Diabetic Retinopathy
Author: Abdhish R Bhavsar, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetes mellitus (DM) is a major medical problem throughout the world. Diabetes causes an array of long-term systemic complications that have considerable impact on the patient as well as society, as the disease typically affects individuals in their most productive years. [ 1 ] An increasing prevalence of diabetes is occurring throughout the world. [ 2 ] In addition, this increase appears to be greater in developing countries. The etiology of this increase involves changes in diet, with higher fat intake, sedentary lifestyle changes, and decreased physical activity. [ 3 , 4 ] Patients with diabetes often develop ophthalmic complications, such as corneal abnormalities, glaucoma, iris neovascularization, cataracts, and neuropathies. The most common and potentially most blinding of these complications, however, is diabetic retinopathy, [ 5 , 6 , 7 ] which is, in fact, the leading cause of new blindness in persons aged 25-74 years in the United States. Approximately 700,000 persons in the United States have proliferative diabetic retinopathy, with an annual incidence of 65,000. An estimate of the prevalence of diabetic retinopathy in the United States showed a high prevalence of 28.5% among those with diabetes aged 40 years or older. [ 8 ] (See Epidemiology.) The exact mechanism by which diabetes causes retinopathy remains unclear, but several theories have been postulated to explain the typical course and history of the disease. [ 9 , 10 ] See the image below. Fundus photograph of early background diabetic retinopathy showing multiple microaneurysms. Federman JL, Gouras P, Schubert H, et al. Systemic diseases. Podos SM, Yanoff M, eds. Retina and Vitreous: Textbook of Ophthalmology. 1994. Continue reading >>
Diabetic Retinopathy
Introduction Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause blindness if left undiagnosed and untreated. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight. To minimise the risk of this happening, people with diabetes should: ensure they control their blood sugar levels, blood pressure and cholesterol attend diabetic eye screening appointments – annual screening is offered to all people with diabetes aged 12 and over to pick up and treat any problems early on This page covers: Am I at risk of diabetic retinopathy? How diabetes can affect the eyes The retina is the light-sensitive layer of cells at the back of the eye that converts light into electrical signals. The signals are sent to the brain and the brain turns them into the images you see. The retina needs a constant supply of blood, which it receives through a network of tiny blood vessels. Over time, a persistently high blood sugar level can damage these blood vessels in three main stages: tiny bulges develop in the blood vessels, which may bleed slightly but don’t usually affect your vision – this is known as background retinopathy more severe and widespread changes affect the blood vessels, including more significant bleeding into the eye – this is known as pre-proliferative retinopathy scar tissue and new blood vessels, which are weak and bleed easily, develop on the retina – this is known as proliferative retinopathy and it can result in some loss of vision However, if a problem with your eyes is picked up early, lifestyle changes and/or treatment can stop it getting worse. Read about the stages of diabetic retinopathy Am I at risk of diabetic re Continue reading >>
What Is Diabetic Retinopathy?
A degenerative eye disease that occurs in people with diabetes, diabetic retinopathy can lead to severe vision loss or blindness if left untreated. Unfortunately, diabetic retinopathy remains incurable. However, it is treatable and preventable. In order to detect and prevent diabetic retinopathy, it is important that diabetes patients understand the causes of the disease, as well as any additional risks to the health of their eyes. For people with diabetes, high blood sugar is a serious health problem. Because diabetics are unable to adequately absorb and process sugar, too much blood sugar can lead to kidney, heart, nerve, and eye damage. Diabetic retinopathy occurs when the tiny blood vessels, known as capillaries, within the retina are damaged. In patients with non-proliferative diabetic retinopathy (NPDR), the walls of the capillaries weaken and develop microaneurysms, or tiny bulges protruding from the blood vessels. Eventually these microaneurysms begin to leak blood and fluid into the retina, causing vision loss. In patients with proliferative diabetic retinopathy (PDR), not only are there progressively more microaneurysms, but new, abnormal capillaries begin to develop within the retina. As these blood vessels spread throughout the retina, they often begin to grow into the jelly-like substance (vitreous) that fills the center of the eye. Ultimately, this abnormal growth causes the capillaries to shut down, leading to vision loss and, in some cases, retinal detachment. Diabetic Retinopathy Risk Factors Patients with type I and type II diabetes are at a high risk of developing diabetic retinopathy. How much the disease progresses and spreads is in almost direct correlation to how long the patient has had diabetes and how long they have gone without consistent eye Continue reading >>
What Is Diabetic Retinopathy?
