Diabetic retinopathy is the most common form of diabetic eye disease. Diabetic retinopathy usually only affects people who have had diabetes for a long time and can result in blindness.
Retinopathy can affect all diabetics and becomes particularly dangerous when it is left untreated.
The longer a person has diabetes, the greater the risk becomes of developing diabetic retinopathy.
- Diabetes retinopathy is just one type of diabetic eye disease.
All people with diabetes should have a dilated eye examination at least once every year to check for diabetic retinopathy
According to the NHS, it is estimated that each year 4,200 people in England are at risk of blindness caused by diabetic retinopathy and there are 1,280 new cases of blindness caused by diabetic retinopathy.
How is diabetic retinopathy caused?
Diabetic retinopathy is caused by prolonged high blood glucose levels. Over time, this causes damage to the small blood vessels within the retina.
This may cause haemorrhages, exudates and even swelling of the retina.
This then starves the retina of oxygen, and abnormal vessels may grow. Good blood glucose control helps to lower diabetes retinopathy risks.
What is diabetic retinopathy?
Diabetic retinopathy occurs when changes in blood glucose levels cause changes in retinal blood vessels.
In some cases, these vessels will swell up (macular oedema) and leak fluid into the rear of the eye. In other cases, abnormal blood vessels will grow on the surface of the retina.
Gradually, diabetic retinopathy becomes more serious and progresses from ‘background retinopathy’ to seriously affecting vision and eventually causing blindness.
Diabetic retinopathy includes 3 different types, each of which is profiled below:
- Background retinopathy
- Diabetic maculopathy
- Proliferative retinopathy
Background retinopathy, also known as simple retinopathy, involves tiny swellings in the walls of the blood vessels.
Known as blebs, they show up as small dots on the retina and are usually accompanied by yellow patches of exudates (blood proteins).
Background diabetic retinopathy needs monitoring by an ophthalmologist.
The macula is the most well used area of the retina, and this stage refers to the progression of background retinopathy into the macular.
This can cause vision problems.
Proliferative retinopathy is an advanced stage of diabetic retinopathy in which the retina becomes blocked causing the growth of abnormal blood vessels.
These can then bleed into the eyes, cause the retina to detach, and seriously damage vision. If left untreated, this can cause blindness. In the case of a vitreous haemorrhage, this loss of vision can be instant.
Retinopathy occurs when blood vessels in the back of the eye, the retina, become damaged. When the blood vessels become damaged they can leak and these leaks can cause dark spots on our vision.
The main causes of retinopathy tend to be sustained high blood glucose levels and high blood pressure as well. Retinopathy can progress over years or decades depending on how good your blood glucose control is.
The good news is that because it takes a long time to develop, it can be spotted before it becomes too serious.
The symptoms of retinopathy tend to come on once retinopathy has been developing for some time. The symptoms present themselves as dark patches on your vision. You may not notice them at first but can be more noticeable if retinopathy is not picked up.
It’s important therefore that you attend your retinopathy screening each year.
People with diabetes should be screened in the UK once each year for retinopathy. A photograph is taken of the eye which allows the specialists to spot any signs of damage that may be present.
Screening appointments mean that the signs can be spotted well in advance of symptoms developing. In the early stages of retinopathy, no treatment is needed but it’s recommended that patients keep good control of their blood sugar levels.
If retinopathy develops laser surgery may be needed. Laser targets the problem blood vessels to prevent them from leaking. Other treatments for advanced retinopathy can include injections or vitrectomy surgery.
What are the symptoms of diabetic retinopathy?
Like many conditions of this nature, the early stages of diabetic retinopathy may occur without symptoms and without pain. An actual influence on the vision will not occur until the disease advances. Macular Oedema occurs when leaking fluid caused the macular to swell.
New vessels on the retina can prompt bleeding, and hence block the vision.
Am I at risk from diabetic retinopathy?
Diabetic retinopathy risk factors include the following.
If any of the below affect you it’s worth having an retinopathy screening examination as quickly as possible.
- Poor blood glucose control
- Protein in urine
- High blood pressure
- Prolonged diabetes
- Raised fats (triglycerides) in the blood
- Increased swellings
- Pregnancy (not gestational diabetes)
Anyone suffering from diabetes faces the risk of developing diabetic retinopathy and other diabetes complications.
The longer a person has diabetes, the greater the risk of developing diabetic retinopathy becomes.
Are there any ways to prevent diabetic retinopathy?
Long-term good blood glucose level management helps to prevent diabetes retinopathy and lower the risk of developing it. Heart disease risk factors also affect retinopathy risk and include stopping smoking, having regular blood pressure and cholesterol checks and having regular eye check-ups.
The risk of developing diabetic retinopathy can be lessened through taking the following precautions:
- Taking a dilated eye examination once a year
- Managing diabetes strictly through medicine, insulin, diet and exercise
- Test for blood sugar levels regularly
- Test urine for ketone levels regularly
Can diabetic retinopathy be treated?
Laser surgery is often used in the treatment of diabetic eye diseases, but each stage of diabetic retinopathy may be treated in a different way. Backround retinopathy has no treatment but patients will need regular eye examinations.
Maculopathy is usually treated with laser treatment (tiny burns that destroy small areas of retina).
This is usually painless and has no side effects, but can influence night driving and peripheral vision.
This type of laser treatment for diabetic retinopathy will not improve vision, but it can prevent deterioration. Proliferative retinopathy is also treated with lasers, with a scattering over the whole retina. This destroys the starved area of the retina.
Serious diabetes retinopathy cases may require eye surgery. This is usually diagnosed due to bleeding in the eye, late-stage proliferative retinopathy or ineffective laser treatment. This type of diabetic retinopathy eye surgery is called vitrectomy.
What the community are saying about diabetic retinopathy
- Jude: I had my yearly eye screening last month and was told that they can just see some retinopathy developing but at the moment it does not need treatment as it is very slight. I was more dismayed with this information because I struggle so much with my glucose numbers and now I am getting complications setting in. Anyway the technician explained to me that if/when it needs treatment they give laser treatment which halts the progression of the retinopathy.
- Anniep: Keeping your BG low is the best way of avoiding complications, my mum was insulin dependent for nearly 40 years, and when she died at 80 she was complication free. But don't be fooled by anybody downplaying the seriousness of diabetic retinopathy.
- Sid Bonkers: I had a retinal scan after diagnosis that showed background retinopathy, two months later whilst having an eye test the optician told me he could see no evidence of background retinopathy. At my second scan I was shown that the background retinopathy that was spotted a year before was still there but that there was no further bleeds.
- Noblehead: My Ophthalmologist stressed after I developed diabetic retinopathy 10 years ago, that keeping blood glucose, blood pressure and cholesterol levels below normal will help prevent or delay the onset of complications due to neuropathy and retinopathy, hence why I monitor them closely and test my blood pressure once a week on my home blood pressure monitor.
- Clp: I had a screen for retinopathy last week and when the picture was taken the lady said it was fine, so I went away quite happy. However, yesterday I got a letter from the hospital saying that my eyes were showing some signs of background retinopathy. This scared me half to death but also confused me. Reading up on it it's usually 5 years before plus before you start to show signs of retinopathy so now I'm wondering have I been diabetic for longer than I thought.