An ophthalmologist and diabetes educator discuss what causes diabetic retinopathy and how you can stop it in its tracks.
Diabetic retinopathy is one of the most common complications that people with Type 1 and Type 2 diabetes face, placing them at risk for diminished vision, and in severe untreated cases – blindness.
However, recent treatment advances have revolutionized the management of diabetic retinopathy, improving outcomes and saving peoples’ eyesight. With proper risk reduction techniques and routine follow-up with an eye care specialist, diabetic retinopathy doesn’t pose as big a threat as it once did.
To learn more about how diabetes impacts the eye and causes retinopathy, as well as how to reduce the risk and symptoms, we spoke with Raymond M. Girgis, MD, FAAO, an ophthalmologist on staff at Jefferson Health, as well as Brianna Hanekom, BSN, RN, CDE, clinical program manager for the Nutrition & Diabetes Education Center.
The Link Between Diabetes and the Eyes
Prolonged high blood sugar, or poor glycemic control, can cause blood vessel damage, particularly in the eyes. When blood sugar levels are volatile, or up and down, it can cause the blood vessels in the eyes to leak, bleed, and weaken, explains Dr. Girgis. “New blood vessel formation can also occur, but ‘new’ here isn’t a good thing. These vessels are abnormal, and their functionality is hindered.”
Diabetic retinopathy is directly related to the amount of time one has had diabetes. Which is not necessarily the same as the amount of time since diagnosis, notes Dr. Girgis.
“As you can imagine, we don’t frequently see diabetic retinopathy within the first few years of a diabetes diagnosis,” continues Dr. Girgis. “There are some cases in which a patient will have a clear case of retinopathy and have yet to be diagnosed with diabetes officially.”
Diabetes may also increase your risk for other eye conditions, such as glaucoma and cataracts, adds Hanekom.
Types of Diabetic Retinopathy
The two main categories of diabetic retinopathy are non-proliferative and proliferative:
- non-proliferative – an early-stage disease, with bleeding, leaking, and microaneurysms, or outpouchings of the blood vessels
- proliferative – a late-stage disease with bleeding, leaking, microaneurysms, and new, abnormal blood vessel development, also known as neovascularization
Diabetic retinopathy can be staged further by how much damage there is, explains Dr. Girgis. Within both non-proliferative and proliferative disease falls another common condition – macular edema. The macula is the central portion of the retina; in macular edema, there is swelling in the macula, which is the most sensitive area responsible for visual acuity (or deciphering shapes and details).
Catching It Early
Diabetic retinopathy symptoms usually affect both eyes. Potential warning signs include blurry vision, eye floaters, and noticing colors appear faded or washed out, says Hanekom. “However, symptoms don’t always occur in early-stage disease, and you can have retinopathy and not even know it. If you have mild symptoms, don’t ignore them or think they aren’t a concern. They can progress before you know it.”
Catching and treating diabetic retinopathy early is critical for preventing serious illness and reducing symptoms, says Dr. Girgis. As soon as you’re diagnosed with diabetes, you should have a dilated retinal exam by either an ophthalmologist (preferably) or an optometrist. Then, establish yearly appointments.
Pregnant women should also talk to their provider about having a dilated retinal exam as part of their pre-conception planning or in the first trimester, adds Hanekom. If there is a diagnosis of retinopathy, it needs monitoring every trimester.
“If you haven’t had an exam in years, remember, it’s better late than never,” continued Dr. Girgis. “If you notice any changes in one or both of your eyes, call right away.”
Making a Change
Self-care can go a long way to reducing your retinopathy risk. The best thing you can do is keep your blood sugar levels regulated, says Hanekom, who has Type 1 diabetes herself. Once blood sugar levels return to normal, any mild symptoms should resolve.
Of course, taking care of your diabetes also involves making other healthy lifestyle choices, such as not smoking; staying active; controlling cholesterol; controlling blood pressure; and losing weight, if possible, notes Dr. Girgis. Hypertension (high blood pressure) and smoking, in particular, are risk factors for retinopathy.
New and Improved Treatment Options
Many cases of diabetic retinopathy can benefit from medical treatment. Up until five years ago, retinopathy was treated using laser therapy/surgery to the retina, which sealed and shrunk leaking blood vessels. Before that, there were no treatments, says Dr. Girgis.
Now, there’s a new, exciting treatment called anti-VEGF (vascular endothelial growth factor). Anti-VEGF are injections given in the white of the eye (the sclera) that help reduce macular swelling, slow vision loss, and treat and reverse the impacts of retinopathy.
Anti-VEGF injections are administered in an outpatient office. There’s virtually no discomfort, and frequency varies depending on the individual, explains Dr. Girgis. Injections may be needed once a month or once every few months.
With the help of these advancements and an overall better understanding of the impacts of diabetic retinopathy, the prognosis is significantly better than it used to be, says Dr. Girgis. If you have diabetic retinopathy, you can be proactive and keep it under control. Eye care specialists and diabetes care and education specialists can offer integral treatment and guidance to ensure you maintain the best sight possible.
To learn more about preventing life-long complications during American Diabetes Month, visit Diabetes.org.