Stage : Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy , or advanced retinopathy, occurs when new, abnormal blood vessels begin to grow inside the eye. When the retina loses nourishment, it signals the body to grow new blood vessels. These abnormal vessels may also grow into the center of the eye.
These changes can cause vision loss in several ways:
- The new, abnormal blood vessels leak easily. As leaky blood vessels outpace healthy ones, the retina gets even less nourishment.
- Leakage of blood into your eye can make it harder to see clearly, and in some cases can block your vision entirely.
- Scar tissue can form on the retina.
Minor bleeding can cause symptoms like dark spots and lines in your vision. Major bleeding can cause severe vision loss. This can include blindness, or the total loss of vision.
Its important to seek treatment if you have diabetes and notice changes in your vision, like seeing cobwebs or floaters. Even if the problem seems to go away on its own, treatment is critical to prevent more serious vision loss from happening in the future.
Your Annual Diabetes Eye Exam
Heres the thing about your eyes: its just too darn easy for these common diabetes eye complications to develop and worsen without it becoming obvious in your day-to-day life until its too late.
However, there are a few key signs the American Optometric Association says should cause anyone with diabetes to schedule an appointment with their optometrist or ophthalmologist quickly, including:
- Sudden blurred or double vision
- Trouble reading or focusing on near-work
- Eye pain or pressure
- A noticeable aura or dark ring around lights or illuminated objects
- Visible dark spots in vision or images of flashing lights
Getting your eyes thoroughly examined each year by an optometrist is critical to diagnosing and treating diabetes-related eye conditions in their earliest stages in order to protect and keep your eyesight.
Lets take a closer look at the four exams conducted during your annual eye check-up.
Yellow Reddish Or Brown Patches On Your Skin
Necrobiosis Lipoidica
This skin condition often begins as small raised solid bumps that look like pimples. As it progresses, these bumps turn into patches of swollen and hard skin. The patches can be yellow, reddish, or brown.
You may also notice:
- The surrounding skin has a shiny porcelain-like appearance
- You can see blood vessels
- The skin is itchy and painful
- The skin disease goes through cycles where it is active, inactive, and then active again
necrobiosis lipodica.
Take action
- Get tested for diabetes, if you have not been diagnosed.
- Work with your doctor to better control your diabetes.
- See a dermatologist about your skin. Necorbiosis lipodica is harmless, but it can lead to complications.
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So Dont Wait For Advanced
Don’t wait until it’s too late. Diabetic retinopathy is a progressive disease, and can lead to blindness if left untreated. So dont wait for advanced-stage symptoms like blurred vision, eyestrain and headaches to appear before you pay a visit to your eye specialist having regular eye health checks is an important weapon against diabetic retinopathy, which often doesnt present early warning signs.
When To Call Your Eye Doctor About Diabetic Retinopathy Symptoms
With diabetes, youre probably already juggling lots of healthcare appointments, but its critical that you add an eye doctor to your team. Todays sophisticated imaging, as well as some of the tried-and-true eye exam tests, allow your eye doctor to see the train coming down the tracks long before you realize it, and the two of you can work together to slow its progress.
If you dont have a regular eye doctor, ask your primary care provider or endocrinologist to recommend one who regularly treats diabetic eye disease. You will need to begin regular comprehensive eye exams at least annually as soon as you are diagnosed with type 2 diabetes.
If youve been diagnosed with type 1 diabetes, you have a little more time. Because type 1 symptoms develop sooner and are more acute , diagnosis usually occurs before diabetic retinopathy has begun to occur. For that reason, the recommendation for newly diagnosed type 1 diabetics is to begin regular comprehensive eye exams within five years. And of course you should also contact your doctor at the onset of any new or changing symptoms as well.
Diabetes Statistics: Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020.
Diabetes Management:Diabetes Care. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview.
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What Does A Diabetic Eye Exam Include
Diabetic eye exams can vary in length and scope, depending on what your eye doctor feels is necessary to successfully manage your condition.
For example, if you have just been diagnosed with diabetes and youve recently had a comprehensive eye exam that showed no signs of diabetic retinopathy, your follow-up diabetic eye exam may require your doctor to simply recheck the condition of your retina.
But if youve had diabetes for a number of years and your doctor has already detected signs of retinopathy or other eye problems related to your disease, your diabetic eye exam may be more extensive and may even include some form of in-office treatment.
The following tests and procedures are commonly performed in most diabetic eye exams:
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Symptoms Of Diabetic Retinopathy
You won’t usually notice diabetic retinopathy in the early stages, as it doesn’t tend to have any obvious symptoms until it’s more advanced.
However, early signs of the condition can be picked up by taking photographs of the eyes during diabetic eye screening.
Contact your optician immediately if you experience:
- gradually worsening vision
- shapes floating in your field of vision
- blurred or patchy vision
- eye pain or redness
These symptoms don’t necessarily mean you have diabetic retinopathy, but it’s important to get them checked out. Don’t wait until your next screening appointment.
