Diabetic Retinopathy

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What is diabetic retinopathy?

Diabetic retinopathy is an eye problem caused by diabetes mellitus. Retinopathy occurs when diabetes damages the tiny blood vessels in the retina, which is the light sensitive tissue in the back of the eye. This damage can lead to problems with your vision, including permanent blindness. However, you may be able to prevent severe vision problems if:

• You keep your diabetes, blood pressure, and cholesterol under control.
• You have regular eye exams.
• You get treatment for retinopathy when your eye care provider thinks it is necessary.

How does it occur?

High blood sugar levels damage small blood vessels. The weakened blood vessels may break and leak fluid and blood. If the condition worsens, some of the blood vessels close off. This prevents oxygen from getting to the retina. If the retina cannot get oxygen, it tries to grow new, abnormal blood vessels. These new blood vessels can bleed, cause cloudy vision, and form scar tissue. This scar tissue can pull on the retina, causing a retinal detachment and possible loss of vision.

The longer you have had diabetes and the worse your blood sugar control is, the more likely you are to have retinopathy.

What are the symptoms?

Diabetic retinopathy begins before you have any symptoms. As the problem gets worse, you may have:

• blurred vision
• floaters, which are black spots or cobweb-like shapes
• temporary or permanent blindness

How is it diagnosed?

Your eye care provider will examine your eyes using an ophthalmoscope (an instrument for seeing inside the eye). You may have pictures taken of the back of your eye and may need a test called fluorescein angiography (FA) or optical coherence tomography (OCT). Your care provider may refer you to a retina specialist (an eye doctor who specializes in diseases of the back of the eye).

How is it treated?

Early treatment before the retina has been badly damaged is the most successful in reducing vision loss from this disease.

Your eye surgeon may use a laser to reduce leaking from blood vessels. The surgeon may also use a laser to help reduce the growth of abnormal blood vessels. These laser treatments are usually performed in the office after numbing the eye with drops or shots.

If you have had bleeding into the clear gel (vitreous) that fills the inside of the eye, the eye surgeon may remove the gel with surgery in the operating room. The gel will be replaced with a clear fluid. This procedure is called a vitrectomy.

New treatments are becoming available to decrease the growth of new blood vessels with shots of medicines in and around the eye. Be sure to ask your eye care provider if these treatments might help you.

How long will the effects last?

As long as you have diabetes, there is a chance you will have retinopathy. However, careful control of your blood sugar level, blood pressure, and cholesterol will help delay and possibly prevent vision loss.

You may need to be treated more than once for retinopathy. Have your eyes checked regularly to make sure you get treatment when you need it.

Retinopathy can cause the retina to become detached. This means the retina is pulled away from the back of the eye. If this happens, you need to see your eye care provider for urgent treatment to reduce the chance of permanent vision loss. Call your provider right away if you start seeing dark spots, floaters, or light flashes or your vision is blocked, blurred, or distorted.

How can I take care of myself?

Follow your provider's recommendations and these guidelines:

• Make sure you have eye exams regularly. Ask your provider how often your eyes should be checked.
• Tell your provider right away if you have any change in your vision.
• Talk to your healthcare provider about the treatment of your diabetes, blood pressure, and cholesterol. Ask your provider for the results of your hemoglobin A1c test. This blood test shows how well your sugar has been controlled in the last 2 to 3 months.

What can be done to help prevent diabetic retinopathy?

To help prevent diabetic retinopathy, follow these guidelines:

• Control your blood sugar.
• Control your blood pressure.
• Control your cholesterol levels.
• Follow your diet and healthcare plan for your diabetes so you have fewer complications.

Reviewed for medical accuracy by faculty at the Wilmer Eye Institute at Johns Hopkins. Web site: http://www.hopkinsmedicine.org/wilmer/

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