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What is Diabetic Retinopathy?

Diabetic Retinopathy is one of the few diseases that make up Diabetic Eye Disease. It is the most common diabetic eye disease and is one of the leading causes of blindness in American Adults. It is caused by changes in the blood vessels of the retina.

Stages of Diabetic Retinopathy

  • Mild Nonproliferative Retinopathy - The earliest stage of diabetic retinopathy. During this stage microaneurysms occur which are small areas of balloon-like swelling in the retina’s tiny blood vessels.
  • Moderate Nonproliferative Retinopathy - The second stage of diabetic retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked
  • Severe Nonproliferative Retinopathy - The third stage of diabetic retinopathy. At this point, more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas will send signals to the body to grow new blood vessels to nourish the eye.
  • Proliferative Retinopathy - This is the last and most advanced stage of diabetic retinopathy. The signals that are sent by the retina and received by the body trigger the growth of new blood vessels. The new blood vessels are abnormal and fragile. They will grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. These blood vessels alone will not cause symptoms or vision loss, but if the thin fragile walls leak, severe vision loss or blindness can occur

How does this happen?

There are two ways that Diabetic Retinopathy can cause vision loss.

1. The fragile blood vessels can leak blood into the center of the eye, which will blur vision. This is characteristic of proliferative retinopathy.

2. Fluid can also leak into the center of the macula (the part of the eye where straight ahead, sharp vision occurs). This makes the macula swell, blurring vision (called macular edema). This can occur at any stage as the disease progresses. Approximately half of people with proliferative retinopathy also have macular edema.

Signs and Symptoms

     Diabetic retinopathy does not have any early warning signs or symptoms. Do NOT wait for symptoms to see your doctor.

How can you protect your vision?

Have good control over both blood sugar levels as well as blood pressure. Also be sure to have regular comprehensive eye exams.

Who is at risk?

     Anyone who has diabetes (type 1 or 2) is at risk. With this being said, everyone with diabetes should get a comprehensive dilated eye exam at least once a year. 40%-45% of Americans who are diagnosed with diabetes have some stage of diabetic retinopathy.

Diabetic retinopathy could be a problem with women who are pregnant. To protect themselves, every pregnant woman with diabetes should have a comprehensive, dilated eye exam as soon as possible.

Treatment Options

During the first three stages of diabetic retinopathy, no treatment is needed (unless you have macular edema). Preventative measures should be taken to control blood sugar, blood pressures, and blood cholesterol.

A vitrectomy is used to remove blood from the vitreous gel of the eye. This would occur if there was a large amount of blood from the vessels leaking in the eye. The procedure is performed under either local or general anesthesia. The doctor makes a tiny incision in the eye. A small instrument is then used to removes the vitreous gel. The gel is replaced with a salt solution. Most people can return home immediately after the vitrectomy but some stay overnight. The eye will be red and sensitive. An eye patch will need to be worn for a few days or weeks to protect the eye and medicated eyedrops should be used.

Proliferative retinopathy is treated with laser surgery. A procedure called scatter laser treatment. This procedure helps to shrink the abnormal blood vessels. The doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, which will cause the abnormal vessels to shrink Two or more sessions are usually needed since a high number of burns are required. Although some peripheral vision may be lost, the treatment can save the rest of the patient's sight. Scatter laser treatment may slightly reduce color as well as night vision.

(This page was adapted from the National Eye Institute)

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