Diabetic Retinopathy

I’ve been told that I have diabetic retinopathy. What is it exactly? 

Diabetic retinopathy is a complication of diabetes where blood vessels in your eye are damaged. There are four stages of the condition. 

Stage 1 – swelling can occur in the retina’s tiny blood vessels.

Stage 2 – some blood vessels that nourish the retina are blocked.

Stage 3 – more blood vessels can become blocked and the retina sends signals to the body to grow new blood vessels.

Stage 4 – new blood vessels grow. They have thin and fragile walls which, if they leak blood, which may lead to vision loss.

What is the retina?

Anyone who has diabetes can get diabetic retinopathy, including people who have:

• Gestational diabetes
• Type 1 diabetes
• Type 2 diabetes

If you have diabetes, risk factors for diabetic retinopathy can include:

• Pregnancy
• Hypertension
• Uncontrolled blood sugar
• Hyperlipidemia (a term that covers several disorders that result in extra fats, also known as lipids, in your blood)

The best way to avoid the disease is by managing your diabetes and controlling your blood sugar. Schedule an appointment with your consultant if you notice any new vision changes. People with diabetes will have regular assessments to monitor and evaluate the health of their eyes. During these assessments, eyes are checked for signs of diabetic retinopathy. 

What are the long-term effects of diabetic retinopathy?

In some cases the blood vessels of your eye can swell and leak or abnormal blood vessels can grow on the surface of the retina. At first you may not notice any change in your vision but overtime diabetic retinopathy may cause vision to decrease.

Common signs and symptoms include:

• Blurred or distorted vision (linked to blood sugar levels)
• Floaters (small black spots) and flashing lights
• Trouble reading or seeing faraway objects
• Loss of central vision
• Sudden loss of vision (blindness)
• New colour blindness or seeing colours as faded
• Poor night vision (night blindness)

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How is diabetic retinopathy diagnosed? 

There are a number of different tests that may be used to diagnose diabetic retinopathy. At Mater Private we use some or all of the following: 

• Visual acuity: this test uses an eye chart to measure how well you see at various distances.
• Slit lamp examination: your eye is examined under high magnification to check for any new blood vessels on the iris. Such new blood vessels would indicate that damage to the retina has caused these new vessels to form in the retina as well as on the iris.
• Tonometry: this test measures the pressure in your eye and checks for glaucoma.
• Eye examination/pupil dilation: drops are used to dilate the pupil of your eye pupil in order to examine the retina in detail.
• Amsler grid: a lined grid that we use to check for distorted or missing lines.

Following these initial tests, a series of retinal examinations will be carried out in order to investigate the extent of damage the diabetic retinopathy might be causing you. These examinations include: 

• Color fundus photography: a photograph is taken of the inner lining of your eye (fundus) to produce a sharp image of your retina and its blood vessels.
• Fluorescein angiogram: a special dye is injected into a vein in your arm, and as the dye passes through the blood vessels in the retina, we take a of your eye. This image can show staining, leakage or non-perfusion (inability of blood to pass through) in the retina and identify areas of damage.
• Indocyanine green angiography: this is similar to the fluorescein angiogram but uses indocyanine green dye.
• Optical coherence tomography: 3D scans of the layers of the macular part of the retina to produce cross-sectional images of your retina.

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How is diabetic retinopathy treated? 

Our advice is that you should not wait for the signs and symptoms of diabetic retinopathy to appear. If you suffer from diabetes, it is vitally important you attend a comprehensive eye examination every year. 

There are four stages of diabetic retinopathy. For the first three stages of the condition, you may not have any symptoms and we may use a wait-and-see approach especially if your vision is good. During this time, you have regular eye exams but don’t need further treatment. Some people need eye exams every two to four months.

For the fourth stage, there are a number of possible treatments. Our consultants take your age, medical history, the extent of retinal damage, your visual acuity and your HgbA1c into account when determining your treatment plan. 

• Scatter laser: treatment to shrink the new blood vessels. You may need two or more laser treatments. Colour and night vision may be reduced.
• Focal laser: this treatment is used to reduce swelling in your retina and to slow the leakage of fluid and reduce the amount fluid in the retina. This may reduce vision loss up to 50%.
• Injections: anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections may be given to reduce swelling at the back of the eye. This can help to slow down vision loss. 
• Vitrectomy: a surgical procedure which removes blood from the centre of your eye to restore vision. During a vitrectomy, the eye doctor makes a small incision in the eye. The provider can repair the blood vessels and remove scar tissue.

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How can I stop my diabetic retinopathy from getting any worse? 

To prevent the progression of diabetic retinopathy, control is very important.

• Control blood sugars
• Control blood pressure
• Control blood cholesterol
• Stop smoking
• Exercise regularly

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Living with diabetic retinopathy

If you have diabetes, it is vitally important to have your eyes examined at least once per year. Pregnant women who have diabetes should schedule an eye exam during their first trimester.

Between eye appointments, call your optician or ophthalmologist if you notice:

• Black spots in your vision
• Blurred vision
• Flashes of light
• Holes in your vision