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How Can I Reduce My Blood Sugar For Diabetes Type 2 Without Drugs
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Favorite Orgs For Essential Info On Diabetic Retinopathy
This nonprofit offers a comprehensive guide to living with diabetes and vision loss in both English and Spanish. For those who have vision troubles, free audio lectures are available on the website where you can learn about diabetes basics, as well as healthy eating and self-care tips from a certified diabetes educator.
The ADA is considered the leading nonprofit for type 1 and type 2 diabetes education. We love how the organizations subsite focuses on ways you can take control of your eye care, including its resource to find an eye care professional to schedule your routine eye exam.
The AAO is the worlds largest association of eye physicians and surgeons, and is a major advocacy organization for people with vision problems. On the site, you can watch quick, informational animations on how diabetic retinopathy affects the eye, sign up for the free newsletter for ophthalmologist-reviewed tips on preserving eye health, and plug in your ZIP code to find an eye specialist near you.
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Testing And Diagnosing Diabetic Retinopathy
When you visit an ophthalmologist, they will question you about your medical history and vision and will ask you to read an eye chart. The doctor will then directly examine your retina using an instrument called an ophthalmoscope.
Some of the features of diabetic retinopathy cannot be seen during a basic eye exam and require special exams. To get a better look at the inside of the eye, your doctor might administer drops to dilate your pupils and will then view the retina with lenses and a special light called a slit lamp. A test called fluorescein angiography can reveal changes in the structure and function of the retinal blood vessels. For this test, the doctor injects a fluorescent yellow dye into one of your veins and then photographs your retina as the dye outlines the blood vessels.
The eye exam will likely also include a check for glaucoma and cataracts, both of which occur more frequently in people with diabetes and can cause vision problems.
Are There Any Ways To Prevent Diabetic Retinopathy
Long-term good blood glucose level management helps to prevent diabetes retinopathy and lower the risk of developing it. Heart disease risk factors also affect retinopathy risk and include stopping smoking, having regular blood pressure and cholesterol checks and undergoing regular eye check-ups.
The risk of developing diabetic retinopathy can be lessened through taking the following precautions:
- Test urine for ketone levels regularly
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Facing Diabetic Retinopathy Head
I learned I had diabetic retinopathy in 2004. Unfortunately, my diagnosis came a little too late, and I lost most of the vision in my right eye. Today, when I do advocacy work, I stress how important it is to stay up to date on your eye exams. It could save your sight, literally. Hereâs what I want others with diabetic retinopathy to know.
What Is Diabetic Retinopathy Again
Diabetic retinopathy, a leading cause of new cases of blindness in adults, affects almost one-third of people over age 40 with diabetes, according to the Centers for Disease Control and Prevention. Diabetic retinopathy occurs when the tiny blood vessels in the eye become damaged by the high sugar levels in the blood stream caused by uncontrolled diabetes. Those damaged vessels leak and bleed into the retina, the seeing layer of your eye . As diabetic retinopathy goes from mild to more seriousa gradual escalation that can take a decade or even twovision becomes increasingly impaired.
The number of people with diabetic retinopathy is expected to increase over the next decade along with rising cases of , a common chronic illness that impacts more than 10% of the U.S. population. People with , which is usually diagnosed in childhood or early adolescence, have an even greater risk of developing diabetic retinopathy simply because they live with the condition longer than those with adult-onset diabetes. In addition to duration of disease, other risk factors for diabetic retinopathy include:
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Having uncontrolled high blood-sugar levels
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Having untreated high blood pressure or
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Having diabetes-related kidney disease
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Diabetic Macular Edema Signs & Symptoms
Like retinopathy, diabetic macular edema is most easily detected during your annual eye exam. Issues with your vision, however, can be a sign of DME, but waiting until there are obvious symptoms will only reduce your chances of successfully treating it and preventing its progression. Regular eye exams are a must when it comes to stopping DME in its tracks.
Complications Of Diabetic Retinopathy
Diabetic retinopathy can lead to other complications within the eye:
Retinal detachment Proliferative diabetic retinopathy is a later stage of the condition where fragile new blood vessels are formed in the eyes. These can bleed easily, and scar tissue that accompanies it can cause the retina to become detached.Diabetic Maculopathy The central area of the retina is known as the macula, and its responsible for the type of vision we use to read or drive. Diabetic maculopathy is when the macula is damaged an example of macular damage is diabetic macular oedema, which involves fluid leaking into the macula and causing loss of vision.Rubeosis Iridis This is when blood vessels grow in the coloured part of the eye called the iris. It may cause a reddish colour to develop in the iris, but it can also lead to neovascular glaucoma, a severe form of glaucoma that can be very painful.
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When Should I Seek Care For Diabetic Retinopathy
If you have diabetes, itâs important to have an eye exam at least once per year. Pregnant women who have diabetes should schedule an eye exam during their first trimester.
