Retinopathy is a disease of the retina . The retina is the nerve layer that lines the back of your eye. It is the part of your eye that “takes pictures” and sends the images to your brain. Many people with diabetes get retinopathy. This kind of retinopathy is called diabetic retinopathy (retinal disease caused by diabetes).
4(a)Diabetic Retinopathy – Cause
Diabetic retinopathy can lead to poor vision and even blindness. Most of the time, it gets worse over many years. At first, the blood vessels in the eye get weak. This can lead to blood and other liquid leaking into the retina from the blood vessels. This is called nonproliferative retinopathy. And this is the most common retinopathy. If the fluid leaks into the center of your eye, you may have blurry vision.
Most people with nonproliferative retinopathy have no symptoms.
If blood sugar levels stay high, diabetic retinopathy will keep getting worse. New blood vessels grow on the retina. This may sound good, but these new blood vessels are weak. They can break open very easily, even while you are sleeping. If they break open, blood can leak into the middle part of your eye in front of the retina and change your vision. This bleeding can also cause scar tissue to form, which can pull on the retina and cause the retina to move away from the wall of the eye (retinal detachment).
This is called proliferative retinopathy. Sometimes people don’t have symptoms until it is too late to treat them. This is why having eye exams regularly is so important.(Get your eyes checked at least once a year for Diabetic Retinopathy)
Retinopathy can also cause swelling of the macula of the eye. This is called macular edema. The macula is the middle of the retina, which lets you see details. When it swells, it can make your vision much worse. It can even cause legal blindness.
If you are not able to keep your blood sugar levels in a target range, it can cause damage to your blood vessels. Diabetic retinopathy happens when high blood sugar damages the tiny blood vessels of the retina.
When you have diabetic retinopathy, high blood pressure can make it worse. High blood pressure can cause more damage to the weakened vessels in your eye, leading to more leaking of fluid or blood and clouding more of your vision.
4(b)Diabetic Retinopathy – Symptoms
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Most of the time, there are no symptoms of diabetic retinopathy until it starts to change your vision. When this happens, diabetic retinopathy is already severe. Having your eyes checked regularly can find diabetic retinopathy early enough to treat it and help prevent vision loss.
If you notice problems with your vision, call an eye doctor (ophthalmologist) right away. Changes in vision can be a sign of severe damage to your eye. These changes can include floaters, pain in the eye, blurry vision, or new vision loss.
An eye exam by an eye specialist (ophthalmologist or optometrist) is the only way to detect diabetic retinopathy. Having a dilated eye exam regularly can help find retinopathy before it changes your vision. On your own, you may not notice symptoms until the disease becomes severe.
Symptoms of diabetic retinopathy and its complications may include:
Blurred, double, or distorted vision or difficulty reading.
Floaters or spots in your vision.
Partial or total loss of vision or a shadow or veil across your field of vision.
Pain, pressure, or constant redness of the eye.
4(c)Diabetic Retinopathy – What Increases Your Risk
Your risk for diabetic retinopathy depends largely on two things: how long you have had diabetes and whether or not you have kept good control of your blood sugar.
You can control some risk factors, which are things that may increase your risk for diabetic retinopathy and its complications. Risk factors that you can control include:
Pregnancy
Women who have diabetes are at increased risk of developing retinopathy during pregnancy. In women who already have retinopathy when they become pregnant, the condition can become much worse during pregnancy. If you get pregnant, you will need to have an eye exam sometime during the first 3 months. You’ll also need close follow-up during your pregnancy and for 1 year after you have your baby.
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Consistently high blood sugar
High blood sugar levels increase your risk of retinopathy. Keeping your blood sugar levels in a target range can reduce your risk for diabetic retinopathy and can slow the progression of the disease if it has already started.
High blood pressure
In general, people with diabetes who also have high blood pressure are more likely to develop complications that affect the blood vessels in the body, including those in the eyes.
Delayed diagnosis and treatment
Getting a dilated eye exam will not prevent retinopathy. But it may reduce your risk of severe vision loss from complications of retinopathy. By detecting it early, you can get treatment that can prevent vision loss and delay the progression of the disease.
