Diabetic Retinopathy
On this page:
This booklet is for people with diabetic retinopathy and their
families and friends. It provides information about diabetic retinopathy and
answers questions about the cause and symptoms of this progressive eye disease.
Diagnosis and types of treatment are described.
The National Eye Institute (NEI) conducts and supports research
that leads to sight-saving treatments and plays a key role in reducing visual
impairment and blindness. The NEI is part of the National Institutes of Health
(NIH), an agency of the U.S. Department of Health and Human Services.
Return to top 
|
Diabetic retinopathy is a complication of diabetes and a leading cause
of blindness. It occurs when diabetes damages the tiny blood vessels
inside the retina, the light-sensitive tissue at the back of the eye. A
healthy retina is necessary for good vision.
If you have diabetic retinopathy, at first you may notice no changes to
your vision. But over time, diabetic retinopathy can get worse and cause
vision loss. Diabetic retinopathy usually affects both eyes. |
|
Return to top
Diabetic retinopathy has four stages:
- Mild Nonproliferative Retinopathy. At this earliest stage,
microaneurysms occur. They are small areas of balloon-like swelling in the
retina's tiny blood vessels.
- Moderate Nonproliferative Retinopathy. As the disease progresses,
some blood vessels that nourish the retina are blocked.
- Severe Nonproliferative Retinopathy. Many more blood vessels are
blocked, depriving several areas of the retina with their blood supply. These
areas of the retina send signals to the body to grow new blood vessels for
nourishment.
-
Proliferative Retinopathy. At this advanced stage, the signals sent
by the retina for nourishment trigger the growth of new blood vessels. This
condition is called proliferative retinopathy. These new blood vessels are
abnormal and fragile. They grow along the retina and along the surface of the
clear, vitreous gel that fills the inside of the eye.
By themselves, these blood vessels do not cause symptoms or vision loss.
However, they have thin, fragile walls. If they leak blood, severe vision loss
and even blindness can result.
Return to top
All people with diabetes--both type 1 and type 2--are at risk. That's why
everyone with diabetes should get a comprehensive dilated eye exam at least once
a year. Between 40 to 45 percent of Americans diagnosed with diabetes have some
stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can
recommend treatment to help prevent its progression.
During pregnancy, diabetic retinopathy may be a problem for women with
diabetes. To protect vision, every pregnant woman with diabetes should
have a comprehensive dilated eye exam as soon as possible. Your doctor may
recommend additional exams during your pregnancy.
Return to top
Blood vessels damaged from diabetic retinopathy can cause vision loss in two
ways:
- Fragile, abnormal blood vessels can develop and leak blood into the center
of the eye, blurring vision. This is proliferative retinopathy and is
the fourth and most advanced stage of the disease.
- Fluid can leak into the center of the macula, the part of the eye where
sharp, straight-ahead vision occurs. The fluid makes the macula swell,
blurring vision. This condition is called macular edema. It can occur
at any stage of diabetic retinopathy, although it is more likely to occur as
the disease progresses. About half of the people with proliferative
retinopathy also have macular edema.
Normal vision |
|
Same scene viewed by a person with diabetic
retinopathy |
Return to top
Diabetic retinopathy often has no early warning signs. Don't wait for
symptoms. Be sure to have a comprehensive dilated eye exam at least once a
year.
Return to top
At first, you will see a few specks of blood, or spots, "floating" in your
vision. If spots occur, see your eye care professional as soon as possible. You
may need treatment before more serious bleeding occurs. Hemorrhages tend to
happen more than once, often during sleep.
Sometimes, without treatment, the spots clear, and you will see better.
However, bleeding can reoccur and cause severely blurred vision. You need to be
examined by your eye care professional at the first sign of blurred vision,
before more bleeding occurs.
If left untreated, proliferative retinopathy can cause severe vision loss and
even blindness. Also, the earlier you receive treatment, the more likely
treatment will be effective.
Return to top
Macular edema and diabetic retinopathy are detected during a comprehensive
eye exam that includes:
- Visual acuity test. This eye chart test measures how well you see
at various distances.
