Diabetic retinopathy is caused by complications in diabetic patients, when high blood sugar levels damage the back of the eye or retina. If it is left undiagnosed and untreated it can cause blindness, so it is important to be aware of the condition if you are diabetic. The condition affects 80% of people who have had diabetes for 20 years or more and the longer a patient has diabetes the higher the risk of developing diabetic retinopathy.
Diabetic retinopathy is when the retina (or light-sensitive tissue in the back of the eye) is damaged by high blood sugar levels in diabetic patients. The retina needs a constant supply of blood in order to convert light into electrical signals, these are then sent to the brain which converts this information into images, allowing you to see. This blood is supplied through a network of small blood vessels which can become damaged by consistently high blood sugar levels, this happens in 3 stages:
Small bulges develop in the blood vessels which may bleed a bit, but don’t usual affect your vision. This is called background retinopathy.
More significant changes to the blood vessels including more severe bleeding known as pre-proliferative retinopathy.
Scar tissue and formation of new blood vessels which are weak and bleed easily develop on the retina, this is called proliferative retinopathy and can cause some loss of vision.
However, if the condition is detected early on lifestyle changes and other treatment can prevent it getting worse.
It is also important to be aware of the factors associated with a higher risk of diabetic retinopathy, such as:
The condition affects people with both type I and type II diabetes and often has no early warning signs. Fortunately it does take several years for diabetic retinopathy to reach a stage where it can threaten your eyesight, and there are ways to minimize the risk. If you are diabetic it is important to:
Typically the early stages of diabetic retinopathy do not have noticeable symptoms which means regular eye screening is essential. If you experience any of the following more advanced symptoms it is important to contact your GP or optician immediately to check for the condition:
Eye screening once a year is recommended for anyone with diabetes over 12 years old. These screenings are important because, as previously mentioned, diabetic retinopathy often doesn’t have any symptoms in its early stages. Regular eye screening allows your optician to scan the back of the eye (retina) for any signs of the condition and if necessary treat the condition early on. Early detection means that the patient may be able to avoid loss of vision or reduce the severity of the condition.
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Specific treatment is not typically used until the more advanced stages of diabetic retinopathy and your vision is at risk. At all stages controlling your diabetes is vital and plays a large part in mitigating the condition. Managing your diabetes in the early stages can help prevent or reduce the damage to your eyesight and in the later stages can reduce the extent of vision loss.
For advanced diabetic retinopathy that is threatening the patient’s sight treatment includes:
Laser treatment is used to treat the growth of new blood vessels in the back of the eye as they tend to be weak and often bleed into the eye. This treatment will not usually improve the patient’s sight but it can help to stabilize the changes in the eye and stop the patient’s vision getting any worse.
Treatment is done under a local anaesthetic to numb the eyes with eye drops to dilate the pupil and special contact lenses to hold the eye open and focus the laser onto the retina. The procedure usually takes around 20-40 minutes and doesn’t usually require an overnight stay in hospital. You may need to return for subsequent treatment at a laser clinic as required.
Treatment can have some side effects for a few hours such as sensitivity to light, blurred vision and aching or discomfort. These issues should be easy to manage with some self-care at home such as painkillers, wearing sunglasses and resting until you feel better.
There are some risks associated with laser treatment such as:
In some cases eye injections of anti-VEGF directly into your eyes may be used to prevent new blood vessels from forming in the retina. The main medicines used are called ranibizumab (Lucentis) and aflibercept (Eylea) and they can help improve vision or stop the condition getting worse.
The treatment is given under local anaesthetic so the eye is numb and the injection is given through a very fine needle directly into the eye ball. They are usually given once a month to begin with but will be less frequent or stopped once the patient’s vision begins to stabilise. Alternatively if the anti-VEGF medications do not work steroid mediations may be used instead.
There are some risks associated with eye injections including:
There is also a small risk of the injections causing a blood clot which may lead to a stroke or heart attack. This risk is small but it is important to be aware of it before undergoing treatment.
Surgery (known as vitreoretinal surgery) may be used to remove some of the transparent jelly-like substance that fills the space behind the lens of the eye (vitreous humour). This operation is known as vitreoretinal surgery and may be necessary if there is a significant amount of blood collected in your eye or if there is a lot of scar tissue which may cause or has already caused retinal detachment.
The surgery is carried out under local anaesthetic and sedation meaning the patient is unconscious during the surgery and does not experience any pain. During the procedure the surgeon makes a small incision and removes some of the vitreous humour and any scar tissue before using a laser to prevent any further loss of vision.
Potential risks of this surgery include:
If diabetic retinopathy is left untreated the blood vessels in the retina become significantly damaged and the patient will experience loss of vision and eventually blindness.
Proliferative diabetic retinopathy is the third and most severe stage in the damage to the blood vessels in the retina. This means that new blood vessels and scar tissue have developed on the retina which can cause significant bleeding into the eye and potentially retinal detachment (when the retina pulls away from the back of the eye). At this stage of diabetic retinopathy there is a high risk of losing vision and the treatment options available may prevent further damage but cannot restore the vision already lost.
Retinal screening is done during your regular diabetic eye screening by your optician. You will be given eye drops to dilate the pupil which allows your optician to get a better look at your retina at the back of your eye. The optician will then take pictures of the retina with a special camera in order to get a closer look at the health of the blood vessels and check for any signs of change.
If not properly managed diabetes can lead to conditions such as retinopathy or maculopathy, which are both caused by damage to the blood vessels in the eye. These blood vessels can become damaged if the patient’s blood sugar is persistently high, and over time this can lead to a loss of vision and even blindness. In order to prevent this it is important to maintain the treatment of your diabetes and attend regular eye screening appointments. If you experience any changes in vision before your next appointment it is important to also make your GP or optician aware.