Diabetic retinopathy is damage to the eye’s retina that occurs with long-term diabetes.
There are two types, or stages of retinopathy: Nonproliferative or proliferative
- Nonproliferative diabetic retinopathy develops first. Blood vessels in the eye become larger in certain spots (called microaneurysms). Blood vessels may also become blocked. There may be small amounts of bleeding (retinal haemorrhages), and fluid may leak into the retina. This can lead to noticeable problems with your eyesight.
- Proliferative retinopathy is the more advanced and severe form of the disease. New blood vessels start to grow in the eye. These new vessels are fragile and can bleed (haemorrhage). Small scars develop, both on the retina and in other parts of the eye (the vitreous). The end result is vision loss, as well as other problems.
Other problems that may develop are:
- Macular oedema – the macula is the area of the retina that provides sharp vision straight in front of you. If fluid leaks into this area, your vision becomes more blurry.
- Retinal detachment – scarring may cause part of the retina to pull away from the back of your eyeball.
- Glaucoma – increased pressure in the eye is called glaucoma. If not treated, it can lead to blindness.
- Cataracts.
People with both type 1 diabetes and type 2 diabetes are at risk for diabetic retinopathy.
The following are very important for preventing diabetic retinopathy:
- Tight control of blood sugar (glucose), blood pressure, and cholesterol.
- Stopping smoking.
People with nonproliferative diabetic retinopathy may not need treatment. However, they should be closely followed-up by an eye doctor trained to treat diabetic retinopathy.
Treatment usually does not reverse damage that has already occurred, but it can help keep the disease from getting worse.
Once your eye doctor notices new blood vessels growing in your retina (neovascularisation) or you develop macular oedema, treatment with laser is usually needed.
TREATMENT
Laser treatment is used to seal leaking blood vessels. This is to preserve remaining sight rather than to restore lost vision. It may also be necessary to laser the macula if the swelling does not resolve.
If proliferative retinopathy has developed, then the doctor may use a laser technique called pan-retinal photocoagulation, which is a type of scatter treatment across the peripheral retina. This helps to minimise the growth of new vessels as well as causing existing abnormal vessels to regress.
This type of treatment is usually spread over a number of sessions, due to the large amount of retina being treated. If extensive proliferative retinopathy has developed and haemorrhage has occurred then a vitrectomy – surgical removal of the vitreous – may be needed. This will remove longstanding blood and scar tissue from inside the eye and maximise the remaining vision.
In recent times, intra-vitreal injections (Lucentis, Eylea or intra-vitreal steroids) may be used as additional or alternative treatment for certain patients with diabetic retinopathy.
Alternative Names
Retinopathy – diabetic; Photocoagulation – retina
RELATED LINKS:
Diabetes Australia www.diabetesnsw.com.au
