Diabetic Retinopathy (DR)

What is Diabetic Retinopathy (DR)?

Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.

Causes of DR

When blood sugar levels are too high for extended periods of time, it can damage capillaries (tiny blood vessels) that supply blood to the retina. Over time, these blood vessels begin to leak fluids and fats, causing edema (swelling). Eventually, these vessels can close off, called ischemia. These problems are signs of non-proliferative diabetic retinopathy (NPDR).

Symptoms of DR

You can have diabetic retinopathy and not be aware of it, since the early stages of diabetic retinopathy often don’t have symptoms.

As the disease progresses, diabetic retinopathy symptoms may include:

• Spots, dots or cobweb-like dark strings floating in your vision (called floaters);
• Blurred vision;
• Vision that changes periodically from blurry to clear;
• Blank or dark areas in your field of vision;
• Poor night vision;
• Colors appear washed out or different;
• Vision loss.

Diabetic retinopathy symptoms usually affect both eyes.

Who is at risk of DR?

Several factors can influence the development and severity of diabetic retinopathy, including:

• Blood sugar levels
  Controlling your blood sugar is the key risk factor that you can affect. Lower blood sugar levels can delay the onset and slow the progression of diabetic retinopathy.

• Blood pressure
  A major clinical trial demonstrated that effectively controlling blood pressure reduces the risk of retinopathy progression and visual acuity deterioration. High blood pressure damages your blood vessels, raising the chances for eye problems. Target blood pressure for most people with diabetes is less than 130/80 mmHg.
• Duration of diabetes
  The risk of developing diabetic retinopathy or having your disease progress increases over time. After 15 years, 80 percent of Type 1 patients will have diabetic retinopathy. After 19 years, up to 84 percent of patients with Type 2 diabetes will have diabetic retinopathy.
• Blood lipid levels (cholesterol and triglycerides)
  Elevated blood lipid levels can lead to greater accumulation of exudates, protein deposits that leak into the retina. This condition is associated with a higher risk of moderate visual loss.
• Ethnicity
  While diabetic retinopathy can happen to anyone with diabetes, certain ethnic groups are at higher risk because they are more like
• Pregnancy
  Being pregnant can cause changes to your eyes. If you have diabetes and become pregnant, your risk for diabetic retinopathy increases. If you already have diabetic retinopathy, it may progress. However, some studies have suggested that with treatment these changes are reversed after you give birth and that there is no increase in long-term progression of the disease.

DR Treatment

The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won’t cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages.

• Laser surgery
  The laser is a very bright, finely focused light. It passes through the clear cornea, lens and vitreous without affecting them in any way. Laser surgery shrinks abnormal new vessels and reduces macular swelling. Treatment is often recommended for people with macular edema, proliferative diabetic retinopathy (PDR) and neovascular glaucoma. In PDR, the laser is applied to all parts of the retina except the macula (called PRP, or panretinal photocoagulation). This treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Panretinal laser has proven to be very effective for preventing severe vision loss from vitreous hemorrhage and traction retinal detachment. Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.

• Vitrectomy surgery
  Vitrectomy is a surgical procedure performed in a hospital or ambulatory surgery center operating room. It is often performed on an outpatient basis or with a short hospital stay. Either a local or general anesthetic may be used.

During vitrectomy surgery, an operating microscope and small surgical instruments are used to remove blood and scar tissue that accompany abnormal vessels in the eye. Removing the vitreous hemorrhage allows light rays to focus on the retina again. Vitrectomy often prevents further vitreous hemorrhage by removing the abnormal vessels that caused the bleeding. Removal of the scar tissue helps the retina return to its normal location. Laser surgery may be performed during vitrectomy surgery. To help the retina heal in place, your ophthalmologist may place a gas or oil bubble in the vitreous space. You may be told to keep your head in certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologist’s instructions so your eye will heal properly.

• Medication injections
  In some cases, medication may be used to help treat diabetic retinopathy.   Sometimes a steroid medication is used. In other cases, you may be given an anti-VEGF medication. This medication works by blocking a substance known as vascular endothelial growth factor, or VEGF. This substance contributes to abnormal blood vessel growth in the eye which can affect your vision. An anti-VEGF drug can help reduce the growth of these abnormal blood vessels.

After your pupil is dilated and your eye is numbed with anesthesia, the medication is injected into the vitreous, or jelly-like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina, and may improve how well you see. Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by your doctor.

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