Diabetic Retinopathy — A Dangerous Complication

Read on to learn about the causes, symptoms, treatments and what you can do to prevent diabetic retinopathy. 

Living with diabetes, there are a lot of things to keep track of. Monitoring high blood sugar levels, doctor appointments, and prescription requests — staying on top of everything about your condition can feel like a full-time job. 

But life with diabetes isn’t a job. You can’t call in sick, can’t take vacation, don’t get paid and not doing your tasks won't get you fired — instead, it might lead to serious health complications later on. Needless to say, it’s a lot of work. But, as with any chronic illness, taking the time and effort to care for your health can reduce your chances of developing diabetes complications.

Here, we look at one of the most common diabetes complications: early diabetic retinopathy, a serious and irreversible condition that can lead to significant vision loss when left untreated. According to the Centers for Disease Control and Prevention (CDC), diabetic retinopathy can affect anyone with diabetes mellitus, both type 1 and type 2 and is the leading cause of vision loss in adults in the United States. 

What is Diabetic Retinopathy? 

Diabetic retinopathy is a diabetic eye disease in which the blood vessels at the back of the eye are damaged due to large amounts of sugar in the blood. 

The damage is done to the part of the eye called the retina, the tissue in the back of the eyeball that controls light and is the primary contributor to our sight. There are two types of diabetic retinopathy: nonproliferative diabetic retinopathy and proliferative diabetic retinopathy.

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Nonproliferative Diabetic Retinopathy

Nonproliferative diabetic retinopathy is the more common form of the disease and is characterized by damaged blood vessels without the growth of new ones. An excessively high blood sugar level weakens the walls of blood vessels, causing smaller vessels to bulge and even leak blood or fluid into the eye and larger blood vessels to grow and dilate. Continuously high blood glucose levels put greater stress on these vessels, to the point where severe vision loss or even total blindness can occur. 

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Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy is the second, less common, but more severe form of diabetic retinopathy. This condition is characterized by damaging blood vessels in the eye alongside the growth of new, abnormal blood vessels. 

With this eye condition, the new blood vessels are weaker than the original ones and can easily leak blood into the eye's fluid. Additionally, the growth of new blood vessels can lead to a buildup of scar tissue that can eventually cause the retina to detach from the rest of the eye. This is called tractional retinal detachment and is an emergency medical condition. 

Moreover, these eye problems can damage the optic nerve, the main way our eyes communicate with our brain, and lead to glaucoma, visual impairment and blindness. 

What Causes Diabetic Retinopathy? 

The primary cause of diabetic retinopathy is hyperglycemia (high blood sugar level). When somebody is hyperglycemic, they have too much sugar in their blood supply to be considered healthy. Because of the glucose in the blood, the blood supply itself can damage some of the blood vessels through which it flows. 

If you’ve ever looked in the mirror after staying up all night studying, working on a paper, dealing with a crying baby or anything of the sort, you’ve noticed the tiny blood vessels that appear in our eyes when we’re tired or our eyes get dry or irritated. While an increase of glucose in the blood can damage any part of our bodies, these tiny blood vessels in the eyes are so small that an increase in sugar in the blood can easily damage them. 

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Diabetic Macular Edema and DME

Diabetic maculopathy, also known as diabetic macular edema (DME), is a complication of diabetic retinopathy in which the macula is specifically damaged. The macula is the portion of the retina at the very center and is one of the most important parts of the eye. Like the rest of the retina, it translates light into images we can see and understand, but the macula is unique in that it helps us see detail, allowing us to do things like read text and recognize people’s faces. 

When the macula is damaged, it can swell, and vision can be largely impaired. Blurry vision and even vision loss can result from DME.  

Symptoms of Retinopathy

The early stages of retinopathy can be asymptomatic, but as the disease duration progresses, symptoms will start to appear. The American Diabetes Association (ADA) position states that diabetic retinopathy diagnostic assessment and treatment options have improved dramatically since 2002, which is why regular eye checkups are essential. It's vital to monitor your visual acuity and watch for any symptoms:
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Early Signs of Retinopathy

Eye Floaters 

Myodesopsias, known colloquially as “eye floaters,” refers to small shadows, spots or lines that can appear in your vision. They are caused by a thickening of the vitreous humor, gel-like fluid that sits in between the lens and the retina. While not a dangerous complication and a relatively normal experience, seeing a significant increase in floaters or a more frequent occurrence of them can be a warning sign of a potential vision issue. 

