Diabetes is one of the most common chronic health conditions in the United States, affecting over 37 million Americans. Among other complications, diabetes is the leading cause of vision loss in the U.S. There are many eye conditions that patients with diabetes are at risk for, including a disease known as diabetic retinopathy.
Diabetic retinopathy is a retinal condition that can affect patients who have type 1 or type 2 diabetes. It occurs when the blood vessels of the retinal vascular system become damaged due to elevated levels of glucose (sugar) in the bloodstream. Too much sugar in the blood causes cellular degradation of blood vessels, leading to decreased elasticity of the vascular tissues and narrowing of the vessels.
When the retinal blood vessels weaken, it can cause leakage of fluid and blood to seep into the retina. In more severe cases, this can lead to the formation of scar tissue and trigger a process known as neovascularization, which is when the retina grows new blood vessels. Unfortunately, these new blood vessels are abnormal and exceedingly delicate, making them susceptible to breaking, leaking, and bleeding. Eventually, this can cause a permanent loss of vision.
Because diabetes has become an increasingly prevalent health issue in the US, cases of diabetic retinopathy are also on the rise. Diabetic retinopathy is one of the most common causes of blindness in adults with Type 1 or Type 2 diabetes. However, if detected early on and managed properly, patients with diabetic retinopathy have a good chance of preserving their vision.
Out of all the patients with diabetes, it’s estimated that one in five of them don’t realize that they have it.
The Stages of Diabetic Retinopathy
Diabetic retinopathy is a progressive condition, which means that it can worsen over time and get worse in stages. The earliest stage of diabetic retinopathy is known as background diabetic retinopathy. It is also sometimes referred to as non-proliferative diabetic retinopathy. The more advanced, severe stage of diabetic retinopathy is called proliferative diabetic retinopathy.
In background diabetic retinopathy, it’s common for patients to not realize that anything is wrong at all. Symptoms may be barely noticeable or even completely absent. At this stage of the condition, leaking and bleeding into the retina has only just begun, so visual disruptions are minimal. As the disease progresses, fluid builds up, which causes the retina to swell. Known as diabetic macular edema, retinal swelling can make vision appear blurry, dull, or distorted.
Proliferative Diabetic Retinopathy
Proliferative diabetic retinopathy is the stage in which neovascularization will occur. Because the blood vessels are damaged, the retina is unable to get the constant cycle of oxygenated blood that it relies on to function properly. In an attempt to correct this and restore blood and oxygen flow, the retina begins to form new blood vessels. However, unlike regular blood vessels, the new blood vessels are malformed, break easily, and can bleed into the retina (also known as a vitreous hemorrhage). There may also be a buildup of scar tissue. In some cases, the scar tissue may adhere to the retina and pull it off the back wall of the eye, resulting in a retinal detachment.
Diabetic Retinopathy Diagnosis
Like many diseases, diabetic retinopathy is easier to treat when detected and diagnosed during the earlier stages. However, the problem is that many patients with diabetic retinopathy don’t experience any symptoms at the beginning and aren’t aware that they have the condition. In many cases, the earliest stages of diabetic retinopathy can only be detected through an eye exam. If a patient knows that they have diabetes, they are strongly advised to schedule an annual diabetic eye exam with an ophthalmologist. By attending regular eye exams, the more likely a patient is to maintain their vision health.
Treatment for Diabetic Retinopathy
There are several different ways that diabetic retinopathy can be treated, depending on the condition’s progression and the amount of damage that has been incurred. Because diabetic retinopathy is much easier to treat and manage when caught at the earliest stages, preventative care is a strong focus that is recommended for diabetic patients. This includes managing blood sugar levels, eating a healthy diet, exercising regularly, and not smoking.
Eye Injections (Eylea, Avastin, and Lucentis)
For cases of proliferative diabetic retinopathy with neovascularization, the standard of care is a class of drugs known as anti-vascular endothelial growth factor (anti-VEGF) medications. Known by the brand names Eylea, Avastin, and Lucentis, these medications are injected directly into the vitreous jelly contained within the eye. They work by blocking the proteins responsible for new blood vessel growth, thereby curbing the neovascularization process. The procedure is performed in-office by a retina specialist using a very tiny needle and topical anesthetic. Although eye injections sound scary, most patients feel very minimal discomfort.
To stop blood vessels from leaking fluid, retina specialists will sometimes perform a surgical procedure known as laser photocoagulation. In this procedure, a laser is used to create a tiny targeted area of scar tissue to seal the problematic blood cells, reduce swelling, inhibit the growth of new blood vessels, or correct damaged retinal tissues.
A vitrectomy is a surgical procedure in which the vitreous gel is removed from the eye. This is usually done in cases where something in the vitreous is obstructing the retina specialist's ability to see or treat the retina. For patients with diabetic retinopathy, this type of procedure is typically only performed to correct complications that occur at the most advanced stages of proliferative diabetic retinopathy or in cases where treatments such as eye injections and laser photocoagulation have been unsuccessful.
For advanced care for diabetic retinopathy in Central California, contact California Retina Consultants today.