Diabetic Retinopathy

Bilat PDR
A patient of mine with bilateral proliferative diabetic retinopathy. Laser treatment scars can be seen in the right eye (pictured on the left). In the left eye, tractional retinal detachment has occurred (pictured on the right). Vision in the left eye is hand movements.

Diabetic retinopathy is a complication of diabetes that affects the eyes. It is caused by damage to the blood vessels in the retina, which is the light-sensitive tissue at the back of the eye.

Symptoms

  • No symptoms in the early stages (detected only on eye screening)
  • Blurred vision
  • Floaters
  • Blindness in end-stage disease

Types

  • Non-proliferative diabetic retinopathy
    • bleeding and leakage from blood vessels
    • can affect vision and cause blurred vision
  • Proliferative diabetic retinopathy
    • growth of new vessels in the eye (can cause bleeding into the eye and floaters)
    • growth of scar tissue in the eye (can cause retina detachment and blindness)
  • Macular edema
    • swelling of the retina at the most sensitive central area
    • can cause significant visual loss as this is the most important part of the retina
Bilat CSME
A patient of mine with bilateral clinically significant macular edema. The bright yellow spots are areas of retina swelling. Vision is affected; the patient’s vision is 6/12 in the right eye and 6/30 in the left eye

Diagnosis

  • Eye screening is important in patients with diabetes, as diabetic retinopathy has no symptoms in the early stages
  • In patients with no retinopathy, screening should be done annually
  • In patients with retinopathy, eye checks are required more often to monitor for disease progression and to start treatment if necessary
  • Photographs of the retina are useful to screen for the disease as well as to compare against photos in the future to monitor for changes
  • Ocular Coherence Tomography (OCT) testing may be required to measure thickness of the retina as the retina is thickened when swelling is present
  • Fundus Fluorescein Angiography (FFA) is useful to identify new vessel growth and areas of retina vessel leakage

Treatment

  • In the early stages of the disease, no treatment is required. The patient is closely monitored for progression to the later stages
  • In severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and clinically significant macular edema, treatment may be required
  • Treatment may consist of
    • laser treatment to the macular or retina
    • injections of anti-VEGF (vascular endothelial growth factor) into the eye
    • surgery to remove blood clots or repair retina detachment in the eye

Screening for diabetic retinopathy is extremely important in diabetic patients, to detect disease in its early stages before it progresses and causes visual loss.