Diabetic Eye Disease: Retinopathy

Written by Neyal J. Ammary-Risch, MPH, MCHES
Reviewed by Suber S. Huang, MD, MBA

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

People in the early stages of diabetic retinopathy often have no symptoms. There is no pain, and vision may not change until the disease becomes severe. Blurred vision may occur when the macula (the part of the retina that provides sharp, central vision) swells from the leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into your eye, blocking vision. Even in more advanced cases, the disease may progress a long way without symptoms. That’s why it is so important to have regular comprehensive dilated eye examinations if you have diabetes.

Will you get diabetic retinopathy?
If you have diabetes, you are at risk of developing diabetic retinopathy. The longer you have diabetes, the more likely it is that you will get this disease. Between 40% and 45% of people with diagnosed diabetes have some degree of diabetic retinopathy.

How can I detect and prevent diabetic retinopathy?
If you have diabetes, you should have your eyes examined at least once a year. During the exam, your eyes are dilated with eye drops to enlarge your pupils. This dilation allows the eye care professional to see more of the inside of your eyes to check for signs of the disease.

If you have diabetic retinopathy, your eye care professional may suggest that you consult a specialist for treatment of complications. The most common complication is macular edema, abnormal swelling of the retina.

This is most commonly treated using injection therapy, where medication is placed inside or around the eye. The Food and Drug Administration has recently approved two new injection treatments: Lucentis (ranibizumab) and Eylea (aflibercept).

Laser treatment, in which a strong light beam is aimed onto the retina, is less commonly performed. Serious complications of bleeding or retina scarring from diabetes may require surgery in the operating room to repair damage.

Together, these treatments and appropriate follow-up care can reduce the risk of blindness by 95%. Moreover, early detection and treatment gives the best chance of restoring vision. However, the more long-standing and advanced the disease, the less likely that vison will improve. That's why finding diabetic retinopathy early is the best way to prevent vision loss.

You cannot prevent diabetic retinopathy, but you can reduce your risk of developing it. Research has shown that controlling blood sugar levels can slow the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy. Additionally, lifestyle factors such as not smoking, reaching and maintaining a healthy weight, controlling blood pressure and cholesterol, exercising and taking medications as prescribed can also help slow or delay the onset of diabetic eye disease.

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