Diabetic retinopathy is a neovascular complication in the retina of the eyeball due to uncontrolled blood sugar and is characterized by dot or blot hemorrhages in the retina, microaneurysms, both hard or soft exudates, or beading along interior blood vessels, called the arcades. Because damaged retinal tissue cannot be healed, it is crucial to have a comprehensive, dilated eye examination in your first five years of diagnosis and then annually.
The treating optometrist or retinal specialist may order frequent follow-ups if the condition worsens. The retina is the only place in the human body where vasculature is visible without being covered by skin. Therefore this tissue is a tool commonly used by optometrists, ophthalmologists, and retinal specialists to track and treat diabetic complications in the eye.
Risk of Diabetic Retinopathy
Patients with diabetes of any type are at risk of developing diabetic retinopathy, which occurs in four stages.
- Mild non-proliferative diabetic retinopathy
- Moderate non-proliferative diabetic retinopathy
- Severe non-proliferative diabetic retinopathy
- Proliferative diabetic retinopathy
Prolifterative diabetic retinopathy can lead to neovascularization and macular edema. Often, if the retinopathy is mild and there is no sign of diabetic macular edema, the patient does not need a referral to a retinal specialist. However, if there is edema present, this can significantly and permanently impact the patient’s vision, and a referral to a retinal specialist for treatment is highly recommended.
Neovascularization occurs when the macula is starved for oxygen, and a signal is sent to the brain to create new blood vessels to provide nutrients to the macula. These vessels are incredibly fragile and will rupture and leak, causing bleeding in the macula. Neovascularization can be devastating to vision and should receive treatment as soon as possible.
Managing Diabetic Retinopathy
Diabetic retinopathy is managed differently based on the stages and locations of hemorrhages or other vascular abnormalities. If macular edema is present, injections into the eye performed by a retinal specialist are often a successful treatment: though they most often require repeated treatments on a regular basis until no more treatable fluid is present in the macula.
Fundus photography takes detailed photographs of the retina and is an excellent way to document any new or existing abnormalities, such as the development of new hemorrhages.
Optical coherence tomography is performed if there is suspicion of neovascularization, elevation, or edema in the macula and will show the health of the layers of the macula. This instrument can also perform angiography, which maps the vasculature in the retina and the development of new vessels.
Non-proliferative diabetic retinopathy is often asymptomatic and only detected with regular comprehensive eye examinations. These are typically performed annually with a report sent to whichever physician treats the patient’s diabetes. However, a patient with developing edema in their macula may notice blurred vision that does not clear, distortion in objects they know to be straight (such as doorframes) and decreased overall visual acuity, even with an updated glasses prescription. Patients at risk of developing edema or other complications should be provided with an Amsler Grid to monitor for any changes. This grid is only effective if used one eye at a time and should be checked twice weekly to catch the onset of changes as quickly as possible.
Diabetic patients can expect doctors to ask the following questions while at an Optometry office:
- When were you diagnosed with diabetes?
- How often do you check your blood sugar?
- What was your last blood sugar level or A1C?
- What is your average blood sugar level?
- Are you being treated for unregulated blood sugar?
- Is there a family history of diabetic complications?
Do Not Let Diabetes Hinder You
While it may be a demoralizing experience, losing one’s eyesight does not have to hinder their life. With the correct knowledge and support, patients with diabetes can regain some, or most, of their sight.