What is Diabetic Retinopathy?
Diabetic retinopathy is the leading cause of blindness in working-age Americans. This disease occurs in patients with diabetes when elevated blood sugar can cause damage to the small fragile retinal blood vessels in the back of the eye.
Long-term damage to blood vessels can lead to poor circulation in the eye which can result in bleeding and vision loss. If left untreated, it can result in complete blindness.
There are two types of diabetic retinopathy. Non-proliferative diabetic retinopathy is the first stage, followed by proliferative diabetic retinopathy, which is more advanced. Diabetic macular edema or DME may also occur. This occurs when blood vessels are damaged and leak fluid into the retina.
Non-Proliferative Diabetice Retinopathy: This is the first stage of diabetic retinopathy. In this stage, blood vessels in the retina can enlarge or become blocked. Some blood vessels become leaky and they may leak blood, fluid, or proteins into the retina. When the leakage affects the center of the retina, the macula, we call this diabetic macular edema and central vision can become blurry.
Proliferative Diabetic Retinopathy: This is considered the advanced form of diabetic retinopathy. At this point, diabetes has caused significant damage to the retina. New, blood vessels have started to grow into the eye, but these new blood vessels are irregular and often very fragile. Some of them break and bleed into the eye causing floaters and considerable loss of vision. If left untreated, scar tissue can begin to develop on the retina and in the vitreous and can lead to retinal detachments.
Both forms of diabetic retinopathy can be treated to help prevent the vision loss. Intravitreal injections of medications into the eye and laser surgery have been shown to be beneficial.
How is Diabetic Retinopathy Diagnosed?
Your retina specialist uses a dilated eye exam to tell if you have diabetic retinopathy. To do this, they give you dilating eye drops that take twenty to thirty minutes to dilate your pupils. Once the drops have dilated your pupils, your eye doctor can look through your pupils to examine your retina.
Your doctor may choose to do an OCT (Optical Coherence Tomography) to more closely evaluate the retina on a cellular level. This imaging modality allows the doctor to carefully examine the retina for signs of edema or swelling in the retina, bleeding, or poor circulation.
In some cases, a doctor might do a fluorescein angiogram to check for severe diabetic retinopathy. A fluorescein angiogram is a test in which dye is injected into your arm and pictures are then taken of the retina. This test allows the doctor to visualize all of the blood vessels in the retina and help determine which stage of diabetic retinopathy you have and to guide treatment options.
Can You Treat Diabetic Retinopathy?
If you have mild non-proliferative diabetic retinopathy, you may not need immediate treatment. But your retina specialist will want to see you regularly to ensure the disease is not developing into proliferative diabetic retinopathy.
In the event that you have developed proliferative diabetic retinopathy or diabetic macular edema (swelling in the retina as a result of blood vessel leakage), your doctor may initiate treatment. There are three primary treatments used for diabetic retinopathy. They are injections, laser treatment, and surgery.
Injections for Diabetic Retinopathy
Anti-VEGF medications are a common medication used to treat diabetic retinopathy. These medications are administered into the middle cavity of the eye known as the vitreous body.
Anti-VEGF stands for anti-vascular endothelial growth factor. Anti-VEGF therapy blocks the production of endothelial growth factor.
VEGF is a protein your cells produce in response to poor circulation that causes abnormal blood vessels to grow. In diabetic retinopathy, it is important to inhibit the production of this molecule to prevent them from bleeding into the eye which can cause vision loss.
Anti-VEGF injections stop new blood vessels from growing, which will help slow down vision loss. Some patients may also receive steroid injections to reduce the swelling in their retinas.
Risks of anti-VEGF injections are rare but include increased eye pressure, infections, and bleeding in the eye. Your doctor will discuss with you how often you will need these injections.
Laser Treatment for Diabetic Retinopathy
A laser treatment called photocoagulation can help seal leaking blood vessels and prevent the formation of new abnormal vessels. This type of laser treatment can be done in the doctor’s office and is usually pain-free.
Surgery for Diabetic Retinopathy
If you have advanced diabetic retinopathy, you may need to undergo a procedure called vitrectomy. Vitrectomy is a surgical procedure done in the operating room where the vitreous gel in the back of the eye is removed.
The purpose of a vitrectomy is to remove blood, fluid, and scar tissue from your eye. Having a vitrectomy allows your retina to work correctly again.
Removing your vitreous allows the surgeon to have direct access to your retina in order to treat the underlying retinal disorder which is causing vision loss.
After the vitreous gel is removed, they may replace it with an air or gas bubble which goes away slowly over time. Occasionally silicone oil is used during the procedure.
Healing and recovery after eye surgery can take a week to several months.
Will Treatment for Diabetic Retinopathy Completely Fix my Vision?
No, treatment for diabetic retinopathy cannot reverse any damage already done to your vision. However, treatment can stop your vision from getting any worse.
It is best to see your retina specialist regularly so they can watch your situation. Your chances of keeping your vision are much greater if a retina specialist keeps track of your eye health.
How Can I Prevent Diabetic Retinopathy?
The easiest way to prevent diabetic retinopathy is to make lifestyle changes that prevent it from developing. Managing your blood glucose levels to the best of your abilities is the simplest way to do this.
Following a healthy diet and exercising will also help keep your vision strong. The longer you have diabetes, the more likely you are to develop diabetic retinopathy.
The most crucial action you can take is to take care of your body and stay on top of your blood glucose levels. Also, controlling your blood pressure and cholesterol will help your eyes stay healthy.
Do you have concerns about treating diabetic retinopathy? Schedule a consultation at Retina Consultants of Austin in Austin, TX, today!