Diabetic retinopathy (DR) is an eye disease that is caused by both insulin-dependent and non-insulin dependent diabetes mellitus. There are 2 types of diabetic retinopathy, 1) non-proliferative (also commonly referred to as background) and 2) proliferative.
Non-proliferative DR always develops before proliferative DR. Patients develop areas of bleeding and/or swelling in the retina from damaged blood vessels. Patients may not have any symptoms at this stage. However, vision can sometimes be blurred if the swelling (called diabetic macular edema) is severe. The more serious and advanced type of diabetic retinopathy is the proliferative type. Patients with proliferative diabetic retinopathy develop new abnormal blood vessels that tend to bleed. Bleeding which fills the back of the eye (vitreous hemorrhage), retinal scarring and detachment, neovascular glaucoma are all complications from proliferative DR.
Eye with Diabetic Retinopathy
How is it diagnosed?
Your eye doctor will dilate your eyes, and look for areas of bleeding and swelling, abnormal blood vessels, scar tissue, and retinal detachment. Tests such as fluorescein angiography, optical coherence tomography, and ultrasound may be used to help determine the severity level of the diabetic retinopathy and help guide management options.
How is it treated?
The treatment depends on how severe the diabetic retinopathy is. There are specific grading scales for the level of severity. Many cases of diabetic retinopathy can simply be observed. Laser treatment may be recommended once the swelling (macular edema) or abnormal blood vessels (proliferative diabetic retinopathy) have reached a severe enough stage. Injection of medicines directly into or around the eye are sometimes needed. Surgery (see section on vitrectomy) is sometimes necessary if there is severe bleeding or retinal detachment in the eye.
Depending on the degree of your diabetes, it is important to follow the directions of your eye doctor. Visits may be needed every six to twelve months at a minimum. Currently, there is no cure for diabetic retinopathy. Along with working with your internist in controlling your diabetes, blood pressure, and cholesterol, most retinal treatments are designed to minimize future vision loss. The best treatment for diabetic retinopathy is prevention. It is important to maintain good control of blood sugar levels and work with your internist, endocrinologist, doctor to prevent further progression of your diabetes. Diet and exercise is stressed as well as good control of hypertension (high blood pressure. Other contributing factors that can cause additional damage and complications in the eye can be related to smoking. Smoking contributes to the obstruction of the blood vessels in the eye and should be stopped by diabetic patients.