Understanding Diabetic Retinopathy
Diabetic retinopathy (DR) is a complication of diabetes that damages the light-sensitive blood vessels in the retina. It is a leading cause of blindness in working-age adults. Persistently high blood sugar makes these vessels fragile, prone to leaking fluid, or closing off entirely.
The "Silent" Threat: Early diabetic retinopathy often causes no noticeable symptoms. By the time vision is affected, the disease is often in an advanced stage.
Signs and Symptoms
Blurred or Fluctuating Vision
Vision may change from day to day or throughout the day, often making reading or driving difficult.
Floaters and Dark Spots
Dark spots or "strings" floating in your vision can indicate bleeding from fragile new vessels into the vitreous gel of the eye.
Critical: Up to 90% of severe vision loss from diabetic retinopathy is preventable with early detection and timely treatment.
Stages of the Disease
| Stage | Condition & Impact |
|---|---|
| Mild to Moderate NPDR | Tiny swellings (microaneurysms) in vessels. Some vessels become distorted or blocked. Usually asymptomatic. |
| Severe NPDR | Many vessels are blocked, depriving the retina of oxygen and signaling the growth of new, abnormal vessels. |
| Proliferative (PDR) | Advanced Stage. Fragile new vessels grow and bleed into the eye. High risk of sudden, severe vision loss. |
| Macular Edema (DME) | Fluid leaks into the macula (the center of vision). This is the most common cause of vision loss in diabetics. |
Risk Factors
While everyone with diabetes is at risk, the following factors significantly increase the likelihood of retinal damage:
- - Duration: The longer you have diabetes, the higher the risk.
- - Control: Poorly managed blood sugar, blood pressure, or cholesterol.
- - Systemic Health: Pregnancy or kidney involvement (protein in the urine).
- - Statistics: After 20 years, nearly all Type 1 and 60% of Type 2 patients have some damage.
Management and Treatment
While damage cannot always be reversed, treatment is highly effective at slowing progression and preserving remaining sight.
1. Medical Management
- - Strict Control: Maintain an HbA1c target of 6–7%.
- - Blood Pressure: Managing systemic pressure protects delicate retinal vessels.
2. Specialized Eye Treatments
- - Laser Therapy: Photocoagulation to seal leaking vessels or shrink abnormal ones.
- - Injections: Anti-VEGF medications can reduce swelling and vessel growth.
- - Vitrectomy: Surgery to remove blood or scar tissue from the center of the eye in advanced cases.
Clinical References
1. National Eye Institute.
Diabetic Retinopathy Overview. Available at:
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy
2. American Academy of Ophthalmology.
Diabetic Retinopathy Symptoms and Causes.
3. Mayo Clinic. Complications of Diabetes: Retinal Health.
4. Stat: Leading cause of blindness in adults aged 20–64.