Diabetic Retinopathy
Without proper management, your entire body may be impacted by diabetes, and your eyes are no exception. Of particular interest to eye and vision health is a specific diabetic complication known as diabetic retinopathy. This condition is found to be the primary cause of vision loss among adults with diabetes. Diabetic retinopathy involves chronic (long-term) high blood glucose levels, due to diabetes’ impact, gradually damaging the retina’s tiny blood vessels.
More than half of all diabetes patients develop diabetic retinopathy, and people with type 1 or 2 diabetes or gestational diabetes, developing during pregnancy are all at risk. While incurable, the good news is that by ensuring proper diabetes management and practicing a healthy lifestyle, you may effectively delay or stop this condition’s progression. Should it worsen, we perform a variety of treatment options at Retina Consultants of Charleston that may help to reduce additional damage.
Diabetic Retinopathy: The Condition Explained
Your retina, an ultrathin, photosensitive nerve layer of nerves on the eye’s back wall, changes light entering the lens into nerve signals. They’re then transported, via the optic nerve, to the brain, where again they transform, into images, giving us the gift of sight.
However, the retina’s tiny blood vessel walls can be weakened by long-term exposure to high blood glucose levels, caused by diabetes. Generally targeting both eyes, you may develop microaneurysms, small, red bulges that leak fluid and blood into the retina. The tiny blood vessels’ walls may also be further destroyed by the formation of blisters, prone to breakage, leading to retinal hemorrhages (excessive bleeding). Diabetic retinopathy has two main stages:
- Nonproliferative diabetic retinopathy (NPDR), developing earlier and far more widespread
- Proliferative diabetic retinopathy (PDR), its more advanced, severe form.
What Is Nonproliferative Diabetic Retinopathy?
In the earlier stages, nonproliferative diabetic retinopathy (NPDR), the more common form may develop. NPDR may be characterized by the lack of symptoms, and often, patients may have no idea that they’re afflicted. However, as it worsens and additional blood vessels become obstructed, certain symptoms may become more noticeable and come and go, including:
- Vision blurriness
- Decreased clarity, or sharpness of vision
- Changes in vision quality, like difficulty viewing distant objects or reading
- Cotton wool spots (CWS), which are cloudy, white retinal patches, forming due to ischemia (reduced blood flow and oxygen)
- Retinal swelling or bleeding
- Exudate (pus)
Should diabetic retinopathy progress, you may develop its more advanced, destructive form, proliferative diabetic retinopathy (PDR). PDR is characterized by neovascularization, a process in which unusual, fragile blood vessels develop underneath the retina, compensating for those lost to previous disorders. These replacement vessels also sprout within the vitreous, the clear, jelly-like substance making up most of the eye. Among PDR symptoms are hazy vision, eye floaters, and concerns with night vision and Iighting changes. PDR is considered a medical emergency, making immediate medical treatment necessary.
If PDR is not treated quickly, you may experience vision-threatening complications. Besides permanent blindness and the loss of an eye, the following may develop:
- Neovascular glaucoma, in which new blood vessels grow on the iris, the part of the eye that controls pupil size and the amount of light allowed in. This new vessel growth can interfere with the eye’s normal fluid flow, raising pressure. You may also have vision loss, eye redness, and severe pain.
- Retinal detachment can occur, as the fragile new blood vessels bleed easily, leading to scar tissue formation. This may cause eye tissue to pull back, moving your retina out of position.
- Vitreous hemorrhage, heavy bleeding in the vitreous gel, can occur, causing floaters and vision blockages, although this may go away once the blood clears.
Ophthalmologic Screening Exams Vital For Diabetic Retinopathy
As nonproliferative diabetic retinopathy can convert into a more dangerous form, regular eye exams are crucial. The longer you’ve lived with diabetes, the greater your chances of developing diabetic retinopathy. As such, at least once per year, comprehensive, dilated eye examinations are recommended for adults diagnosed with diabetes.
During your annual ophthalmologic eye exam, your eyes will be thoroughly evaluated. Your doctor will look for such concerns as atypical blood vessels, bleeding, leakage, swelling, and retinal detachments, a serious condition involving the partial or full separation of the retina from its permanent placement. Should you notice any visual changes, including sudden ones, or blurry, spotty, or hazy vision, let your eye doctor know. Dark, floating spots or cobweb-like streaks are different, though, as they’re considered medical emergencies, demanding fast medical treatment.
