Diabetic Retinopathy
Diabetic retinopathy, or retinal damage from diabetes, is the most common cause of vision loss in working-age adults in the United States. The elevated levels of blood sugar in patients with diabetes lead to blood vessel damage in the retina. These damaged blood vessels leak fluid and blood into the retina and eventually cause abnormal blood vessel growth. Without treatment, this leakage and abnormal blood vessel growth can lead to permanent blindness.
Risk Factors
The main risk factors for the development of diabetic retinopathy are the duration a patient has had diabetes and how well the blood sugar has been controlled. Certain associated conditions, such as high blood pressure, elevated cholesterol, smoking, obesity, pregnancy, and kidney disease, can increase a patient’s risk of developing diabetic retinopathy.
Symptoms
Patients often have no symptoms in the early stages of diabetic retinopathy. As the condition progresses, patients develop blurry vision, floaters, and dark or shaded areas in the field of vision. Diabetic retinopathy is typically present in both eyes, though it may be more severe in one eye compared to the other.
Subspecialties & Types
There are two general categories of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is the earlier stage of diabetic retinopathy and is characterized by damaged blood vessels within the retina that leak blood or fluid. PDR is the more advanced stage of diabetic retinopathy and is characterized by the growth of abnormal new blood vessels on the surface of the retina or optic nerve. Without treatment, these abnormal blood vessels often lead to significant bleeding, scar tissue formation, retinal detachment, and permanent vision loss.
Diagnosis
A complete eye examination, including dilation of the pupil, is the best way to diagnose diabetic retinopathy. In addition, retinal physicians use several specialized tests, including retinal photography, optical coherence tomography (OCT), and fluorescein angiography to diagnose the stage of diabetic retinopathy and to determine the necessary treatment plan.
Treatment
The most common vision-threatening complication of diabetic retinopathy is diabetic macular edema (swelling or fluid buildup in the central part of the retina). The primary treatment for diabetic macular edema is with intravitreal injections (injections of medicine into the eye). When the swelling/edema is not directly in the center of the retina, laser may also be a treatment option.
Despite how awful it sounds to have an injection into the eye, we take great care to make it as painless as possible. Not only do these injections typically result in vision improvement, but they also reverse the damage from diabetes. These injections may need to be repeated monthly for up to 2 years or longer in order to see the maximum benefit. In our practice, we use the latest medications, including Eylea HD, Vabysmo, and Pavblu, to ensure our patients have the best outcomes and need the least number of injections to complete the treatment.
For the more advanced stage of diabetic retinopathy, proliferative diabetic retinopathy, intra-vitreal injections are also commonly used. However, once a patient develops this stage of diabetic retinopathy, it is also likely that pan-retinal photocoagulation (PRP) laser treatment will be required to shrink abnormal new blood vessels and prevent further significant bleeding.
Intravitreal injection treatment may also be used for PDR. In more severe cases of PDR, vitrectomy surgery (removal of the vitreous gel from the back of the eye) may be necessary to address complications like vitreous hemorrhage (bleeding into the back of the eye) or tractional retinal detachment (caused by scar tissue pulling on the retina).
Above all, it is important to keep the blood sugar under as good control as possible and to treat any other underlying conditions mentioned above that can contribute to the progression of diabetic retinopathy. If the blood sugar remains very elevated, patients may continue to lose vision despite all of the treatments available. Regular eye exams are extremely important in patients with diabetes, as the earlier diabetic retinopathy is caught and treated, the better the outcome. Regular visits with a doctor from Mid Atlantic Retina Specialists may help to lower your risk of vision loss from diabetic retinopathy.
Schedule a Consultation for Diabetic Retinopathy
At Mid Atlantic Retina Specialists, our team of experienced retina specialists can diagnose and treat a wide variety of retinal conditions, including diabetic retinopathy. Request an appointment today at one of our retina centers in Hagerstown, MD, (link retina-centers/frederick text: Frederick, MD), Chambersburg, PA, or Bedford, PA.
