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Diabetic Retinopathy: Your Questions Answered

Diabetic retinopathy is a common complication of diabetes and the leading cause of new-onset blindness in American adults. Effective treatments are available to preserve vision for eyes at risk of vision loss from diabetic retinopathy. The most opportune time for these treatments is before any vision has been lost, since even advanced diabetic retinopathy can be present when a person has no vision complaints or problems.

What causes diabetic retinopathy?

Diabetic retinopathy is caused by changes in the blood vessels of the retina, the thin, light-sensitive inner lining in the back of your eye. These changes are called diabetic retinopathy.

How does diabetes damage the vessels in the retina?

Elevated levels of blood glucose can damage the body in various ways, including harming the blood vessels in your eyes. Diabetes can affect the lining of the blood vessels in your eyes, causing them to thicken and develop leaks. Poor circulation in the retinal vessels can compound these problems by causing the production of fragile new vessels.

What are the stages of retinopathy?

Diabetic retinopathy is broadly classified as nonproliferative diabetic retinopathy and proliferative retinopathy. After 20 years of diabetes, most persons with diabetes will shows some signs of nonproliferative diabetic retinopathy, which is generally not sight-threatening itself unless macular edema is present. Proliferative diabetic retinopathy is a more serious stage of retinopathy and poses a greater risk of hemorrhage into the vitreous humor, the clear gel that fills the center of the eye, or detachment of the retina leading to severe vision loss. Diabetic macular edema can occur with either nonproliferative or proliferative diabetic retinopathy.

There are various levels of nonproliferative diabetic retinopathy that your eye doctor can identify. In nonproliferative diabetic retinopathy, elevated blood glucose can cause damage to the blood vessels in the retina. These vessels can leak blood or fluid. When fluid collects in the central part of the retina, blurred vision may occur—this is called macular edema. Macular edema can be treated with laser surgery when central vision is threatened.

A more dangerous stage of diabetic eye disease is proliferative retinopathy. During this stage, abnormal blood vessels grow over the surface of the retina. These fragile blood vessels may rupture and bleed into the vitreous humor. Vitreous hemorrhages may block the passage of light to the retina and loss of vision or even blindness may occur. In addition, these fragile blood vessels cause scar tissue, which may pull on the retina and cause the retina to detach from the back of the eye.

Can diabetic retinopathy be cured?

Diabetic retinopathy cannot be cured but effective treatments have been established that preserve vision and dramatically reduce the risk of vision loss. These treatments include laser treatments and vitrectomy surgery. Additionally, it is crucial to note that tight blood glucose control and control of accompanying conditions such at high blood pressure, kidney disease, elevated cholesterol, anemia, and obesity greatly reduce the risk of onset and progression of diabetic retinopathy.

How is diabetic retinopathy treated?

Your eye doctor may suggest laser photocoagulation for diabetic retinopathy. Drs. Lloyd M. Aiello and William P. Beetham performed early pioneering development of laser surgery for the treatment of diabetic eye disease at the Joslin Diabetes Center. During laser photocoagulation, the ophthalmologist focuses a laser light beam on the retina. This laser scars the areas of the retina to stop the formation of new blood vessels and to shrink any new vessels that are present. Laser photocoagulation is also used to seal leaking blood vessels that may cause edema or swelling in the macula area of the eye. Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. The primary goal of laser surgery is to prevent further vision loss and not to restore vision that has already been lost, which is why finding diabetic retinopathy early is the best way to prevent vision loss.

Does laser treatment hurt?

Laser treatment generally is not painful but may cause some temporary discomfort. The laser surgery is done on an outpatient basis in the ophthalmologist’s office. After treatment, some people may experience a slight decrease in vision or it may become more difficult to adjust to darkness, a side effect that diabetes itself may cause. But the overall benefits of the laser treatment far outweigh these relatively minor drawbacks.

What if a hemorrhage has already occurred?

Serious cases of eye damage in people with diabetes can be treated. If a hemorrhage does occur and vision is lost, or if the scar tissue threatens to detach the retina from the back of the eye, vitrectomy surgery can successfully restore vision.

A vitrectomy is performed under either local or general anesthesia. The doctor makes a tiny incision in the eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.

You will probably be able to return home after the vitrectomy and you will need to wear an eye patch for a few days to protect your eye. You also will need to use medicated eye drops to protect against infection. Thanks to this procedure, many people who once were blind can now see.

What can you do to protect your vision?

Finding and treating the eye disease early, before it causes vision loss or blindness, is the best way to control eye disease in people with diabetes. So if you have diabetes, make sure you receive a comprehensive dilated eye examination at least once a year. Also, keep good control of your glucose levels and other health problems such as high blood pressure, kidney disease, and elevated cholesterol.

The Beetham Eye Institute is located at the Joslin Diabetes Center. The Beetham is dedicated to providing total eye care services that prevent, diagnose, and treat eye problems related to diabetes. For more information about The Beetham Eye Institute, please click here.

Page last updated: July 25, 2014