Smoking
Although smoking has not been proved to increase the risk of retinopathy, smoking makes many of the other health problems faced by people with diabetes worse, including disease of the small blood vessels.Stopping smoking has many health benefits ,it will reduce your chances of getting serious diabetic complications as well as the financial gain you will have more money in your pocket at the end of the month.
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If you have type 2 diabetes and use the medicine rosiglitazone (Avandia, Avandamet, Avandaryl) to treat your diabetes, you may have a higher risk for problems with the center of the retina (the macula). The U.S. Food and Drug Administration (FDA) and the makers of the drug have warned that taking this medicine could cause swelling in the macula, which is called macular edema.
4(d)Diabetic Retinopathy – When To Call a Doctor
Call your doctor immediately if you have diabetes and notice:
Floaters in your field of vision. Floaters often appear as dark specks, globs, strings, or dots. A sudden shower of floaters may be a sign of a retinal detachment, which is a serious complication of diabetic retinopathy.
A new visual defect, shadow, or curtain across part of your vision. This is another sign of retinal detachment.
Eye pain or a feeling of pressure in your eye.
New or sudden vision loss. The sudden onset of partial or complete vision loss is a symptom of many disorders that can occur within or outside the eye, including retinal detachment or bleeding within the eye. Sudden vision loss is always a medical emergency.
Watchful waiting
Watchful waiting is not an option if you have diabetes and notice changes in your vision.
If you have type 2 diabetes, even if you do not have any symptoms of eye disease, you still need to have your eyes and vision checked regularly by an eye specialist (ophthalmologist or optometrist). If you wait until you have symptoms, it is more likely that complications and severe damage to the retina will have already developed. These may be harder to treat and may result in permanent vision loss.
If you have type 1 diabetes, are age 10 or older, and were diagnosed 5 or more years ago, you should have your eyes checked even if you don’t have symptoms. If you wait until you have symptoms, it is more likely that complications and severe damage to the retina will have happened. These may be harder to treat. And the damage may be permanent.
4(e)Diabetic Retinopathy – Exams and Tests
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Diabetic retinopathy can be detected during a dilated eye exam by an ophthalmologist or optometrist. An exam by your primary doctor, during which your eyes are not dilated, is not an adequate substitute for a full exam done by an ophthalmologist. Eye exams for people with diabetes can include:
Visual acuity testing
Visual acuity testing measures the eye’s ability to focus and to see details at near and far distances. It can help detect vision loss and other problems.
Ophthalmoscopy and slit lamp exam
These tests allow your doctor to see the back of the eye and other structures within the eye. They may be used to detect clouding of the lens (cataract), changes in the retina, and other problems.
Gonioscopy
Gonioscopy is used to find out whether the area where fluid drains out of your eye (called the drainage angle) is open or closed. This test is done if your doctor thinks you may have glaucoma, a group of eye diseases that can cause blindness by damaging the optic nerve.
Tonometry
This test measures the pressure inside the eye, which is called intraocular pressure (IOP). It is used to help detect glaucoma. Diabetes can increase your risk of glaucoma.
Your doctor may also do a test called an optical coherence tomography (OCT) to check for fluid in your retina. Sometimes a fluorescein angiogram is done to check for and locate leaking blood vessels in the retina, especially if you have symptoms, such as blurred or distorted vision, that suggest damage to or swelling of the retina.
Fundus photography
Can track changes in the eye over time in people who have diabetic retinopathy and especially in those who have been treated for it.
Fundus photography produces accurate pictures of the back of the eye (the fundus). An eye doctor can compare photographs taken at different times to watch the progression of the disease and find out how well treatment is working. But the photos do not take the place of a full eye exam.
4(f)Early detection
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Early detection and treatment of diabetic retinopathy can help prevent vision loss. For people in whom diabetic retinopathy has not been diagnosed, the Diabetes Association recommends that screening be done based on the following guidelines:
People with type 1 diabetes who are age 10 and older should have a dilated eye exam within 5 years after diabetes is diagnosed and then every year.
People with type 2 diabetes should have an exam as soon as diabetes is diagnosed and then every year.
If your eye exam results are normal, your doctor may consider follow-up exams less often. For example, you may have an exam every 2 years. But if you are diagnosed with retinopathy, you may need frequent eye exams.
