Diabetic Retinopathy

diabetic retinopathy

The retina is made up from special cells called rods and cones which line the back of your eyes. Light enters your eye and passes through the lens which focuses the light on to the retina. Messages about what you see are then passed from the cells in the retina to the optic nerve, and on to the brain. Many tiny blood vessels in the retina take oxygen and nutrients to the cells of the retina.

What is retinopathy?

The term retinopathy covers various disorders of the retina, which can affect vision. Retinopathy is usually due to damage to the tiny blood vessels in the retina. Retinopathy is commonly caused by diabetes, but is sometimes caused by other diseases such as very high blood pressure.

How does diabetic retinopathy occur?

Over several years, a high blood glucose level can weaken and damage the tiny blood vessels in the retina. This can result in:

  • Small blow-out swellings of blood vessels (microaneurysms).
  • Small leaks of fluid from damaged blood vessels (exudates).
  • Small bleeds from damaged blood vessels (haemorrhages).
  • Blood vessels may just become blocked.

New abnormal blood vessels may grow from damaged blood vessels. This is called proliferative retinopathy. These new vessels are delicate and can bleed easily. The leaks of fluid, bleeds and blocked blood vessels may damage the cells of the retina.

What symptoms does diabetic retinopathy cause?

Most people with diabetic retinopathy do not have any symptoms or visual loss due to their retinopathy. Initial symptoms that may occur include blurred vision, seeing floaters and flashes, or even having a sudden loss of vision.

Different types of diabetic retinopathy

Different parts of the retina can be affected

The macula is a small part of the retina which is roughly in the centre at the back of the eye. The macula is where you focus your vision. So, when you read or look at an object, the light focuses on the macula. The central and most important part of the macula is called the fovea. The outer part of the retina is used for peripheral vision. Retinopathy can affect the macula, the peripheral (outer part) of the retina, or both. It is much more serious if the macula is affected.

  • Background retinopathy does not change your sight. With this you have some tiny microaneurysms, tiny leaks of fluid and tiny bleeds in various parts of the retina. A doctor or optometrist can see these as tiny dots and blots on the retina when they examine the back of the eye.
  • Pre-proliferative retinopathy is more extensive than background retinopathy. There are signs of blood flow becoming restricted, but not yet showing new blood vessels growing.
  • Maculopathy is when there is damage to your macula.
  • Proliferative retinopathy occurs when damaged blood vessels in the retina make chemicals called growth factors. These can cause new tiny blood vessels to grow (proliferate) from the damaged blood vessels. They are delicate, and can easily bleed, obscuring your vision.

Who gets diabetic retinopathy?

Retinopathy is a common complication of diabetes. It is more common in people with type 1 diabetes.

  • Duration of diabetes. The longer you have had diabetes, the higher your risk of developing retinopathy.
  • Poor glucose control.
  • High blood pressure.
  • Nephropathy (kidney disease).
  • Pregnancy.
  • Other risk factors include smoking, obesity and having a high cholesterol level.

Can diabetic retinopathy be prevented?

  • Your blood glucose level is well-controlled.
  • Your blood pressure and cholesterol levels are well-controlled.
  • You are also advised to stop smoking if you smoke.
  • Eye checks for diabetic retinopathy
  • You should have an eye check at least once a year.
  • Testing your vision.
  • Taking digital photographs of your retina (to compare with previous examinations).
  • Another test which is sometimes done at the eye hospital, when retinopathy is suspected, is a fluorescein angiogram. This involves having a special dye injected into one of the veins in your arm. This dye then travels to the blood vessels in your eye. A camera with a special filter is used to show up any swollen, leaking or abnormal blood vessels.

What is the treatment for diabetic retinopathy?

If you have mild diabetic retinopathy then you will not usually require any treatment other than controlling any other risk factors (for example, blood pressure, glucose and cholesterol levels).

Laser treatment

Laser treatment is used mainly if you have new vessels growing (proliferative retinopathy), or if any type of retinopathy is affecting the macula. A laser is a very bright light that is very focused so it makes tiny burns. A burn can seal leaks from blood vessels, and stop new vessels from growing further. Various eye operations may be needed if you have a bleed into the vitreous humour or develop a detached retina. An operation may also occasionally be needed if your laser treatment has not been successful.

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