Diabetic Retinopathy

Statistics from the National Eye Institute regarding Diabetic Retinopathy: “According to the National Eye Institute, it is estimated that nearly 5.4 million Americans, ages 18 and over currently have diabetic retinopathy.

This eye disease causes over 8000 cases of new blindness annually, and is the primary cause of blindness for people ages 25 to 74” (Valero and Drouilhet, 2001). Early detection can save your vision!

What is diabetic retinopathy?

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Diabetic Retinopathy Specialist Washington DC - Diabetic Eye Doctor

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. Patients with diabetes must be vigilant with eye care and annual eye examinations in order to avoid vision loss due to diabetic retinopathy. The use of medications and daily blood sugar monitoring can make a major impact on containing the worsening of diabetic retinopathy.

With diabetes, sugar (glucose) builds up within blood vessels in the retina and tissues of the body causing it to attach to the proteins in the wall. This alters the vessel’s normal structure and functioning. The vessels eventually get blocked and leak fluid. When they cannot deliver an adequate amount of blood supply to the eye, the eye can generate abnormal new blood vessels. Early diabetic retinopathy usually has no symptoms. However, worsening diabetic retinopathy can lead to visual loss and blindness.

How often should diabetic eye examinations be performed?

Baseline eye examinations are advisable, followed by annual screening examinations thereafter, in patients with newly diagnosed and well-controlled diabetes mellitus. For patients with longstanding diabetes mellitus or poor glycemic control, it may be necessary to be followed more frequently by a diabetic eye doctor. Early detection is crucial in preventing vision loss due to diabetes.

How is diabetic retinopathy diagnosed?

Retinopathy, particularly at its earliest stages, may not produce any visual symptoms. If symptoms do present, they can be fluctuating visual acuity, blurred vision, distortion, noting that objects look smaller or larger than normal, and floaters. Early detection is the best way to prevent vision loss. Therefore, it is crucial for all patients with diabetes to undergo a dilated examination at least once a year and more frequently once diabetic retinopathy is detected.

Learn more about diabetic retinopathy.

Diabetic Retinopathy & Treatment

There are two main categories of diabetic retinopathy: nonproliferative diabetic retinopathy and proliferative retinopathy. Treatment depends primarily upon the type and severity of the retinopathy. The most important aspect of treatment, however, is prevention. By regularly monitoring blood sugar, and maintaining a healthy program of diet and exercise, you can significantly reduce your chances of developing retinopathy.

Nonproliferative Retinopathy (NPDR)

The milder of the two forms of diabetic retinopathy is nonproliferative retinopathy. NPDR is characterized by the presence of microaneurysms, hemorrhage, exudate, and/or fluid in the retina. At its earliest detection, NPDR may not require any treatment, but in more severe stages of NPDR, treatment such as intravitreal injections and/or laser may be necessary to stabilize or to reverse some of these diabetic changes in the retina.

Patients who have had diabetes for a long time or patients that have poor blood glucose control have a higher likelihood of developing diabetic retinopathy. In its earliest forms, diabetic retinopathy does not typically impact a patient’s vision so it is imperative to be examined annually by a diabetic eye specialist to detect diabetic retinopathy.

Proliferative Retinopathy (PDR)

PDR is the more advanced form of diabetic retinopathy and can have devastating visual consequences if undiagnosed or untreated. PDR is characterized by the growth of abnormal blood vessels in the context of longstanding or uncontrolled diabetes mellitus. Typically, these abnormal blood vessels arise due to underlying ischemia (poor blood flow) due to diabetes, and they can grow unchecked in the retina, on the optic nerve, into the vitreous, or on the iris. Because these blood vessels are intrinsically abnormal, they tend to bleed and/or result in scar tissue formation within the eye, leading to devastating visual sequelae such as vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma.

Two main classes of medications can be used to treat diabetic eye disease — Anti-VEGF (Vascular Endothelial Growth Factor) agents and steroids

This in-office procedure utilizes local anesthesia to deliver potent medications into the vitreous cavity to arrest or reverse underlying diabetic retinopathy.

Laser surgery for diabetic retinopathy is performed by directing a beam of light into the eye to treat the damaged parts of the retina. In cases of background diabetic retinopathy with macular edema, the laser is used to seal off leaking blood vessels and to stimulate the eye to reabsorb the fluid. When abnormal blood vessel growth is present, as in proliferative diabetic retinopathy, laser is used to decrease and prevent blood vessel growth. Laser surgery is often performed in the office and usually only requires topical or local anesthesia. Multiple laser treatments are often necessary.

Vitrectomy is typically required for more advanced forms of proliferative diabetic retinopathy, which may involve vitreous hemorrhage and/or tractional retinal detachment. In cases such as these, surgery may be recommended to remove the vitreous gel in order to better visualize and possibly treat abnormal blood vessels in the retina. It may also be necessary to access and release scar tissue on the surface of the retina.

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