Diabetic retinopathy is an ocular manifestation of diabetes, a systemic disease, which affects up to 80 percent of all patients who have had diabetes for 10 years or more. The longer a person has diabetes, the higher his or her chances are of developing diabetic retinopathy.
Despite these intimidating statistics, research indicates that at least 90 percent of new cases could be reduced. Education on diabetic eye disease and retinopathy is especially important because it is often preventable or treatable. Unfortunately, this means it can go unnoticed in the early stages. As the disease progresses, permanent vision loss is a real possibility if the patient does not receive treatment.
There are multiple forms of diabetic retinopathy, and only your doctor can determine your particular form. With one form, blood vessels may swell and leak fluid. In another, abnormal new blood vessels grow on the surface of the retina.
Stages of Diabetic Retinopathy
In the early stages of diabetic retinopathy, many do not notice a change to their vision because there are little to no symptoms. If an eye doctor does not catch diabetic retinopathy early, one could sustain mild blurriness at near or far distances, as well as floaters. In severe cases, a sudden loss of vision may occur.
Unfortunately, diabetic retinopathy can result in permanent damage that cannot be reversed. However, if caught in time, prescribed treatments may slow development and prevent vision loss.
The diabetic care plan must include a complete history and examination consisting of the following:
The duration of diabetes, past glycemic control (A1c), medications, systemic history (obesity, renal disease, systemic HTN, serum lipid levels, pregnancy), and eye history. The physical exam entails visual acuity, intra-ocular pressure (IOP), gonioscopy (neovascularization of iris or elevated IOP), slit-lamp biomicroscopy, dilated fundus exam (DFE) with stereoscopic exam of posterior pole, exam of peripheral retina and vitreous with binocular indirect ophthalmoscope (BIO) or slit lamp biomicroscopy with contact lens. The diagnosis and treatment can vary and is based on the classification of both eyes to category and severity of diabetic retinopathy, with presence or absence of clinically significant macular edema (CSME). Control of blood glucose, blood pressure, and lipids is crucial.
Focal laser photocoagulation is considered as a first line treatment for diabetic retinopathy. Second line treatment can vary and may include: Intravitreal Anti-VEGF agents, intravitreal steroids as an adjunct, periocular steroids in case of severe CSME, sustained release steroid implants, Fenofibrate for treatment of CSME, Vitrectomy with membrane peeling surgery consideration for CSME without refractory to laser and pharmacotherapy, CSME and taut posterior hyaloid and/or macular pucker may benefit from ERM and ILM peeling.
Strict control of blood glucose, blood pressure, and lipids are essential in the prevention and management of CSME and diabetic retinopathy. Diabetics with diabetic retinopathy must have frequent follow-up examinations to evaluate visual acuity, systemic status, glycemic status, IOP, gonioscopy, stereo exam of posterior pole with dilated fundus, exam of peripheral retina and vitreous, DFE every 3-4 months for severe non- proliferative diabetic retinopathy (N PDR) and proliferative diabetic retinopathy (PDR).
Diabetics without diabetic retinopathy must have annual dilated eye exams.
Concerned about the onset of diabetic retinopathy? Please call us at 360-455-4425 to schedule a preventative eye examination today with Dr. Craig Rouse.
Learn more about this type of diabetic eye disease by watching our video.