Diabetic retinopathy 

Diabetic retinopathy is a complication resulting from a chronic condition – diabetes. This complication results from the damage to small and medium size blood vessels of retina which is the light-sensitive tissues at the back of the eye. In the early stages, diabetes retinopathy causes no symptoms, and when symptoms occur it may still be reversible and therefore early diagnosis is paramount. However, the condition can progress to further damage and even cause blindness. 

Diabetic retinopathy can affect people with type 1 and type 2 diabetes. The longer you have diabetes with uncontrolled blood sugar levels, the higher your chances of developing diabetic retinopathy. 

Symptoms

Diabetic retinopathy may not show symptoms early, but the following symptoms may occur as the condition progresses. 

• Blurred vision 
• Distorted or wavy vision
• Vision loss 
• Dark strings or spots in your vision, also called floaters 
• An empty or dark area in your vision 
• Fluctuation vision 

When you should see a doctor 

Managing diabetes is the best prevention method for vision loss resulting from diabetic retinopathy. Visiting your eye doctor every year for an eye exam is important if you have diabetes. 

Gestational diabetes and having diabetes before pregnancy can increase your risk of developing diabetic retinopathy. If you are pregnant, the doctor may recommend additional eye examinations during your pregnancy. 

Ensure you contact your eye doctor immediately if you experience sudden vision changes or your vision becomes hazy, blurry, or spotty. 

Causes 

Excess sugar in the blood for an extended period can block the tiny blood vessels transporting nutrients to the retina. This also leads to a shortage of blood in the retina, which causes the eye to attempt to grow new blood vessels. The new blood vessels do not develop properly, leading to blood leakage in the eye, glaucoma and loss of vision. 

Two main types of diabetic retinopathy affect people. They include:

• Early diabetic retinopathy 

This is the most common diabetic retinopathy, also known as nonproliferative diabetic retinopathy (NRDR). In this condition, the blood vessels do not grow. It weakens the retinal blood vessels, and small bulges protrude from the wall of the smaller vessels. In some cases, blood and fluid will leak from the smaller vessels into the retina. The larger retinal vessels may dilate and have irregular diameters. The condition can become severe as the blood vessels get blocked. 

In some cases, the damage in retinal blood vessels leads to the accumulation of fluid (oedema) in the macula (the centre of the retina). If oedema in the macular reduces vision, treatment is necessary to prevent permanent vision changes. 

• Advanced diabetic retinopathy 

Proliferative diabetic retinopathy occurs when diabetic retinopathy progresses to an advanced stage. In this condition, the damaged retinal blood vessels close off, leading to the growth of new, abnormal retinal blood vessels. The new retinal blood vessels are weak and can leak their content into the vitreous humour (the clear, jellylike fluid that fills the centre of the eye).

The scar tissues resulting from the growth of new retinal blood vessels can make the retina detach from the back of the eye. In cases where the new blood vessels interfere with the normal fluid flow from the eye, increased eye pressure may occur. The increased blood pressure will damage the optic nerve (the nerves that send signals from the eye to the brain to interpret images), causing glaucoma. 

Risk factors 

People with diabetes can have diabetic retinopathy. Your risk for having diabetic retinopathy is higher if you: 

• Have diabetes for a long period 
• Have High cholesterol
• Use tobacco products 
• Have poor controlled blood sugar level 
• Are pregnant 
• Are a Native American, Hispanic or afro Caribbean black.

Complications 

The complications from diabetic retinopathy can lead to serious vision problems, including:

• Vitreous haemorrhage 

The new retinal blood vessels can bleed into the vitreous humour. If the bleeding is minimal, you might see floaters, but in severe cases, when the blood fills your vitreous cavity, complete vision loss will occur. 

Vitreous haemorrhage alone doesn’t lead to permanent vision loss. The blood can clear from the eye in a few weeks or even months if the leak has stoped, following which your vision will become clear.

• Retinal detachment 

The new, irregular blood vessels occurring in diabetic retinopathy will stimulate scarring, leading to the retina being pulled away from the rear side of the eye(traction). This causes floaters, light flashes, or vision loss. 

• Glaucoma 

When new blood vessels develop in the iris, they may interfere with normal fluid flow from the eye, leading to increased eye pressure. The pressure can damage the optic nerve. 

• Blindness

Diabetic retinopathy, glaucoma, macular oedema, or the combination of these eye conditions can cause permanent vision damage and even loss, especially with improper management of the the condition. 

Prevention 

Preventing diabetic retinopathy isn’t always possible. But, regular exams, managing blood pressure and blood sugar, and early treatment for vision issues can prevent permanent vision loss. 

If you have diabetes, you can reduce your risk of developing diabetic retinopathy with the following. 

• Manage diabetes 

Incorporate physical activities and healthy into your routine. Ensure you engage in at least 150 minutes of moderate aerobic exercise, like walking every week. Take your insulin shots and oral diabetes medication as prescribed by your doctor. 

• Monitor your blood sugar levels

Checking and recording your blood sugar levels several times daily may be necessary, especially if you are under stress or sick. Speak with your doctor every day to know how often you need to check your blood sugar. 

• Consult your doctor about the glycosylated haemoglobin test 

This test also called haemoglobin A1C test, which checks the average blood sugar levels within 2 – 3 months. People with diabetes should aim for an AIC result of below 7%. 

• Control your cholesterol and blood pressure 

Exercising regularly, losing excess weight, and eating healthy foods, including medication, can help control your blood pressure and cholesterol. 

• Quit smoking 

Smoking increases the risk of different complications from diabetes, including diabetic retinopathy.  

• Pay attention to changes in your vision 

If your vision becomes spotty, hazy, or blurred, ensure you contact your eye doctor immediately. 

Diabetes doesn’t always cause vision loss, but you should actively manage the condition to prevent complications affecting the eye. If you experience symptoms of diabetic retinopathy, contact Optimal Vision immediately on 020 7183 3725 to schedule an appointment with our eye doctor.