If you have diabetes (type 1 or type 2), you could get diabetic retinopathy, a condition that affects your eyes. But your chances of getting it depend on several things: How long you’ve had it How often your blood glucose changes How well controlled your sugars are At first, you may not even know you have diabetic retinopathy. Or, you might just notice minor vision problems. Either way, there are things you can do to prevent it. And there are treatments to help slow it down. You might not have any until your condition becomes severe. When you do start having symptoms, you might notice: A loss of central vision when you read or drive Inability to see colors Holes or black spots in vision See your doctor right away if you have any of these issues. When left untreated, diabetic retinopathy damages your retina. This is the lining at the back of your eye that transforms light into images. If your blood glucose level (blood sugar) is too high for too long, it blocks off the small blood vessels that keep the retina healthy. Your eye will try to grow new blood vessels, but they won’t develop well. They start to weaken and leak blood and fluid into your retina. This can cause another condition doctors call macular edema, which makes your vision blurry. As your condition gets worse, more blood vessels become blocked. Scar tissue builds up because of all the new blood vessels your eye has grown. This extra pressure can cause your retina to detach. It can also lead to glaucoma and other problems that may result in blindness. An eye doctor can usually tell if you have diabetic retinopathy during an eye exam. He’ll probably dilate your pupils to look for any changes in blood vessels or to see if new ones have grown. He’ll also check to see if your retina is swollen or has bec Continue reading >>
Diabetic Retinopathy
Diabetic RetinaScreen is a new, government-funded screening programme, offering free, regular diabetic retinopathy screening to people with diabetes aged 12 and over. Diabetic retinopathy is a common complication of diabetes which affects the small blood vessels in the lining at the back of the eye. This lining is called the retina. The retina helps to change what you see into messages that travel along the sight nerve to the brain. A healthy retina is necessary for good eyesight. Diabetic retinopathy can cause the blood vessels in the retina to leak or become blocked and damage your sight. In the early stages, diabetic retinopathy will not affect the sight, but if the changes get worse, eventually the sight will be affected. The categories of retinopathy are: Background retinopathy Background retinopathy occurs in the early stages and damage is limited to tiny bulges (microaneurysms) in the blood vessel walls. Although these can leak blood and fluid they do not usually affect vision. Pre-proliferative diabetic retinopathy is detected This is where there are changes detected in the retina that do not require treatment but need to be monitored closely as there is a risk that they may progress and affect the eyesight. A referral will be made to an Ophthalmology Clinic. It is important that you attend this appointment. Proliferative diabetic retinopathy Proliferative diabetic retinopathy occurs where fragile new blood vessels form on the surface of the retina over time. These abnormal vessels can bleed or develop scar tissue causing severe loss of sight. Diabetic macular oedema Diabetic macular oedema occurs where leaky blood vessels affect the part of the retina called the macula. If fluid leaks from these vessels and affects the centre of the macula, the sight will be af Continue reading >>
Diabetic Retinopathy
Diabetic retinopathy is a condition that occurs in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Diabetic retinopathy is a serious sight-threatening complication of diabetes. Diabetes interferes with the body's ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes. Over time, diabetes damages the blood vessels in the retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. This causes the retinal tissue to swell, resulting in cloudy or blurred vision. The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness. Symptoms of diabetic retinopathy include: Seeing spots or floaters Blurred vision Having a dark or empty spot in the center of your vision Difficulty seeing well at night When people with diabetes experience long periods of high blood sugar, fluid can accumulate in the lens inside the eye that controls focusing. This changes the curvature of the lens, leading to blurred vision. However, once blood sugar levels are controlled, blurred distance vision will improve. Patients with diabetes who can better control their blood sugar levels will slow the onset and progression of diabetic retinopathy. Often the early stages of diabetic retinopathy have no visual symptoms. That is why the American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy. T Continue reading >>
Stages