Women who have type 1 or type 2 diabetes and who are planning to become pregnant should have an exam before becoming pregnant, if possible, and then once during the first 3 months (first trimester) of pregnancy. The eye doctor can decide whether you need further screening for retinopathy during pregnancy based on the results of the first-trimester exam.
4(g)Diabetic Retinopathy – Treatment
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There is no cure for diabetic retinopathy. But laser treatment (photocoagulation) is usually very effective at preventing vision loss if it is done before the retina has been severely damaged.
Surgical removal of the vitreous gel (vitrectomy) may also help improve vision if the retina has not been severely damaged. Sometimes injections of an anti-VEGF (vascular endothelial growth factor) medicine or an anti-inflammatory medicine help to shrink new blood vessels in proliferative diabetic retinopathy.
Because symptoms may not develop until the disease becomes severe, early detection through regular screening is important. The earlier retinopathy is detected, the easier it is to treat and the more likely vision will be preserved.
You may not need treatment for diabetic retinopathy unless it has affected the center (macula) of the retina or, in rare cases, if your side (peripheral) vision has been severely damaged. But you do need to have your vision checked regularly.
If the macula has been damaged by macular edema, you may need laser treatment. For more severe retinopathy, you may need either laser treatment or vitrectomy. These procedures can help prevent, stabilize, or slow vision loss when they are done before the retina has been severely damaged. Newer treatment includes medicines like anti-VEGF medicine or steroids that are injected into the eye.
Surgical removal of the vitreous gel (vitrectomy) is done when there is bleeding (vitreous hemorrhage) or retinal detachment, which are rare in people with early-stage retinopathy. Vitrectomy is also done when severe scar tissue has formed.
Treatment for diabetic retinopathy is often very effective in preventing, delaying, or reducing vision loss. But it is not a cure for the disease. People who have been treated for diabetic retinopathy need to be monitored frequently by an eye doctor to check for new changes in their eyes. Many people with diabetic retinopathy need to be treated more than once as the condition gets worse.
Also, controlling your blood sugar levels is always important. This is true even if you have been treated for diabetic retinopathy and your eyes are better. In fact, good blood sugar control is especially important in this case so that you can help keep your retinopathy from getting worse.
Ideally, laser treatment should be done early in the course of the disease to prevent serious vision loss rather than to try to treat serious vision loss after it has already developed.
People with diabetes who have any signs of retinopathy need to be examined as soon as possible by an ophthalmologist.
4(h)Diabetic Retinopathy – Prevention
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There are steps you can take to reduce your chance of vision loss from diabetic retinopathy and its complications:
Control your blood sugar levels.
Keep blood sugar levels in a target range by eating a healthful diet, frequently monitoring your blood sugar levels, getting regular physical exercise, and taking insulin or medicines for type 2 diabetes if prescribed.
Control your blood pressure.
Retinopathy is more likely to progress to the severe form and macular edema is more likely to occur in people who have high blood pressure. It is not clear whether treating high blood pressure can directly affect long-term vision. But in general, keeping blood pressure levels in a target range can reduce the risk of many different complications of diabetes.
Have your eyes examined by an eye specialist (ophthalmologist or optometrist) every year
Screening for diabetic retinopathy and other eye problems will not prevent diabetic eye disease. But it can help you avoid vision loss by allowing for early detection and treatment.
See an ophthalmologist if you have changes in your vision. Changes in vision-such as floaters, pain or pressure in the eye, blurry or double vision, or new vision loss-may be symptoms of serious damage to your retina. In most cases, the sooner the problem can be treated, the more effective the treatment will be.
The risk for severe retinopathy and vision loss may be even less if you:
Don’t smoke
Although smoking has not been proved to increase the risk of retinopathy, smoking may aggravate many of the other health problems faced by people with diabetes, including disease of the small blood vessels.
Avoid hazardous activities
Certain physical activities, like weight lifting or some contact sports, may trigger bleeding in the eye through impact or increased pressure. Avoiding these activities when you have diabetic retinopathy can help reduce the risk of damage to your vision.
Get adequate exercise
Exercise helps keep blood sugar levels in a target range, which can reduce the risk of vision damage from diabetic retinopathy. Talk to your doctor about what kinds of exercise are safe for you.
Resources
https://www.visioncenter.org/blog/diabetic-eye-exam/
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