Diabetic Retinopathy – Exploring the Basics

December 21, 2018

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Vision loss is a global phenomenon, quite a serious one, and so is the diabetes. Imagine the recipe of disaster that can be brewed when the two of these are combined. Well, diabetic retinopathy is exactly that, diabetes and vision loss combined together, affecting around 285 million people globally.

Talking of the diabetic retinopathy in the U.S., according to a recently published report:

These stats published by Prevent Blindness America further complement this:

So, here we are, diabetic retinopathy affecting the vision of around 7.7 million American adults aged 40 or above with an overall national prevalence rate of 5.4%. Vision loss due to diabetic retinopathy not only strikes disaster for the individual suffering from it, but it also hurts the economy quite badly.

Now wondering how much it costs the U.S. government in terms of healthcare costs related to this eye disease. Well, according to this publication:

One of the most simplest and effective ways to minimize the risk of vision loss due to diabetic retinopathy is to manage the blood sugar levels and blood pressure levels of the population through early detection and timely treatment of the disease.

So, let’s embark on our quest to get acquainted with this diabetic-induced ocular disease.

What is Diabetic Retinopathy?

It is an eye condition specifically occurring in people suffering from diabetes, a serious complication of diabetes also popularly known as “DR”. It affects the eye by progressively damaging the retina, a lining at the back of the eye comprised of light-sensitive tissues.

Diabetes is a disease capable of interfering with body’s natural tendency to store and utilize sugar (glucose), mostly characterized by raising the sugar level in the blood, which can result in damaging different body parts, including the eyes.

Over a period of time, diabetes affects retina by damaging the blood vessels within it, causing them to leak blood and other bodily fluids. This results in swelling of the retinal tissue, ultimately leading to a cloudy or blurred vision.

Normally, this condition affects both eyes and the longer a person carries diabetes, the higher is their likelihood of developing diabetic retinopathy. If diagnosis and treatment are delayed, it can also cause blindness.

Treatment of diabetic retinopathy may vary from person to person depending majorly on the extent of the damage done to the retina. Some DR patients might also need surgery to seal retinal blood vessels. Sometimes, a patient might need to get specialized medication injected into their eyes to control inflammation or stopping the development of new blood vessels.

For people suffering from advanced DR, an eye doctor might recommend a surgical procedure for removal and replacement of the gel-like fluid (known as vitreous) present in the back of the eye. Sometimes, DR leads to retinal detachment as well and surgery serves as the best option for repairing it.

Diabetic Retinopathy Symptoms

Often, DR remains symptomless through its early developmental stages. That’s why experts recommend getting an eye exam on regular basis, once a year at least.

Some of the major symptoms of diabetic retinopathy include:

Blurry vision
Appearance of spots or floaters across the field of vision
Trouble seeing things properly at night

Types of Diabetic Retinopathy

This eye disease is classified into two major types:

1: Non Proliferative Diabetic Retinopathy (NDPR)

Considered as the early stage of DR, symptoms mostly remain nonexistent to mild in non proliferative diabetic retinopathy. NDPR weakens retinal vessels leading to formation of tiny bulges (referred as microaneurysms), from which blood and fluid is leaked into the retina. This leakage can also result in swelling of the macula.

2: Proliferative Diabetic Retinopathy (PDR)

Also known as PDR, proliferative diabetic retinopathy is the advanced stage of the disease whereby retina is deprived of the oxygen due to blood circulation problems. This can trigger growth of fragile new blood vessels within the retina, including the vitreous, the gel-like fluid filling the back of the eye. This is when vision starts clouding or blurring.

Other major complications of proliferative diabetic retinopathy include retinal detachment due to scar tissue formation as well as glaucoma. PDR can also prompt growth of new blood vessels within the region of the eye responsible for draining fluid from the eye. This significantly raises the fluid pressure of the eye, capable of damaging the optic nerve and glaucoma is an eye disease involving damage to the optic nerve. Leaving PDR untreated can lead to sever vision loss as well as blindness.

Diabetic Retinopathy Diagnosis

Majority of the experts believe that nothing works as well as a comprehensive eye exam for diagnosing DR, especially focused on evaluation of the retina and macula. The procedure may include:

Taking patient history to outline vision difficulties, determining the presence or absence of diabetes and to enlist any other overall health concerns capable of affecting vision.
Measuring visual acuity to gauge the extent of the damage done to the central vision
Checking refraction to verify whether or not new prescription for eyeglasses is needed.
Pupil dilation to evaluate ocular structures thoroughly, also including retina examination.
Measuring ocular pressure (eye pressure).
Assessing the current status of the retina through retinal tomography or photography of the retina.
Assessing abnormal growth of blood vessels through fluorescein angiography.

Diabetic Retinopathy Treatment

There can be varied approaches when it comes to treatment for diabetic retinopathy, such as:

1: Lifestyle Management

It basically involves improving your lifestyle, aimed at controlling your blood pressure and blood sugar levels to stop vision loss. Strictly follow an appropriate diet regime as recommended by your nutritionist coupled with taking the medicine prescribed by your diabetes doctor. Sometimes, managing your blood sugar levels rightly can even help you regain some of your vision. Similarly, managing your blood pressure also complements your endeavor, as it keeps your eye’s blood vessels healthy.

2: Medication

Anti-VEGF (anti vascular endothelial growth factor) therapy is recommended by many optometrists and ophthalmologists to control DR, comprising mainly of Eylea, Avastin and Lucentis drugs. This type of medication has proved much helpful in reducing the swelling of the macula, slowing down vision loss caused by it. Anti-VEGF treatment is administered as shots (injections) within the eye. Another effective way of reducing macular swelling is the steroid medication, also administered by injecting into the eye.

3: Laser Surgery

Laser surgery is preferred as a tool for sealing off the leaking retinal blood vessels, reducing retinal swelling as a result. This treatment also proves helpful in shrinking blood vessels, preventing them from growing again. Sometimes, multiple sessions of the surgery are needed.

4: Vitrectomy

Eye doctors resort to vitrectomy for dealing with advanced PDR, removing vitreous gel and blood from leaking vessels in the back of your eye. This can also be used for removing scar tissues from the retina.

5: Alternate Solutions

Luckily, rapidly advancing technology also brings forth innovative and convenient low-vision aids like IrisVision, which can help people cope with their vision loss. This novel solution is designed to enhance vision for people suffering from diabetic retinopathy and other degenerative age-related eye diseases like macular degeneration.