Diseases & Conditions

Diabetic retinopathy

Diabetic retinopathy is a complication of diabetes that results from damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, however, diabetic retinopathy can result in blindness. In the United States, diabetic retinopathy is a leading cause of blindness in adults.

Diabetic retinopathy can happen to anyone who has type 1 diabetes or type 2 diabetes. In fact, up to 45 percent of adults diagnosed with diabetes in the United States have some degree of diabetic retinopathy, according to the National Eye Institute. And the longer you have diabetes, the more likely you are to develop diabetic retinopathy.

To protect your vision, take prevention seriously. Start by controlling your blood sugar level and scheduling yearly eye exams.

You can have diabetic retinopathy and not know it. In fact, symptoms are unusual in the early stages of diabetic retinopathy.

As the condition progresses, diabetic retinopathy symptoms may include:

• Spots floating in your vision
• Blurred vision
• Dark streaks or a red film that blocks your vision
• Poor night vision
• Vision loss

Diabetic retinopathy usually affects both eyes.

Early detection of diabetic retinopathy is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly dilated eye exam — even if your vision seems fine. If you become pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy.

Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.

Diabetic retinopathy is best diagnosed with a dilated eye exam. During the exam, your eye doctor will look for:

• Abnormal blood vessels
• Swelling, blood or fatty deposits in the retina
• Damage to the nerve tissue
• Growth of new blood vessels and scar tissue
• Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)
• Retinal detachment

As part of the eye exam, your doctor may do a retinal photography test called fluorescein angiography. First, your doctor will dilate your pupils and take pictures of the inside of your eyes. Then a special dye will be injected into a vein in your arm. More pictures will be taken as the dye circulates through your eyes. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid.

Your doctor also may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina and whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor treatment effectiveness.

Treatment for diabetic retinopathy depends on the type of diabetic retinopathy you have, its severity and how well it may respond to specific treatments.

Early diabetic retinopathy
If you have nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your retina to determine if you need laser treatment.

Advanced diabetic retinopathy
If you have proliferative diabetic retinopathy, you'll need prompt surgical treatment. Sometimes surgery is recommended for severe nonproliferative diabetic retinopathy, too. Depending on the specific problems with your retina, options may include:

• Focal laser treatment. This laser treatment, also known as photocoagulation, can stop the leakage of blood and fluid in the eye. It's done in your doctor's office or eye clinic. During the procedure, leaks from abnormal blood vessels are sealed with laser burns. Focal laser treatment is usually done in a single session. Your vision will be blurry for about a day after the procedure. Sometimes small spots caused by the laser burns may appear in your visual field. The spots generally fade and disappear with time. If you had blurred vision from swelling of the central macula before surgery, however, you may not recover completely normal vision.
• Scatter laser treatment. This laser treatment, also known as panretinal photocoagulation, can shrink the abnormal blood vessels. It's also done in your doctor's office or eye clinic. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the new blood vessels to shrink and disappear. Scatter laser treatment is usually done in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.
• Vitrectomy. This procedure can be used to remove blood from the center of the eye (vitreous) and scar tissue that's tugging on the retina. It's done in a surgery center or hospital under local or general anesthesia. During the procedure, the doctor makes a tiny incision in your eye. The blood-filled tissue and scar tissue are removed with delicate instruments and replaced with a salt solution, which helps maintain your eye's normal shape. Sometimes a gas bubble must be placed in the cavity of the eye to help reattach the retina. After surgery, you may stay in the hospital overnight. If a gas bubble was placed in your eye, you may need to remain in a facedown position until the gas bubble disappears — often several days. You'll need to wear an eye patch and use medicated eyedrops for a few days or weeks. Often, vitrectomy is followed or accompanied by laser treatment.

Surgery often slows or stops the progression of diabetic retinopathy, but it's not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss is possible. Even after treatment for diabetic retinopathy, you'll need regular eye exams. At some point, additional treatment may be recommended.

Researchers are studying new treatments for diabetic retinopathy, including medications that may help prevent abnormal blood vessels from forming in the eye. Some of these medications are injected directly into the eye to treat existing swelling or abnormal blood vessels.