What is diabetic retinopathy (diabetic eye disease)?

DIABETIC EYE DISEASE

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Diabetes is a condition where high level of glucose in the blood causes damage to organs in the body.  The retina is one of the most vulnerable parts of the body that can be damaged by diabetes, a condition known as diabetic retinopathy.  Diabetes causes damage to the blood vessels of the retina, a thin and delicate tissue that is responsible for vision. In some people suffering from diabetic retinopathy, blood vessels swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina that can lead to bleeding and retinal detachment.  These changes in the retina causes vision loss.

A healthy retina is necessary for good vision.

If you have diabetic retinopathy, you may not notice any change to your vision at first.  Gradually, the condition can worsen and cause vision loss. Diabetic retinopathy usually affects both eyes, it is therefore very important for early detection and prompt treatment to minimize vision loss.

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Who is at risk for diabetic retinopathy?

All diabetics—both Types 1 & 2—are at risk of diabetic retinopathy.

Risk of developing the eye condition can increase as a result of:

• Duration of diabetes — the longer you have diabetes, the greater your risk of developing diabetic retinopathy

• Poor control of your blood sugar level

• High blood pressure

• High cholesterol

• Pregnancy -  Pregnancy can sometimes make diabetic retinopathy worsen rapidly.  Every pregnant woman with diabetes should have a comprehensive dilated eye exam as early as possible.

• Tobacco use

How do I prevent vision loss from diabetic retinopathy?

Diabetes doesn't necessarily lead to vision loss. By taking an active role in you diabetes management it can go a long way toward preventing diabetic retinopathy from developing or getting worse.

You can look after your eyes by having regular eye exams, working with your GP and diabetic specialist (endocrinologist) to get good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.

If you have diabetes, you could reduce your risk of getting diabetic retinopathy by doing the following:

• Monitor your blood sugar level. You should regularly check and record your blood sugar level several times a day.  When you are ill (such as have a cold) you may need to perform measurements more frequently.  Ask your GP how often you need to test your blood sugar. 

• Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Have enough exercise, such as walking, each week. Take your diabetes medications or insulin as directed by your GP.  Regularly check the 3 month HbA1C percentage.

• Keep your blood pressure and cholesterol under control. Eating healthy foods, exercising regularly and losing excess weight can help. Sometimes medication is needed, too.

• Try to quit smoking if you smoke.  Smoking increases your risk of various diabetes complications, including diabetic retinopathy.

• Pay attention to changes in your vision. Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.  We recommend getting into a habit of checking your vision yourself each eye separately once a week so you could notice when symptom worsen in one eye.

How is diabetic retinopathy diagnosed?

Diabetic retinopathy is diagnosed with comprehensive eye examination, which includes a dilated eye exam as well as with special eye examination instruments.

After checking your vision and eye pressure, eye drops are placed in your eyes to enlarge (dilate) the pupils.  Your eye specialist will use a microscope lens to examine your retina for signs of diabetic retinopathy.  After the exam, your close-up vision may remain blurred for several hours because of the dilating drops.

Your eye specialist may also order special testing to determine the level of retinopathy or decide if treatment is needed. Most commonly doctor would recommend an Ocular Coherence Tomography, or OCT, to check for diabetic macular oedema. This is a non-invasive test, similar to an ultrasound, that helps detect fluid within the macula due to diabetes.  Macular oedema may be treated by laser or injection therapy.

Another test, a fluorescein angiogram, uses a special dye that is injected into the vein in your arm. Pictures are taken as the dye passes through the blood vessels in your retina, allowing for the identification of parts of retina capillaries damaged by diabetes and any leaking blood vessels that may require treatment.

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Treatment

In mild and moderate stages of diabetic retinopathy, no treatment is needed unless macula edema is present. To prevent diabetic retinopathy from getting worse, patients are encouraged to see GP regularly to control their blood sugar, blood pressure and cholesterol. 

When there is diabetic macular oedema or when there is abnormal blood vessel growth as result of diabetes (advance stage), additional treatments are available.

1. Intravitreal Injection (injection into the eye)

Diabetes can cause swelling of the macula due to fluid leakage and results in loss of vision.  Medications such steroids and anti-vascular endothelial growth factor drugs (VEGF), can be used by direct injection into the eye to reduce leakage, swelling or new blood vessel growth.  Intravitreal injection treatment has been shown in many large clinical studies internationally to be a safe procedure.  The injection of anti-VEGF and steroid agents has been shown to be effective for diabetic macular oedema and is approved for use in Australia.

2. Focal laser treatment - focal treatment of laser of microscopic aneurysms in the retina can help diabetic macular oedema.

3. Scatter laser treatment (Panretinal photocoagulation)

Scatter laser treatment helps to shrink the abnormal blood vessels and is therefore required for treatment of advanced diabetic retinopathy. Your doctor will place laser spots throughout the entire peripheral retina, causing the abnormal blood vessels to shrink. Because it's necessary to use a large number of laser spots, more than one session is often required to complete treatment.

You may notice some loss of side vision and it may slightly reduce your color and night vision.  However scatter laser treatment is needed to preserve your central vision when there is advanced diabetic retinopathy.  Sometimes your doctor will combine treatment of intravitreal injection with scatter laser treatment.

4. Vitrectomy

You may require a surgical procedure called a vitrectomy if bleeding is severe, if it does not clear up on its own or if you develop a retinal detachment related to your diabetic retinopathy.  Your doctor may refer you to a subspecialist doctor who is able to perform this surgery.