Diabetic retinopathy develops in stages over time. If you're diagnosed with diabetic retinopathy after diabetic eye screening, lifestyle changes and/or treatment can reduce the chances of the problem progressing. The main stages of diabetic retinopathy are described below. You won’t necessarily experience all of these. Stage one: background retinopathy This means that tiny bulges (microaneurysms) have appeared in the blood vessels in the back of your eyes (retina), which may leak small amounts of blood. This is very common in people with diabetes. At this stage: your sight isn't affected, although you're at a higher risk of developing vision problems in the future you don't need treatment, but you'll need to take care to prevent the problem getting worse – read more about preventing diabetic retinopathy the chances of it progressing to the stages below within three years is over 25% if both of your eyes are affected Stage two: pre-proliferative retinopathy This means that more severe and widespread changes are seen in the retina, including bleeding into the retina. At this stage: there's a high risk that your vision could eventually be affected you'll usually be advised to have more frequent screening appointments every three or six months to monitor your eyes Stage three: proliferative retinopathy This means that new blood vessels and scar tissue have formed on your retina, which can cause significant bleeding and lead to retinal detachment (where the retina pulls away from the back of the eye). At this stage: there's a very high risk you could lose your vision treatment will be offered to stabilise your vision as much as possible, although it won't be possible to restore any vision you've lost Diabetic maculopathy In some cases, the blood vessels in the part of th Continue reading >>
Diabetic Retinopathy: Know The Signs, Symptoms And Treatments
A disease that steals a person’s eyesight is one of the many potential complications of diabetes. Learn why eye care is crucial. Left unchecked, diabetes can affect almost every part of the body — from skin and bone to the heart, liver and nerves. A common and vulnerable target: the eyes. MORE FROM MICHIGAN: Sign up for our weekly newsletter About 30 to 40 percent of patients with diabetes in the United States experience diabetic retinopathy, which occurs when high blood sugar damages the tiny blood vessels of the retina. The severity is tied to the duration and management of a patient’s diabetes. Over time, advanced cases can lead to poor vision or even blindness. That’s why preventive self-care and regular eye exams are important, says Thomas Gardner, M.D., a professor of ophthalmology at the University of Michigan Kellogg Eye Center. “Like most other diseases, success lies in early diagnosis and treatment,” says Gardner. “The prognosis for retaining good vision for people who keep their diabetes well controlled is much, much better than it used to be." Why diabetic retinopathy is dangerous Many people aren’t aware they have diabetic retinopathy until it has moved from early stages (nonproliferative retinopathy) to a point when leaking blood vessels break open and cause scar tissue that can pull on the retina (proliferative retinopathy). A delayed or lack of treatment “can make it very difficult to maintain vision,” Gardner says. Diabetic retinopathy symptoms The condition is often asymptomatic, especially in early cases. But as it progresses, effects are pronounced — including a lessened (or lost) ability to read or drive. Gardner says patients also may start “seeing blood floating around in their eyes” in the form of tiny black or red dots. Continue reading >>
Diabetic Retinopathy
On this page: Diabetes and diabetic retinopathy • DR symptoms • Types of diabetic eye disease • Who gets diabetic retinopathy? • Minorities and diabetic eye disease • When is DR a disability? • Eye exam assistance program • Prevention • Diabetic retinopathy videos Diabetic retinopathy — vision-threatening damage to the retina of the eye caused by diabetes — is the leading cause of blindness among working-age Americans. The good news: Diabetic retinopathy often can be prevented with early detection, proper management of your diabetes and routine eye exams performed by your optometrist or ophthalmologist. According to the International Diabetes Federation (IDF), the United States has the highest rate of diabetes among 38 developed nations, with approximately 30 million Americans — roughly 11 percent of the U.S. population between the ages of 20 and 79 — having the disease. About 90 percent of Americans with diabetes have type 2 diabetes, which develops when the the body fails to produce enough insulin — a hormone secreted by the pancreas that enables dietary sugar to enter the cells of the body — or the body becomes resistant to insulin. This causes glucose (sugar) levels in the bloodstream to rise and can eventually damage the eyes, kidneys, nerves or heart, according to the American Diabetes Association (ADA). Risk factors for type 2 diabetes include obesity, an unhealthful diet and physical inactivity. Unfortunately, the prevalence of obesity and type 2 diabetes has increased significantly in the United States over the past 30 years. According to data released by the U.S. Centers for Disease Control and Prevention (CDC) in December 2015, there were 1.4 million new cases of diabetes reported in the U.S. in 2014. Though this annual number is d Continue reading >>
Diabetic Retinopathy
