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Diabetic Retinopathy

Diabetic retinopathy is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). The condition can develop in anyone who has type 1 or type 2 diabetes. It affects individuals who have persistent high blood sugar levels for 5 or more years. Greater the duration of diabetes, greater the chances of a person having retinal pathology. Among those who have high blood sugar levels on first detection and those who have uncontrolled sugar levels thereafter will have greater risk of developing the retinal disease.

Risk Factors

Anyone who has diabetes can develop diabetic retinopathy. The risk of developing the eye condition can increase as a result of:

  • Having diabetes for a long time
  • Poor control of your blood sugar level
  • High blood pressure
  • High cholesterol
  • Pregnancy
  • Tobacco use

Symptoms

You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, you might develop:

  • Spots or dark strings floating in your vision (floaters)
  • Blurred vision
  • Fluctuating vision
  • Dark or empty areas in your vision
  • Vision loss

When to see an eye doctor

Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Developing diabetes when pregnant (gestational diabetes) can increase your risk of diabetic retinopathy.

Complications

In the starting it manifests as bleeding from small blood vessels of the retina and in later stages it leads to new vessels formation which eventually bleed in the retina and cause swelling of retinal tissue (which we call as diabetic macular edema). This causes visual loss to the patient.


Vitreous hemorrhage: If left untreated and unattended this disease can lead to permanent blindness caused by proliferation of blood vessels causing vitreous bleeding. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision.


RD: New blood vessels can grow in the front part of your eye (iris) and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build. This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).


Glaucoma: Untreated bleed can stimulate the growth of scar tissue, which can pull the retina away from the back of the eye and subsequently cause retinal detachment (RD).

Glaucoma illustration

Prevention and management

All these complications can easily be prevented by timely screening of the retina (which should be done annually) and subsequently treating the retina with green lasers. Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty, or hazy.


  1. Ask your doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test, or HbA1C test, reflects your average blood sugar level for the two- to three-month period before the test. For most people with diabetes, the HbA1C goal is to be under 7%.
  2. Keep your blood pressure and cholesterol under control.
  3. Optical Coherence Tomography is a non-invasive imaging technique that provides detailed cross-sectional images of the retina, especially useful for detecting macular edema.
  4. Fluorescein Angiography is a diagnostic test that uses a dye to visualize blood flow in the retina and helps detect new blood vessels in the retinal periphery.

Green Lasers are the most important part of the treatment, which can permanently control and cure the disease. Use of intra-vitreal injections is done for the treatment of Macular Edema.