If you have diabetes mellitus, your body does not use and store sugar properly. Over time, diabetes can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. The damage to retinal vessels is referred to as diabetic retinopathy.
Nonproliferative Diabetic Retinopathy (NPDR)
NPDR commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates. Many people with diabetes have mild NPDR, which usually does not affect their vision. When vision is affected, it is the result of macular edema and/or macular ischemia.
Macular edema is swelling, or thickening, of the macula, a small area in the center of the retina that allows us to see fine details clearly. The swelling is caused by fluid leaking from retinal blood vessels. It is the most common cause of visual loss associated with diabetes. Vision loss may be mild to severe, but even in the worst cases, peripheral (side) vision continues to function.
Macular ischemia occurs when small blood vessels (capillaries) close completely. Vision blurs because the macula no longer receives sufficient blood supply to work properly. Unfortunately, there are no effective treatments for macular ischemia.
Nonproliferative diabetic retinopathy
Proliferative Diabetic Retinopathy (PDR)
PDR is the more advanced stage of diabetic eye disease. It happens when the retina starts growing new blood vessels. This is called neovascularization. These fragile new vessels often bleed into the vitreous, the gel-like substance that fills the inside of the eyeball. If they only bleed a little, you might see a few dark floaters. If they bleed a lot, it might block all vision.
These new blood vessels also can form scar tissue. Scar tissue can cause problems with the macula or lead to a detached retina.
PDR is a very serious eye condition where severe vision loss can occur due to complications, such as neovascular glaucoma and even loss of the eye.
Proliferative diabetic retinopathy
You can have diabetic retinopathy and not know it. This is because it often has no symptoms in its early stages. As diabetic retinopathy gets worse, you will notice symptoms such as:
seeing an increasing number of floaters
having blurry vision
fluctuating vision from blurry to clear
having poor night vision, and
noticing colors appear faded or washed out
Diabetic retinopathy symptoms usually affect both eyes.
Your treatment is based on what your ophthalmologist sees in your eyes. Treatment options may include:
Medical control: Controlling your blood sugar and blood pressure can stop vision loss. Carefully follow the diabetes diet your nutritionist or primary doctor recommends. Take the medicine your diabetes doctor prescribes for you. Sometimes, good sugar control can even bring some of your vision back. Controlling your blood pressure keeps your eye’s blood vessels healthy.
Eye medicine: One type of medication is called anti-VEGF medication. These include Avastin, Eylea, and Lucentis. Anti-VEGF medication helps to reduce swelling of the macula, slowing vision loss and perhaps improving vision. This drug is given by injections (shots) in the eye. At Polaris Eye & Laser, we are pleased to provide anti-VEGF injections for patients who need them. Dr. Kim will recommend how many injections you will need over time.
Laser surgery: Laser surgery might be used to help seal off leaking blood vessels. This can reduce swelling of the retina and improve your vision. Laser surgery can also help shrink blood vessels and prevent them from growing again. Sometimes more than one treatment is needed.
Retina with double arrow indicating recent laser treatment and single arrow indicating past laser treatment
Vitrectomy: If you have advanced PDR, your ophthalmologist may recommend surgery called vitrectomy. This is usually performed by a retina surgeon. During the surgery, vitreous gel and blood from leaking vessels in the back of your eye are removed. This allows light rays to focus properly on the retina again. Scar tissue also might be removed from the retina.
Ways to prevent vision loss from diabetic retinopathy
If you have diabetes, talk with your primary care doctor about controlling your blood sugar. High blood sugar damages retinal blood vessels and that causes vision loss.
Do you have high blood pressure or kidney problems? Ask your doctor about ways to manage and treat these problems.
See your ophthalmologist regularly for dilated eye exams. Diabetic retinopathy may be found before you even notice any vision problems.
If you notice vision changes in one or both eyes, call your ophthalmologist or Polaris Eye & Laser right away for prompt diagnosis and treatment.
Get treatment for diabetic retinopathy as soon as possible. This is the best way to prevent vision loss.
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