Tweet Diabetic retinopathy is the most common form of diabetic eye disease. Diabetic retinopathy usually only affects people who have had diabetes (diagnosed or undiagnosed) for a significant number of years. Retinopathy can affect all diabetics and becomes particularly dangerous, increasing the risk of blindness, if it is left untreated. The risk of developing diabetic retinopathy is known to increase with age as well with less well controlled blood sugar and blood pressure level. According to the NHS, 1,280 new cases of blindness caused by diabetic retinopathy are reported each year in England alone, while a further 4,200 people in the country are thought to be at risk of retinopathy-related vision loss. All people with diabetes should have a dilated eye examination at least once every year to check for diabetic retinopathy. What is diabetic retinopathy? Diabetic retinopathy occurs when changes in blood glucose levels cause changes in retinal blood vessels. In some cases, these vessels will swell up (macular oedema) and leak fluid into the rear of the eye. In other cases, abnormal blood vessels will grow on the surface of the retina. Unless treated, diabetic retinopathy can gradually become more serious and progress from ‘background retinopathy’ to seriously affecting vision and can lead to blindness. Diabetic retinopathy includes 3 different types: What are the symptoms of diabetic retinopathy? Like many conditions of this nature, the early stages of diabetic retinopathy may occur without symptoms and without pain. An actual influence on the vision will not occur until the disease advances. Macular oedema can result from maculopathy and affect vision occurs if leaking fluid causes the macular to swell. New vessels on the retina can prompt bleeding, which can also Continue reading >>
What Are The Stages Of Diabetic Retinopathy?
The early stage of this disease is called nonproliferative diabetic retinopathy. In this stage blood vessels swell and sometimes bulge or balloon (aneurysm). The vessels may leak fluid that can build up in the retina and cause swelling. This condition is called macular edema, and it changes the vision of individuals with the disease. The blurriness is sometimes compared to trying to look through water. Description: In nonproliferative retinopathy, a slight deterioration in the small blood vessels of the retina, portions of the vessels may swell and leak fluid into the surrounding retinal tissue. Credit: National Eye Institute, National Institutes of Health The fluid deposits that build up in the retina may clear up on their own, but fatty deposits sometimes remain that can affect vision. Later, vessels may begin to bleed inside the retina. In many cases when the small blood vessels close down, new, unhealthy blood vessels grow. These unhealthy blood vessels are not able to feed the retina. This stage of the disease is known as proliferative diabetic retinopathy. Description: Proliferative retinopathy, an advanced form of diabetic retinopathy, occurs when abnormal new blood vessels and scar tissue form on the surface of the retina. Credit: National Eye Institute, National Institutes of Health The unwanted blood vessels can grow on the back of the vitreous. Vitreous is the clear jelly-like fluid that fills most of the eyeball. vessels may also bleed into the vitreous. This bleeding may cause dark spots (floaters), strands that look like cobwebs, or clouded vision. Scars from these abnormal blood vessels sometimes pull the retina away from the back of the eye. As a result, the retina can tear or come completely loose from the eye. A detached or torn retina may result in se Continue reading >>
Diabetic Retinopathy
What is diabetic retinopathy? Diabetic retinopathy is an eye condition that affects the retinas of people with diabetes. It is caused by changes in the blood vessels of the eye and occurs as a result of high blood sugar (glucose) that people with diabetes have over a long period of time. The retina is a light-sensitive nerve tissue at the back of the eye. The retina converts the light rays that enter the eye into electrical impulses that travel along the optic nerve to the brain. Too much blood glucose can destroy the blood vessels in the back of the eye, preventing the retina from receiving the proper amount of nutrients it needs to maintain vision. Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. In the early stages of the disease (nonproliferative retinopathy), these blood vessels leak fluid and distort sight. In the more advanced stage (proliferative retinopathy), fragile new blood vessels grow around the retina and in the vitreous humor (a clear substance inside the eye). If these blood vessels are not treated, they may bleed and blur vision, or may scar and detach (disconnect) the retina. Anyone with diabetes (Type 1 or Type 2) is at risk of developing diabetic retinopathy. The factors that affect risk include: The type of diabetes a person has (Type 1 or 2); How well-controlled the blood glucose is; and, How long a person has had diabetes. What are the symptoms of diabetic retinopathy? Usually, there are no symptoms of early diabetic retinopathy, and the person’s sight may not be affected until the condition is severe. Symptoms of diabetic retinopathy include: The loss of central vision, for example, when reading or driving; Loss of the ability to see color; Blurred or distorted vision; Small spots (floaters). Because reti Continue reading >>
