Diabetic Retinopathy

Diabetic retinopathy is the most common eye disease
Diabetic retinopathy is the most common eye disease

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

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.

Diabetic maculopathy

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

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.

Transcript

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.

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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.
Your Comments
 
I have high blood sugar levels and I went for my eye test and my vision has been blurry for a while and has gotten worse . Test came back with me having cataracts in my left eye . I can still see but it's starting to effect my normal day and I have been told its not enough yet to warrant an operation to correct it . I'm only 40 and now I feel like I'm 60
Posted by Brigid , Edinburgh on Thursday, September 20, 2012
I have just had my annual eye screening results for the 4th year's screening. I have been told for the last 3 years that I have background retinopathy and also a mole behind my right eye. The results I recieved last week told me my eyes are normal. I contacted the hospital who did the screening, who then had a second look at my results and told me the readings are correct. Has this happened to anyone else. I have never heard of it improving without medical intervention.
Posted by Pauline, Scunthorpe on Sunday, July 01, 2012
Hi, I am a type 1 and have been for 37 yrs this year. I have retinopathy, with macular oedema and am waiting for an operation to have the vitreous jelly removed (left eye). I also have retinopathy in the right eye but the left eye is my worse one. The left eye has small bleeds continually, there is no room for any more laser. My left eye has hardly any sight and my peripheral vision in right eye is not good. I was stopped driving three years ago and registered partially sighted 2 years ago. I hope people can read our experiences and learn from these. I never really looked after myself until 5 years ago and wished I had listened sooner. Please look after yourselves as much as you can, because even though they say long term diabetics get these problems I'm sure having good control could help. Take care
Posted by tracey69, stevenage on Monday, May 07, 2012
I have had a letter today saying I have developed Diabetic Retinopathy which has really pee'd me of as I only have one eye anyway has anyone been in this situation as any advice would be welcome. Toucan
Posted by Toucan, Norfolk. on Thursday, February 23, 2012
I think this should be allowed as there is so many Diabetics now. I took diabetes at the age of 6 my sister at the age of 2 and my brother at the age of 28 that is three insulin dependant in one family. I have a very well controlled record, and hb1 always between 6 and 7. I have had it 48 yrs so it could happen to me. Yes I agree very much so
Posted by Bernadette McClean, Bangor Northern Ireland on Tuesday, October 04, 2011
I have recently had a vitrectomy in my left eye. I, unfortunately, have lost the sight in this eye. Thankfully the retinopathy in my right eye is not as aggressive as in my left one. I have tried for years to get my sugar under control but I am so sensitive to medication. I am now on Victoza plus tablets and finally my sugar is slowly coming under control. Never give up hope. Every day is a challenge and no matter how bad a day is - laugh and make the best of it.
Posted by Carolyn, Farnham Surrey on Tuesday, August 23, 2011
I have been diagnosed with Type 2 for about 6 years and control BG with a cocktail of tablets. My HbA1c's are at acceptable levels. For a time I was screened for retinopathy by the Paula Carr Trust, visiting my Doctor's surgery with a photo record taken at each visit concluding on each occasion that treatment was not necessary. Following a visit to the optician a couple of years ago he concluded (no photographs taken) that I should be referred to the local Hospital's eye clinic. An initial examination (no photographs) concluded that I would benefit from Laser Treatment. (I was quite surprised since I didn't have a problem with my eyesight, other than that corrected by a pair of glasses every couple of years, but accepted the diagnosis - after all I was being advised by an expert, why should I know any different! It was explained that by cauterising the blood vessels in the periphery of the eye, blood would be encouraged into the centre vision and reduce any likely problems in that area. Sounded logical! A first session went well with no pain or discomfort and within a day or so felt as if my eyesight had improved (purely subjective). Several months later I received a second treatment but this time with a lot of pain (the power level of the Laser was reduced twice during the treatment because of my obvious discomfort). The result - the following morning I found it difficult to read the newspaper - the page was a patchy blur which "eased off" later in the day. It seems that the centre of one eye had flared up with "leaking blisters". So beware of over intensive laser treatment of retinopathy administered by over zealous, albeit well meaning, practitioners. If the treatment hurts - even a little - say so and ask to have each examination recorded by photo.
Posted by Pipsqueak10, East Kent on Wednesday, November 10, 2010
I spent most of last year partially sighted as both of my retinas detached. Not for one moment should you think 'it won't happen to me' because it will. I now can no longer drive, have severe difficulty seeing in the dark and find difficulty seeing fine detail. I have only had good blood glucose control in the last two years after completing a carb counting course, which changed my understanding of this unforgiving condition that we try and live with. Having nearly been blind last year it is not somewhere I want to be again. It is essential to look after yourselves.
Posted by Catherine, London on Monday, November 08, 2010
I was diagnosed 11 years ago with IDD, and recent eye screening shows signs of early retinopathy. Of all the long term complications associated with diabetes blindness is a terrifying thought, also the loss of a limb and the inability to walk. I try to keep my insulin to a minimum, what is considered to be a low, medium or high dose? I know different insulins vary but throughout the day I take between 14- 16 mmol of Humalog and at night 8 mmol of Lantis.
Posted by eleni , UK on Sunday, November 07, 2010
I have had diabetes for 31 years. I went for a screening about 7 years ago and it looked clear. However under closer examination I was diagnosed with a 'change in the retina'. At no stage did my consultant make me aware of anything other that the 'change' and for 3 years I carried on blissfully unaware of what was happening. When I turned up 1 day he asked me if everything was OK and the damage was close to the 'central vision' so would only operate when it affected my sight. I went home and realised that my vision was worse (spider webs). I immediately got transferred out of that hospital and was treated in a few weeks. During that time I had an optician do the retina screen and all was fine... but it wasn't. So what I've learnt is@ ask questions, do not sit there and assume it's ok; if there is a change ask what you can do, do not believe a 10 pound Optician's photo will give you piece of mind as they can still be wrong; look into vitamins as most people recomend Vitamin C - my GP suggested asprin and antioxidants which are are supposed to be good too. I take a multi vitamin aimed at the eyes which has lutin and vitamins A, C and E in it. I've now been discharged from the hospital and am still working without any issues so far.
Posted by RichH on Thursday, November 04, 2010
I was called back to see a consultant after a routine retinopathy check. He said they had identified bleeding in the disc of the eye and he would review the position in three months. What are the implications of this as I had thought that my control was pretty good.
Posted by peter7, England on Thursday, November 04, 2010
This is my second year of type 2 diabetes. A year prior to being diagnosed I suffered a central retinal vein occlusion (CRVO). I have had retinal photography recently and I was wondering if this may be the result of diabetes.
Posted by windyg, newcastle on tyne on Thursday, November 04, 2010
I was diagnosed with type 2 diabetes in May 2010, and I am on Metformin. As yet (November), I have not been referred to a chiropodist or for diabetic retinopathy.
Posted by SteveMB on Thursday, November 04, 2010
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