Diabetic Retinopathy

Proliferative & Non-Proliferative Diabetic Retinopathy

Diabetic retinopathy is a condition where high blood sugars damage the blood vessels in the retina (the retina is the layer of cells in the back of the eye that transmit light to the brain to form images).  There are two main types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

• Non-Proliferative Diabetic Retinopathy: Among the first signs of diabetic retinopathy are microaneurysms, which are small red “blood dots” or hemorrhages that indicate pouches in the retinal capillaries and arteries (small blood vessels). These pouches leak serum or fluid from the bloodstream into the retina called exudates, which may cause it to swell. This swelling of the retina is known as macular edema. As retinopathy progresses, white spots in the retina, known as cotton-wool spots, may also develop which suggests lack of oxygen or blood flow. The swelling of the macula (diabetic macular edema) is the most common reason a patient with Diabetes will notice blurred central vision. Vision loss can range from mild to severe because of diabetic macular edema (DME).
• Proliferative Diabetic Retinopathy-In some patients, diabetic retinopathy may progress from non-proliferative to proliferative. Proliferative diabetic retinopathy is characterized by neovascularization (neo = “new” and vascularization = “blood vessels”). That is, the appearance of new, fragile blood vessels on the optic nerve or retina’s surface. These new blood vessels frequently bleed into the vitreous cavity, causing hemorrhage. Furthermore, they may cause scarring on the retina, which can pull the retina, causing tractional retinal detachment. These new blood vessels are like “weeds in the garden” and may even grow in the front of the eye on the iris, causing a severe type of glaucoma to develop.

What are the warning symptoms of diabetic retinopathy? 

Often those diagnosed with diabetic retinopathy have normal vision, particularly when there is no diabetic macular edema, vitreous hemorrhage or tractional retinal detachment. This is precisely why regular eye examinations are important and can yield the most effective treatment because early detection is extremely vital.

When patients do exhibit symptoms, they often begin with blurred vision. Patients may also begin to see floaters, which may be signs of a vitreous hemorrhage.

What are the causes of  diabetic retinopathy?

Generally, diabetic retinopathy is caused by damage to the retinal blood vessels as a result of elevated sugar (glucose) levels in the bloodstream. Chronic elevated glucose levels may damage normal retinal blood vessels, causing them to leak fluid or create small hemorrhages in the retina. In more advanced stages, the retinal blood vessels can become blocked, restricting the retina’s oxygen levels. As a reaction to this, the retina grows new blood vessels or neovascularization.

What is the treatment for diabetic retinopathy?

The first measure of treatment in diabetic retinopathy is to control blood glucose levels. This will not prevent or reverse diabetic retinopathy, but tends to slow its progress. Doctors can use laser photocoagulation to treat macular edema, placing small burns around the retina’s center, known as the macula. Alternately, doctors may inject drugs such as ranibizumab (Lucentis), bevacizumab (Avastin), aflibercept (Eylea) or steroids into the eye, in a treatment known as an intravitreal injection.  Similar to the pills or Insulin that is necessary to manage one’s diabetes, these injections may be necessary to manage the complications of the disease for years to come.

Doctors and patients can determine the most suitable treatment methods based on the patient’s severity and the macular edema’s precise location. Often, intravitreal injections must be repeated in order to control the macular edema. Proliferative diabetic retinopathy is generally treated with laser photocoagulation, where laser burns are placed in the peripheral retina, but can also be augmented with intravitreal injections. This treatment creates a lower oxygen demand for the retina, either reducing or totally resolving retinal and optic nerve neovascularization. Both forms of treatment can be performed in an office setting.

In cases of vitreous hemorrhages or traction retinal detachment, a patient may require a surgical procedure known as vitrectomy. Unlike intravitreal injections or laser photocoagulation, vitrectomy is performed in an operating room.

In treating diabetic retinopathy, early detection is imperative. Treatment is much easier and less invasive in the earlier stages and timely treatment of diabetic retinopathy is the best way to guard against progressive vision loss.  Although keeping one’s blood sugars under control does not guarantee good vision, it can reduce the risk of blindness compared to those patients who don’t control their blood sugars.

Contact Our Retina Doctors Today

If you have diabetes, it’s important to have your pupils dilated by an eye care professional and if diabetic retinopathy is diagnosed, seeing a retina specialist can be important in the prevention of further vision loss. Contact the Retina Associates of Orange County to schedule your appointment today.