Diabetic Retinopathy
Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes and is a leading cause of blindness.[1] It affects up to 80 percent of people who have had diabetes for 20 years or more.[2] At least 90% of new cases could be reduced if there were proper treatment and monitoring of the eyes.[3] The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy.[4] Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness for people aged 20 to 64 years.[5] Signs and symptoms[edit] Normal vision The same view with diabetic retinopathy. Emptied retinal venules due to arterial branch occlusion in diabetic retinopathy (fluorescein angiography) Diabetic retinopathy often has no early warning signs. Even macular edema, which can cause rapid vision loss, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day. In the first stage which is called non-proliferative diabetic retinopathy (NPDR) there are no symptoms, the signs are not visible to the eye and patients will have 20/20 vision. The only way to detect NPDR is by fundus photography, in which microaneurysms (microscopic blood-filled bulges in the artery walls) can be seen. If there is reduced vision, fluorescein angiography can be done to see the back of the eye. Narrowing or blocked retinal blood vessels can be seen clearly and this is called retinal ischemia (lack of blood flow). Macular edema in which blood vessels leak their contents into the macular regi Continue reading >>
Diabetic Retinopathy
Diabetic retinopathy is caused by changes in the blood vessels of the retina. When these blood vessels are damaged, they may leak blood and grow fragile new vessels. When the nerve cells are damaged, vision is impaired. These changes can result in blurring of your vision, hemorrhage into your eye, or, if untreated, retinal detachment. Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in the United States. What Is Diabetic Retinopathy, Testing, and Treatments Watch these video animations to learn more about diabeticretinopathy, the affect that the diabetic retinopathy has on the eyes,and tests and treatments options for the condition. The symptoms described above may not necessarily mean that you have diabetic retinopathy. However, if you experience one or more of these symptoms, contact your ophthalmologist for a complete exam. It is also important to note that pregnancy and high blood pressure may aggravate diabetic retinopathy. People with untreated diabetes are 25 times more at risk for blindness than the general population. The longer a person has had diabetes, the higher the risk of developing diabetic retinopathy. Fortunately, with regular, proper eye care and treatment when necessary, the incidence of severe vision loss has been greatly reduced. If you have diabetes, your ophthalmologist can help to prevent serious vision problems. Diabetic retinopathy can cause vision loss in two ways: Macular Edema Macular edema is a condition where your retinal blood vessels develop tiny leaks. When this occurs, blood and fluid leak from the retinal blood vessels and fatty material (called exudate) is deposited in the retina. This causes swelling of the retina and is called diabetic macular edema. When this swelling occurs in the ce Continue reading >>
Diabetic Retinopathy
Practice Essentials Diabetes mellitus (DM) is a major medical problem throughout the world. Diabetes causes an array of long-term systemic complications that have considerable impact on the patient as well as society, as the disease typically affects individuals in their most productive years. [1] An increasing prevalence of diabetes is occurring throughout the world. [2] In addition, this increase appears to be greater in developing countries. The etiology of this increase involves changes in diet, with higher fat intake, sedentary lifestyle changes, and decreased physical activity. [3, 4] Patients with diabetes often develop ophthalmic complications, such as corneal abnormalities, glaucoma, iris neovascularization, cataracts, and neuropathies. The most common and potentially most blinding of these complications, however, is diabetic retinopathy, [5, 6, 7] which is, in fact, the leading cause of new blindness in persons aged 25-74 years in the United States. Approximately 700,000 persons in the United States have proliferative diabetic retinopathy, with an annual incidence of 65,000. An estimate of the prevalence of diabetic retinopathy in the United States showed a high prevalence of 28.5% among those with diabetes aged 40 years or older. [8] (See Epidemiology.) The exact mechanism by which diabetes causes retinopathy remains unclear, but several theories have been postulated to explain the typical course and history of the disease. [9, 10] See the image below. In the initial stages of diabetic retinopathy, patients are generally asymptomatic, but in more advanced stages of the disease patients may experience symptoms that include floaters, distortion, and/or blurred vision. Microaneurysms are the earliest clinical sign of diabetic retinopathy. (See Clinical Presentat Continue reading >>
