Diabetic Retinopathy
Protecting the Eye Health of Diabetic Patients
What Is Diabetic Retinopathy?
Diabetic retinopathy is the most common ophthalmic complication of diabetes, caused by elevated blood sugar damaging the microvasculature of the retina. The risk increases with the duration of diabetes, and it occurs in approximately 60% or more of patients who have had diabetes for over 20 years.
In the early stages, there are almost no noticeable symptoms, so regular fundus examinations are essential for all diabetic patients, even in the absence of symptoms. Early detection and appropriate treatment can significantly reduce vision loss.
Stages of Diabetic Retinopathy
Mild Non-Proliferative (Mild NPDR)
Small balloon-like microaneurysms begin to appear in the retinal microvasculature. Vision is usually unaffected and regular monitoring is required.
Moderate Non-Proliferative (Moderate NPDR)
Intraretinal hemorrhages, hard exudates, and cotton-wool spots appear, and some vessels begin to occlude. Macular edema may also be present.
Severe Non-Proliferative (Severe NPDR)
Multiple vessel occlusions occur and retinal ischemia progresses. Approximately 50% or more may progress to the proliferative stage within one year, requiring aggressive treatment.
In response to retinal ischemia, abnormal new blood vessels grow, and these fragile vessels bleed easily. Serious complications such as vitreous hemorrhage and tractional retinal detachment can occur, and blindness may result without treatment.
- !Vitreous hemorrhage: intraocular bleeding from ruptured new blood vessels
- !Tractional retinal detachment: fibrovascular membranes pulling on the retina
- !Neovascular glaucoma: new blood vessels growing on the iris causing elevated intraocular pressure
Can occur at any stage of diabetic retinopathy. Fluid leaks from damaged blood vessels, causing swelling in the macula. It is the most common cause of vision loss in diabetic retinopathy patients and can be effectively treated with anti-VEGF injections.
Risk Factors and Symptoms
Risk Factors
- Duration of diabetes (high risk after 10+ years)
- Poor blood sugar control (elevated HbA1c)
- Concurrent hypertension
- Hyperlipidemia
- Pregnancy (gestational diabetes)
- Smoking
- Concurrent kidney disease
Key Symptoms
- Decreased or fluctuating vision
- Floating spots or lines in vision (floaters)
- Blurred or hazy vision
- Decreased night vision
- Changes in color perception
- Dark areas in the visual field
- Often asymptomatic in the early stages
Treatment Options
Laser Photocoagulation
Laser is applied to ischemic areas of the retina to reduce oxygen demand and inhibit new blood vessel growth. Panretinal photocoagulation (PRP) is the standard treatment for proliferative diabetic retinopathy. Focal laser is used for microvascular abnormalities near the macula.
Intravitreal Anti-VEGF Injection
The primary treatment for diabetic macular edema (DME), it suppresses vascular endothelial growth factor (VEGF) to reduce swelling and improve vision. Medications such as Lucentis and Eylea are injected into the vitreous cavity and require regular administration.
Vitrectomy
Performed when vitreous hemorrhage persists or tractional retinal detachment develops. The clouded vitreous is removed and fibrovascular membranes on the retina are excised to stabilize the retina. Success rates have improved significantly with the latest microsurgical techniques.
Regular Eye Examinations for Diabetic Patients
If you have diabetes, regular eye check-ups are essential!
Thorough blood sugar management (maintaining HbA1c below 7%), controlling blood pressure and cholesterol, and regular eye examinations are the most important steps in preventing and slowing the progression of diabetic retinopathy.