- Dilated eye exam. Drops are placed in your eyes to widen, or
dilate, the pupils. Your eye care professional uses a special magnifying lens
to examine your retina and optic nerve for signs of damage and other eye
problems. After the exam, your close-up vision may remain blurred for several
hours.
- Tonometry. An instrument measures the pressure inside the eye.
Numbing drops may be applied to your eye for this test.
Your eye care professional checks your retina for early signs of the disease,
including:
- Leaking blood vessels.
- Retinal swelling (macular edema).
- Pale, fatty deposits on the retina--signs of leaking blood
vessels.
- Damaged nerve tissue.
- Any changes to the blood vessels.
If your eye care professional believes you need treatment for macular edema,
he or she may suggest a fluorescein angiogram. In this test, a special
dye is injected into your arm. Pictures are taken as the dye passes through the
blood vessels in your retina. The test allows your eye care professional to
identify any leaking blood vessels and recommend treatment.
Return to top
Macular edema is treated with laser surgery. This procedure is called focal
laser treatment. Your doctor places up to several hundred small laser burns in
the areas of retinal leakage surrounding the macula. These burns slow the
leakage of fluid and reduce the amount of fluid in the retina. The surgery is
usually completed in one session. Further treatment may be needed.
A patient may need focal laser surgery more than once to control the leaking
fluid. If you have macular edema in both eyes and require laser surgery,
generally only one eye will be treated at a time, usually several weeks
apart.
Focal laser treatment stabilizes vision. In fact, focal laser treatment
reduces the risk of vision loss by 50 percent. In a small number of cases, if
vision is lost, it can be improved. Contact your eye care professional if you
have vision loss.
Return to top
During the first three stages of diabetic retinopathy, no treatment is
needed, unless you have macular edema. To prevent progression of diabetic
retinopathy, people with diabetes should control their levels of blood sugar,
blood pressure, and blood cholesterol.
Proliferative retinopathy is treated with laser surgery. This procedure is
called scatter laser treatment. Scatter laser treatment helps to shrink the
abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the
areas of the retina away from the macula, causing the abnormal blood vessels to
shrink. Because a high number of laser burns are necessary, two or more sessions
usually are required to complete treatment. Although you may notice some loss of
your side vision, scatter laser treatment can save the rest of your sight.
Scatter laser treatment may slightly reduce your color vision and night
vision.
Scatter laser treatment works better before the fragile, new blood vessels
have started to bleed. That is why it is important to have regular,
comprehensive dilated eye exams. Even if bleeding has started, scatter laser
treatment may still be possible, depending on the amount of bleeding.
If the bleeding is severe, you may need a surgical procedure called a vitrectomy.
During a vitrectomy, blood is removed from the center of your eye.
Both focal and scatter laser treatment are performed in your doctor's office
or eye clinic. Before the surgery, your doctor will dilate your pupil and apply
drops to numb the eye. The area behind your eye also may be numbed to prevent
discomfort.
The lights in the office will be dim. As you sit facing the laser machine,
your doctor will hold a special lens to your eye. During the procedure, you may
see flashes of light. These flashes eventually may create a stinging sensation
that can be uncomfortable.
You will need someone to drive you home after surgery. Because your pupil
will remain dilated for a few hours, you should bring a pair of sunglasses.
For the rest of the day, your vision will probably be a little blurry. If
your eye hurts, your doctor can suggest treatment.
Return to top
If you have a lot of blood in the center of the eye (vitreous gel), you may
need a vitrectomy to restore your sight. If you need vitrectomies in both eyes,
they are usually done several weeks apart.
A vitrectomy is performed under either local or general anesthesia. Your
doctor makes a tiny incision in your 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. Some people
stay in the hospital overnight. Your eye will be red and sensitive. You will
need to wear an eye patch for a few days or weeks to protect your eye. You also
will need to use medicated eyedrops to protect against infection.
