Diabetic retinopathy is an eye condition which is a complication of diabetes. Diabetic retinopathy can cause bleeding (haemorrhages) at the back of the eye and the growth of abnormal blood vessels, both of which can cause blurred and patchy vision.
What is it?
Diabetic retinopathy is one of the leading causes of preventable blindness in Australia. According to the Centre for Eye Research Australia, 1 in 3 people with diabetes are diagnosed with diabetic retinopathy.
There are two different types of Diabetic retinopathy:
Non-proliferative diabetic retinopathy (NPDR) is the more common form and occurs gradually over time. When you have NPDR, the walls of the blood vessels in your retina weaken due to increased blood glucose levels. Smaller blood vessels can create tiny bulges within the walls which can sometimes leak fluid and blood into the retina or become blocked. Some of the larger vessels may begin to dilate and become irregular.
As NPDR worsens, it may progress to more severe vision loss and can also progress to proliferative diabetic retinopathy.
Proliferative diabetic retinopathy (PDR) is the more severe form of diabetic retinopathy and can lead to blindness if not treated early. PDR occurs when a reduced oxygen supply to the retina stimulates the growth of new blood vessels (neovascularisation). These new fragile blood vessels tend to leak and bleed and can create scar tissue.
Other complications you may experience due to diabetic retinopathy may include:
Macular oedema, which can occur in both NPDR and PDR when fluid leaking from either the damaged or new retinal blood vessels builds up in the macula, causing swelling.
The macula is a small oval shaped area, about 5.5mm in diameter, responsible for your sharp central vision and most of your colour vision. The macula is used for looking at fine detail of objects at all distances, near and far.
Retinal detachment can occur in PDR where scar tissue from the growth of new blood vessels can cause the retina to detach from the back of the eye. Symptoms include spots floating in your vision and/or flashes of light, often in your peripheral/side vision.
Glaucoma can occur in PDR if the new blood vessels interfere with the normal flow of fluid out of the eye, leading to increased pressure inside the eye. Click here for more information on glaucoma.
Symptoms
Often diabetic retinopathy may not show symptoms in the early stages which is why it’s important to have regular eye tests.
Once it progresses, symptoms of diabetic retinopathy can include:
- Blurry or distorted vision which cannot be corrected with glasses.
- Fluctuations in vision (gets better and worse).
- Sensitivity to light and glare.
- Floaters (moving spots or dark strings in your vision).
- Patchy vision or holes in your vision.
- Flashes of light, often in your peripheral/side vision.
If you notice any symptoms or more symptoms even after being diagnosed, visit your eye care practitioner as soon as possible.
Causes and risk factors
People who have any type of diabetes (type 1, type 2, or gestational which is diagnosed during pregnancy) are at risk of developing diabetic retinopathy. The longer you have diabetes, the higher the risk of developing diabetic retinopathy. Smoking with diabetes may increase the risk of developing diabetic retinopathy as smoking can increase blood pressure and blood sugar levels.
If you have diabetes, it is important to have regular eye tests to monitor for any potential problems.
Reducing the risk
There are ways of reducing your risk of developing diabetic retinopathy or preventing it from getting worse if you are in the early stages. This includes:
- Managing your blood sugar levels, blood pressure, and cholesterol levels.
- Taking any prescribed diabetes medication.
- Not smoking.
- Exercising regularly and maintaining a healthy, nutrient-rich diet.
- Having regular eye examinations.
Diagnosis
If you have diabetes, it is important to have regular eye examinations and to tell your practitioner that you have diabetes. In the initial stages of diabetic retinopathy, there are often no symptoms, and an eye examination can determine if you have diabetic retinopathy.
An optometrist or ophthalmologist will test your vision and look at the back of your eye to examine the retina and check your blood vessels. Often, they will photograph the back of your eye to monitor changes over time. Some routine tests include:
- Checking your visual acuity, which is your ability to see at different distances. This can include recognising letters at varying distances.
- Assessing your peripheral vision with a visual field test, which is your ability to see in your side vision.
- Checking your retina at the back of your eye with an Ophthalmoscope by shining a light into your eye and looking through different lenses or using an Optical Coherence Tomography scan (OCT) which creates a 3D cross section image to see the layers in the retina and take digital colour photos of the retina.
- Checking the surface of your eye and other structures within the eye with a microscope called a slit lamp.
- Measuring the pressure in your eyes.
Treatment
Managing your diabetes and blood sugar is your first line of defence against diabetic retinopathy. As diabetic retinopathy progresses, other treatments depending on the type and extent of your condition, may include:
- Injections in your eye, called Anti-VEGF injections, which can reduce inflammation and reduce the formation of abnormal blood vessels. Click here for more information on Anti-VEGF injections.
- Laser treatment or Panretinal Photocoagulation (PRP) can reduce the growth of new abnormal blood vessels and fluid from leaking under the retina.
- Surgery, called Vitrectomy, which removes the naturally occurring fluid in your eye called the vitreous.
For more information
- Visit Diabetes Australia.
- Always speak to your GP and eye care professional about the best treatment options for you.
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