Sometimes, floaters are caused simply by the vitreous humor pulling on the retina — a common thing that happens as we age. But, in other cases, they can be a sign of leaky blood vessels due to too much sugar in the blood flowing to the retina/ 

For someone with diabetes, it is good practice to tell your doctor if you notice anything changing in your vision. Even if it may seem like no big deal, it can be an early sign of a larger issue.  

Blurred vision 

Blurred vision can also be one of the early signs of diabetic retinopathy. As the disease progresses, things up close or far away can start to become blurry, and it may be more difficult to make out words or details. Blurred vision can also fluctuate, so you may have blurry vision one day but find it has cleared up by the next. However, regardless of whether it goes away, recurring blurry vision can be a direct sign to talk to your doctor and request an eye exam. 

Dark spots 

Dark or blind spots in your vision, also called scotomas, can be a symptom of diabetic retinopathy. These are caused by blood or fluid leaking into the eye from damaged blood vessels in the retina. Additionally, scar tissue from damaged or burst blood vessels in the eye can create blind spots in your vision, and if left untreated or if routinely high blood sugar continues, they can spread to complete vision loss. 

Vision loss

Because the retina is vital to our vision process, damage to it can cause permanent vision loss. This severe retinopathy can be partial or complete and can not be corrected or fully reversed. 

Noticing any of these symptoms, no matter how small or innocuous they may seem, is important to ensuring that diabetic retinopathy does not go unchecked. If you are experiencing anything strange or abnormal about your vision, it might be time to talk to your doctor, endocrinologist or medical team about scheduling a diabetic eye exam. 

Diabetic Retinopathy Treatment

There is no cure for diabetic retinopathy, but there are ways to mitigate the symptoms and slow the progression of the disease. Early treatment and preventative measures are the best ways to manage complications related to diabetes, such as diabetic retinopathy. Prevention can include regular eye exams, keeping blood glucose levels in range and working with your doctor to lower your A1c. 

The Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS), administered in the 1970s and 1980s,  exhibited the effects of laser eye treatment with proliferative retinopathy and macular edema.

PRP treatment for retinopathy, also known as "Panretinal Photocoagulation," is a laser therapy used to treat proliferative diabetic retinopathy (PDR). The treatment prevents further abnormal blood vessel growth and stabilizes vision loss by applying numerous minor laser burns across the peripheral retina.

The DRS was a seminal diabetic retinopathy clinical research trial, providing a firm evidence base for the effectiveness of PRP in reducing the progression of proliferative diabetic retinopathy and severe sight loss in high-risk diabetic retinopathy eyes.

Additionally, high cholesterol and high blood pressure can increase your likelihood of developing diabetic retinopathy, so maintaining control over your general health is imperative to reducing your likelihood of developing the condition. 

Injections, Lasers and Surgery — Oh my!  

In recent years, there's been a growth in treatment options available to people struggling with diabetic retinopathy. 

Some injection medications can treat the symptoms of retinopathy and slow down the progression of the disease. In some cases, these medications can work to reverse the effects of retinopathy. These injections, called Anti-vascular endothelial growth factor (Anti-VEGF) drugs, can stop the blood vessels from leaking fluid and blood into the eye by slowing the production of VEGFs.

VEGF is a type of protein that, when overproduced, can cause small blood vessels in the eyes to leak and grow abnormally. Anti-VEGF drugs block the body from producing VEGF so that blood vessels in the eye are no longer impacted. Injections are usually given once per month, though they may dwindle as treatment progresses and eyesight improves. 

Laser Surgical Treatment

For people struggling with advanced retinopathy, lasers can shrink inflamed blood vessels in the eye and increase vision performance. This is called scatter laser surgery or pan-retinal photocoagulation. Multiple sessions may be needed, but lasers can also be used in conjunction with injections to treat severe diabetic retinopathy and significantly improve this eye condition. 

Lastly, eye surgery, or vitrectomy, may be needed to treat severe diabetic retinopathy. This may also be required if you have experienced tractional retinal detachment or detachment of part or all of the retina from the rest of the eye. During this surgery, a doctor can repair damaged blood vessels leaking into the eye and causing blurred vision or fix a torn or damaged retina. 

Final Thoughts 

Life with diabetes is complicated and tiring — when times get hard, it can be easy to put your diabetes care on the back burner and focus on other elements of your life. While that's normal and even expected at some point or another, staying in control of your blood sugar levels through tight glycemic control and managing difficult high blood sugar levels is vital to avoiding strenuous eye problems and complications like diabetic retinopathy. If you are experiencing some symptoms, contact your eye doctor as soon as possible.