Return to top
Yes. Both treatments are very effective in reducing vision loss. People with
proliferative retinopathy have less than a five percent chance of becoming blind
within five years when they get timely and appropriate treatment. Although both
treatments have high success rates, they do not cure diabetic
retinopathy.
Once you have proliferative retinopathy, you always will be at risk for new
bleeding. You may need treatment more than once to protect your sight.
Return to top
If you have lost some sight from diabetic retinopathy, ask your eye care
professional about low vision services and devices that may help you make the
most of your remaining vision. Ask for a referral to a specialist in low vision.
Many community organizations and agencies offer information about low vision
counseling, training, and other special services for people with visual
impairments. A nearby school of medicine or optometry may provide low vision
services.
Return to top
The National Eye Institute (NEI) is conducting and supporting research that
seeks better ways to detect, treat, and prevent vision loss in people with
diabetes. This research is conducted through studies in the laboratory and with
patients.
For example, researchers are studying drugs that may stop the retina from
sending signals to the body to grow new blood vessels. Someday, these drugs may
help people control their diabetic retinopathy and reduce the need for laser
surgery.
Return to top
The NEI urges everyone with diabetes to have a comprehensive dilated eye exam
at least once a year. If you have diabetic retinopathy, you may need an eye exam
more often. People with proliferative retinopathy can reduce their risk of
blindness by 95 percent with timely treatment and appropriate followup care.
A major study has shown that better control of blood sugar levels slows the
onset and progression of retinopathy. The people with diabetes who kept their
blood sugar levels as close to normal as possible also had much less kidney and
nerve disease. Better control also reduces the need for sight-saving laser
surgery.
This level of blood sugar control may not be best for everyone, including
some elderly patients, children under age 13, or people with heart disease. Be
sure to ask your doctor if such a control program is right for you.
Other studies have shown that controlling elevated blood pressure and
cholesterol can reduce the risk of vision loss. Controlling these will help your
overall health as well as help protect your vision.
Return to top
You can protect yourself against vision loss by working in partnership with
your eye care professional. Ask questions and get the information you need to
take care of yourself and your family.
What are some questions to ask?
About my eye disease or disorder...
- What is my diagnosis?
- What caused my condition?
- Can my condition be treated?
- How will this condition affect my vision now and in the future?
- Should I watch for any particular symptoms and notify you if they occur?
- Should I make any lifestyle changes?
About my treatment...
- What is the treatment for my condition?
- When will the treatment start and how long will it last?
- What are the benefits of this treatment and how successful is it?
- What are the risks and side effects associated with this treatment?
- Are there foods, drugs, or activities I should avoid while I'm on this
treatment?
- If my treatment includes taking medicine, what should I do if I miss a
dose?
- Are other treatments available?
About my tests...
- What kinds of tests will I have?
- What can I expect to find out from these tests?
- When will I know the results?
- Do I have to do anything special to prepare for any of the tests?
- Do these tests have any side effects or risks?
- Will I need more tests later?
Other suggestions
- If you don't understand your eye care professional's responses, ask
questions until you do understand.
- Take notes or get a friend or family member to take notes for you. Or,
bring a tape recorder to help you remember the discussion.
- Ask your eye care professional to write down his or her instructions to
you.
- Ask your eye care professional for printed material about your condition.
- If you still have trouble understanding your eye care professional's
answers, ask where you can go for more information.
- Other members of your health care team, such as nurses and pharmacists,
can be good sources of information. Talk to them, too.
Today, patients take an active role in their health care. Be an active
patient about your eye care.
|
If you have diabetes, get a comprehensive dilated eye exam at least
once a year.
- Proliferative retinopathy can develop without symptoms. At this
advanced stage, you are at high risk for vision loss.
- Macular edema can develop without symptoms at any of the four stages
of diabetic retinopathy.
- You can develop both proliferative retinopathy and macular
edema and still see fine. However, you are at high risk for vision
loss.
Your eye care professional can tell if you have macular edema or any
stage of diabetic retinopathy. Whether or not you have symptoms, early
detection and timely treatment can prevent vision
loss. |
Return to top
Coma