Between eye appointments, call your healthcare provider if you notice:
- Black spots in your vision.
- Blurred vision.
- Flashes of light.
- Holes in your vision.
Anyone who has diabetes has a risk of developing diabetic retinopathy. This serious eye condition needs immediate treatment. Without intervention, it can lead to vision loss and even blindness. But timely treatment can prevent vision loss and stop disease progression. The best way to avoid the disease is by managing your diabetes and controlling your blood sugar. Schedule an appointment with a healthcare provider if you notice any new vision changes.
Last reviewed by a Cleveland Clinic medical professional on 03/22/2021.
References
Know Your Blood Sugar Blood Pressure And Cholesterol Levels
It can be easier to keep your blood sugar levels, blood pressure and cholesterol levels under control if you know what level they are and monitor them regularly.
The lower you can keep them, the lower your chances of developing retinopathy are. Your diabetes care team can let you know what your target levels should be.
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What Is Dry Eye Syndrome
Dry eye syndrome or dry eye disease or keratoconjunctivitis sicca can be found in over 50 percent of all patients with diabetes, explains Bevels, making it a common diabetes eye complication.
Many patients are asymptomatic, but still have the disease or the beginning process of the disease developing, says Bevels, whose clinic, Elite Dry Eye Spa, specializes in dry eye syndrome.
Chronic use of any topical eye medication can lead to a dry eye diagnosis, adds Bevels. This means that patients who require long-term medications for their eyes should be on the lookout for signs of dry eye syndrome, get a proper diagnosis, and follow-through with treatment quickly to prevent any further issues.
Get Your Eyes Screened
Eye screening is a way of spotting eye problems before you notice any changes to your sight.
Everyone whos over 12 years old and living with diabetes is entitled to an NHS diabetes eye screening once a year. Its one of your 15 Healthcare Essentials and a vital diabetes health check.
Diabetic retinopathy can become quite advanced before it starts affecting your sight, so that’s why it’s important to go to your regular eye screening appointments. That way, you can get the righttreatment in time.
Weve also got more information about what happens during an eye screening, so you can feel prepared going to your appointment.
Because of the coronavirus pandemic, some eye screening services have been paused. Read our latest update for more information on routine appointments.
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What Is The Retina And How Does It Function
The retina is a thin layer of tissue that lines the inside of the back of the eye.
The retina is supplied with oxygen and nourishment by blood vessels. Light enters through the front of the eye and focuses on the retina.
Simply speaking, the retina can be divided into two main areas: the macula: responsible for our sharp and detailed central vision, and the mid and peripheral retina: responsible for our peripheral vision and helps to detect movement.
The retina converts this light into electrical signals that eventually travel to the brain.
How Does Diabetes Develop
Researchers arent sure about the exact cause of type 1 diabetes. However, type 2 diabetes is much more well known. Insulin is a hormone that the body produces which allows the sugar in your blood to access the cells in your body. Sugar is necessary for your cells to create energy, and insulin resistance usually occurs after a specific cycle develops.
First, a person is, for whatever reason, unable to make enough insulin to cover all the glucose that they eat. The body tries to make extra insulin to make up for the shortfall. The pancreas is unable to keep up with the increased need for insulin, and excess sugar floats throughout the blood doing damage instead of being absorbed by cells to create energy.
Eventually, insulin becomes less effective at helping glucose enter the cells and blood sugar levels rise ever higher. This effect is known as insulin resistance, and in type 2 diabetes it takes place gradually. Due to the gradual nature of insulin resistance, doctors recommend certain lifestyle changes to either slow the advance of the disease or halt its progress altogether.
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Am I At Risk From Diabetic Retinopathy
Diabetic retinopathy risk factors include the following.
If any of the below affect you its worth having an retinopathy screening examination as quickly as possible.
- Poor blood glucose control
- Raised fats in the blood
Anyone suffering from diabetes faces the risk of developing diabetic retinopathy and other diabetes complications
The longer a person has diabetes, the greater the risk of developing diabetic retinopathy becomes. However, keeping blood glucose levels well controlled can help to significantly slow down the development of retinopathy.
People with diabetes should, however, be aware that a rapid improvement in blood glucose levels can lead to a worsening of retinopathy. A rapid improvement in blood glucose levels in this case is defined as a drop in HbA1c of 30 mmol/mol or 3%.
Retinopathy occurs when blood vessels in the back of the eye, the retina, become damaged. When the blood vessels become damaged they can leak and these leaks can cause dark spots on our vision.
The main causes of retinopathy tend to be sustained high blood glucose levels and high blood pressure as well. Retinopathy can progress over years or decades depending on how good your blood glucose control is.
The good news is that because it takes a long time to develop, it can be spotted before it becomes too serious.
Its important therefore that you attend your retinopathy screening each year.
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