McFarland Clinic

Q & A: Diabetic Retinopathy

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November 20, 2013

Answers to questions about the diabetic retinopathy from McFarland Clinic Ophthalmologist & Retina Specialist Tracy Kangas, MD, PhD.

What is Diabetic Retinopathy?

Diabetic retinopathy is a disease of the small blood vessels of the retina. Diabetic retinopathy is a complication of diabetes. People with Type 1 diabetes and Type 2 diabetes can develop diabetic retinopathy over time.

Classification of diabetic retinopathy can be non-proliferative or proliferative. Non-proliferative means no new blood vessels are present; conversely, proliferative means new blood vessels are present.

Diabetic retinopathy is caused when sugar (glucose) creates leaky areas in the blood vessels resulting in leaks. It can also cause small blood vessels in the retina to close.

The longer you have diabetes and the less controlled your blood sugar, the more likely you are to develop diabetic retinopathy.

What are the symptoms of diabetic retinopathy?

Over 14 million Americans have diabetes and only half of these are aware they have the disease. It is possible to have the diabetic retinopathy and not even know it. Often there are no symptoms in the early stages of the disease. As the condition progresses, symptoms may include:

  • Spots or dark strings floating in your vision (floaters)
  • Blurred vision
  • Fluctuating vision
  • Dark or empty areas in your vision
  • Vision loss
  • Difficulty with color perception

What does the retina do?

The retina is the light sensitive tissue located in the back of the eye. It acts like film in a camera - images come through the eye's lens and are focused on the retina. The retina then converts these images to electric signals and sends them via the optic nerve to the brain.

What are the complications of diabetic retinopathy?

Diabetic retinopathy can have numerous complications because of the abnormal growth of blood vessels in the eye. Complications can include:

  • Vitreous hemorrhage - when the new blood vessels break and leak into the vitreous (clear gel that fills the space between the retina and the lens)
  • Retinal detachment - abnormal blood vessels stimulate the growth of scar tissue, which can pull the retina away from the back of the eye, resulting in floating spots, flashes of light or severe vision loss
  • Macular Edema - caused by the leakage of fluid and lipids from the diseased vessels into the central part of the retina. Over time, the swollen nerves die and vision decreases.
  • Glaucoma - increased pressure in the eye can damage the nerves that carries the images to the brain
  • Blindness - diabetic retinopathy is the leading cause of blindness in working age Americans, 20-55 years old.

Why do patients with diabetes have decreased vision?

Macular edema is the most common reason for decreased vision in patients with diabetes. Macular edema means central retina swelling. The macula is the very sensitive part of the central retina the sees fine detail. Swelling in this part of the eye results in blurred vision.

What treatment options are available for those with diabetic retinopathy?

Treatment options for diabetic retinopathy can be non-surgical or surgical procedures and often are a combination of both. Non surgical treatment includes observation, pan-retinal laser (PRP) or injections into the vitreous.

Most complications arise with patients that have proliferative diabetic retinopathy, though treatment can be done on both non-proliferative and proliferative.

A treatment option for vitreous hemorrhage is to have a vitrectomy, which is a surgical procedure that removes the vitreous gel from the eye. Often, the pan-retinal laser (PRP) is used in combination with the vitrectomy. If the retina has detached, it can be repaired during surgery.

Macular edema is treatable by using the laser or using intravitreal injections. After treatment, it may take 6 weeks to 24 weeks for vision to improve.

How do you prevent diabetic retinopathy?

The best way to prevent diabetic retinopathy is controlling blood sugar to prevent the progression of the disease.

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