopathy may not have any symptoms. As it progresses, diabetic eye damage leads to visual impairment.

To treat diabetic retinopathy, medications, injections, and surgery are used.

See your ophthalmologist regularly to monitor your diabetic retinopathy.

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