What Are Diabetic Retinopathy Diagnostic Methods?
To diagnose and test for diabetic retinopathy, the diagnostic methods may depend on your condition and its severity. Most diabetic eye exams are alike in that they usually start with a dilated eye exam. With dilation, special eye drops are given to maintain an open position for the afflicted eye’s pupil, widening it, and permitting a closer, unobstructed retinal view. Certain diagnostic techniques may be utilized during this exam:
- Ophthalmoscopy – With this test, your ophthalmologist may employ an ophthalmoscope, a tool that identifies and evaluates retinal damage.
- Optical coherence tomography (OCT) – This technique involves an infrared light that takes cross-sectional retinal images. OCT gives them the ability to determine if any fluid has leaked into the retinal tissue, causing macular edema (swelling).
- Fluorescein angiography – This technique involves a yellow dye being injected into your bloodstream to highlight the eye’s blood vessels. Retinal specialists then use a special camera to capture retinal photos, displaying unusual blood vessel development and obstructed or leaking vessels.
How is Diabetic Retinopathy Treated?
In the event diabetic retinopathy is diagnosed, your ophthalmologist may initially monitor your eyes’ health. But should you have vision changes, there may be the need for treatments to reduce further damage, including:
- Injectable medications, referred to as anti-vascular endothelial growth factor (anti-VEGF) drugs, are commonly used to delay diabetic retinopathy’s progression. They help stop new blood vessel growth by inhibiting the responsible proteins. Ophthalmologists inject anti-VEGF medications directly into your vitreous, with a very thin needle. Your doctor may decide to inject you with corticosteroids, rather than anti-VEGF medications.
- Laser treatments may be performed, as they effectively decrease retinal swelling, reduce blood vessel size, and stop any leaking.
- A vitrectomy, a minimally invasive procedure, involving the partial or full removal of the vitreous from the back of the eye, may be performed. Often, a vitrectomy is recommended when excessive retinal bleeding has caused scarring in your eye.
Proper Diabetes Management and Diabetic Retinopathy Improvement
While an incurable condition, by following your normal diabetes management efforts, you may be able to delay or stop diabetic retinopathy’s vision loss. With any diabetes type, you must continue to diligently manage your health, including always taking your insulin and other prescribed medications. You should also regularly test your glucose levels, as per your primary care doctor’s directions.
It may be helpful to have your doctor prescribe a glycosylated hemoglobin test. Also called hemoglobin A1C, it provides an average of your blood sugar levels for the preceding 2-3 months; ideally, an average level of below 7% should be your goal. It’s also important to regulate control of your cholesterol and blood pressure levels. Adults with any type of diabetes need to maintain blood pressure below 130/80 mm Hg.
Yes, the foods you consume and how you eat them contribute to your vision health and overlying diabetes status. Try to eat foods high in essential nutrients and low in fat and calories, and keep to an eating schedule of three daily meals, at regular times, to better enable your body to use insulin, a vital hormone that converts sugar into energy. A healthy diet may also help you to maintain your weight, further promoting proper blood glucose management. You should consume foods containing healthy carbohydrates and dietary fiber, which helps control blood glucose levels. Eat heart-healthy fish, like salmon, and foods with monounsaturated and polyunsaturated fats, like olive oil. However, avoid foods or drinks with added fats, sugars, saturated or trans fats, and each day, take in less than 2,300 milligrams (mg) of sodium and 200 mg of cholesterol.
Certain nutrients have been shown to impart valuable benefits for diabetic retinopathy. Most are antioxidants, special nutrients that protect your body from oxidative and cellular damage and heightened inflammation. These nutrients, including vitamins C, D, E, and zinc, may promote such benefits as improving blood flow, pressure, and diabetes, in general, and repairing vessel damage.
Yes, regular exercise may delay the condition’s onset and progression, while defending the retina and reducing inflammation. For people with diabetes, it’s advised that you engage in at least 150 minutes per week of moderate-intensity physical activity, such as bicycling or swimming. Additionally, you should take part in activities involving all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) two or more days per week. Be sure to stretch, to promote flexibility and prevent soreness afterward.
Schedule a Diabetic Retinopathy Consultation in South Carolina
Diabetic retinopathy is a manageable condition, and you can take preventive steps to reduce or even stop the progression of vision loss. Should you have any questions or concerns, please contact Retina Consultants of Charleston for an appointment with our retina specialists.
