High blood sugar levels can damage blood vessels in the retina (the nerve layer at the back of the eye that senses light and sends these images to your brain).
Diabetic patients can have numerous ocular complications leading to severe vision loss and sometimes blindness. Although diabetic retinopathy can affect persons with either Type 1 or Type 2 Diabetes, persons with Type 1 are at a higher risk of developing severe disease.

There are two types of diabetic retinopathy

  • Non-proliferative diabetic retinopathy (NPDR): An early stage of diabetic
    retinopathy characterized by tiny blood vessels leaking blood, fluid or
    exudates. Many people develop diabetic macular edema, diabetic macular ischemia (poor oxygenated blood flow) or both.

    • Macular edema is swelling or thickening of the macula, the central vision area of the retina at the back of the eye. This is the most common cause of visual loss in diabetes that may be reversible if treated early.
    • Macular ischemia is the closure of all the small blood vessels (capillaries) in the central vision area of the retina at the back of the eye. This leads to permanent vision loss.

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  • Proliferative diabetic retinopathy (PDR): A late stage of diabetic retinopathy characterized by abnormal new blood vessel growth on the surface of the retina or optic nerve. These abnormal vessels grow in response to poor blood supply due to the diabetic damage to your normal blood vessels.
    Unfortunately, these abnormal new vessels tend to break and bleed causing significant bleeding and scarring, which can lead to wrinkling or detachment of the retina.

diabetic_retina_img_2

Complications

  • Vitreous hemorrhage: This is characterized by a bleed into the vitreous cavity, or the middle part of the eye due to the fragile, abnormal new blood vessels breaking. This causes your vision to be obscured and may take days, months or even years to reabsorb all of the blood. If the blood in the middle cavity of the eye does not clear in a reasonable time period, the vitreous blood may need to be removed with vitrectomy surgery.
  • Neovascular glaucoma: Occasionally in cases of PDR, the new abnormal blood vessels can grow in the front of the eye and block the normal drainage
    channels. This leads to a blockage of normal fluid flow out of the eye leading to pressure build up causing pain and damage to the optic nerve.
  • Traction retinal detachment: When PDR is present, the abnormal vessels can create scar tissue that shrink, wrinkle and pull on the retina therefore causing visual distortion and loss of vision.

 

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What causes Diabetic Retinopathy?

  • Poor blood sugar control leads to oxidative damage to the small blood vessels (capillaries) in the eye. This continuous damage leads to progressive visual complications including diabetic macular edema, diabetic macular ischemia, non-proliferative diabetic retinopathy, proliferative diabetic retinopathy,
    vitreous hemorrhage, tractional retinal detachments and neovascular
    glaucoma.

How do you treat Diabetic Retinopathy?

  • The best treatment is to prevent the development of retinopathy with strict control of your blood sugar levels and blood pressure.
  • If damage is already present, the main goal of treatment is to prevent further loss of vision.
Medical Treatments
    • Injections of anti-Vascular
      Endothelial Growth Factor therapy for diabetic macular edema,
      proliferative diabetic retinopathy and neovascular glaucoma.
    • Laser surgery for diabetic macular edema, proliferative diabetic
      retinopathy and neovascular
      glaucoma. Laser surgery does not cure diabetic retinopathy or
      improve vision and is utilized to prevent further vitreous bleeding or abnormal new vessel growth. Multiple laser treatments over time are sometimes necessary and do not always prevent further loss of vision.
Surgical treatments
    • In advanced cases of tractional retinal detachments or proliferative diabetic retinopathy, a vitrectomy may be required to remove the blood-filled vitreous and scar tissue. Surgery is usually done early because macular distortion or traction retinal detachment will cause permanent visual loss and the longer the retina is out of place, the more serious the vision loss will be.

For More Information and Educational Resources

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