Diabetic Retinopathy

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Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that impacts the blood vessels in the retina. High blood sugar levels can damage these vessels, leading to vision impairment and increasing the risk of other conditions such as glaucoma, cataracts, retinal detachment, and even blindness. About 26% of Americans with diabetes have diabetic retinopathy, and its prevalence increases with the duration and severity of diabetes.

Both individuals with type 1 and type 2 diabetes can develop diabetic retinopathy; however, patients with type 1 diabetes are at a higher risk compared to those with type 2. Additional factors that can increase the risk include conditions like obesity, pregnancy, and kidney disease, as well as lifestyle choices such as smoking.

Stages of Diabetic Retinopathy

There are four stages of diabetic retinopathy, each increasing in severity:

• Mild non-proliferative diabetic retinopathy (NPDR): This is the early stage of diabetic retinopathy, where the retinal blood vessels develop small bulges called microaneurysms. Typically, there are no noticeable symptoms during this stage.
• Moderate non-proliferative diabetic retinopathy (NPDR): In this stage, some blood vessels may become blocked, leading to a reduced supply of nutrients and oxygen to certain areas of the retina.
• Severe non-proliferative diabetic retinopathy (NPDR): During this stage, the blood vessels become increasingly blocked. Scar tissue begins to form, and the retina responds to oxygen deprivation by growing new, fragile blood vessels. Patients may experience vision problems, such as blurriness or dark spots.
• Proliferative diabetic retinopathy (PDR): This is the most advanced stage of diabetic retinopathy, characterized by the growth of abnormal blood vessels that can bleed and form scar tissue. This scar tissue can pull the retina out of position, causing a retinal detachment. If left untreated, this condition can lead to permanent vision loss.

Diabetic Retinopathy Symptoms

In the early stages of diabetic retinopathy, most patients don’t experience noticeable symptoms. As the condition progresses, symptoms may include:

• Blurry vision
• Floaters
• Difficulty seeing at night
• Blind spots
• Objects appearing wavy or uneven

In severe stages, diabetic retinopathy can lead to severe complications such as eye pain, significant vision loss, vitreous hemorrhage (bleeding in the eye), and even total blindness.

Diagnosing Diabetic Retinopathy

A retina specialist can diagnose diabetic retinopathy through a comprehensive eye exam, during which they’ll check for signs of swelling, abnormal blood vessels, and leakage. Diagnostic methods include:

• Eye dilation: During an eye exam, the doctor will apply special drops to widen the pupil, allowing for a better examination of the retina.
• Ophthalmoscopy: A retina specialist may use an ophthalmoscope to shine a light into the eye and examine the retina.
• Fluorescein angiography: In this test, a colored dye is injected into the bloodstream. The dye travels to the blood vessels in the eye, and a special camera captures images to identify any abnormalities in the retina.
• Optical coherence tomography (OCT): This non-invasive technique uses infrared light waves to capture cross-sectional images of the retina.
• Fundus photography: This diagnostic and monitoring tool utilizes a specialized camera to capture detailed images of the retina, optic nerve, and blood vessels at the back of the eye.

Treating Diabetic Retinopathy

The treatment for diabetic retinopathy varies based on its severity. In mild and moderate cases, your doctor may recommend changes to your diabetes management plan to better control your blood sugar levels. For more advanced cases of diabetic retinopathy, additional treatments may be necessary, including:

• Panretinal Photocoagulation (PRP): PRP is a comprehensive laser treatment used on the peripheral retina to inhibit the growth of abnormal blood vessels in the eye. It can reduce the risk of severe vision loss by 60% over two years.
• Focal laser treatment: Also known as photocoagulation, this procedure utilizes a high-energy laser to close abnormal blood vessels, preventing further leakage.
• Vitrectomy: This surgical procedure involves the removal of the vitreous humor fluid from the eye, allowing the retina specialist to repair the eye. Vitrectomies can also be combined with PRP therapy to treat vitreous hemorrhage.
• Anti-vascular endothelial growth factor (anti-VEGF) medications: Anti-VEGF medications are a group of drugs used to inhibit the growth of blood vessels in the eye. Examples of anti-VEGF medications include Vabysmo, Eylea HD, Cimerli, and Lucentis, which are administered directly into the eye via injection. These medications can also help manage macular edema, a condition where fluid builds up in the macula.