Diabetic Retinopathy

Diabetes is the disease of the small blood vessels caused by uncontrolled high blood sugar levels. This causes the blood vessels in the retina (light sensitive layer at the back of your eyes which allows you see) to either leak blood or become blocked, this leads to the permanent damage of the blood vessels. If the blood vessels are damaged the retina cannot be supplied with blood the retina needs and retina will become impaired, hence you could lose your vision. Diabetic patients should be attending, eye tests, diabetic eye screenings and blood sugar monitoring appointments on a regular basis. Diabetic retinopathy can occur in patients that suffer from type 1 or type 2 diabetes.

There are different stages to diabetic retinopathy:

• Background diabetic retinopathy, whilst your vision will not be affected, the retina will show small leakages of blood.  Patients that are at this stage can develop further complications to their vision and retina health if they do not get control of their diabetes.

• Pre-proliferative diabetic retinopathy, the changes to retina are more severe, there are more prominent leakages of the blood on the retina. At this stage your vision may be affected and you are at a higher risk of further complications to the health of your eyes and vision.

• Proliferative diabetic retinopathy; your risk of losing your eyesight is very high, treatment will be offered but it will not regain the vision you have lost. At this stage controlling the affect diabetic retinopathy has on your eyes can be very difficult.

• Diabetic maculopathy is where there is a leakage of fluid or blockages of the blood vessels in the central part of your vision, the macula. The macula is where you see colour and fine detail. Damage in this area will have an effect on your central vision.

• Worsening of the vision

• Blurred vision

• Areas of your vision that are patchy or dark

• Floaters

• Sudden vision loss

• Fluctuations in your vision

• Loss of colour vision

‍

What the optician could see at the back of diabetic eyes (on the retina):

• Small dot or blot hemorrhages

• Microaneurysms (small bulges of the blood vessel)

• Flame shaped hemorrhages

• Hard exudates (small yellow lesions)

• Retinal oedema (fluid in the retina caused by blood leakage)

• Cotton wool spots (areas of the retina that have not received enough oxygen due blockage of blood vessels)

• Unusual new blood vessels (IRMA) between the small arteries and veins

• Fluid build up, hard exudates and ischaemia in your central vision (types of diabetic maculopathy)

• Growth of new blood vessels on your optic nerves or in your peripheral retina

• Large hemorrhages which have engorged the vitreous (jelly like structure in front of the retina)

• Retinal detachment arising from diabetic retinopathy complications

Diabetic retinopathy is caused by the damage of the blood vessels in the eyes by uncontrolled blood sugar levels.

Other factors that make it harder to control diabetes are

• Poor diet

• Not taking your diabetic medication

• Not attending your annual eye test

• Not attending your diabetic eye screenings

• Not attending your blood sugar monitoring appointment with your GP or diabetic nurse

• High blood pressure

• High cholesterol

• High intake of alcohol

• Sedentary lifestyle – get exercising

• Smoking

Firstly attend all your blood sugar monitoring and eye appointments. If you do not wish to go to the clinic for your diabetic retinal screening, this can be done privately with most independent opticians (chargeable) alongside your annual free NHS eye test.

Treatment varies according to the level of diabetic retinopathy present in your eyes.

Background diabetic retinopathy is normally monitored and we ask our patients to control their diet more strictly and monitor their blood sugar levels better. We will review you every 12 months.

Pre-proliferative diabetic retinopathy is normally reviewed & monitored every 3-6 months. Again you will be asked to manage your diet and blood sugar levels more strictly. You may need treatment at this stage by an ophthalmologist.

Proliferative diabetic retinopathy & diabetic maculopathy will need treatment and an Ophthalmologist would monitor & treat you closely. We advise strict control of your diet and blood sugar levels.

Diabetic retinopathy affecting or threatening your eyesight will be treated in the following ways:

Laser treatment; diabetes in the eye can lead to the formation of new blood vessels, they can grow quickly but are weak. Due to the weakness of new blood vessels they tend to leak blood. Laser treatment will help stop this. Laser treatment can also help if you have diabetic maculopathy. The treatment does not require an overnight stay.

Injections are used to treat the diabetes in the eyes; they are anti-VEGF injections and stop the formation of new blood vessels (which are prone to leaking) in diabetic retinopathy. The injection does enter the eyeball and is guided to the area of the retina that requires treatment.

Eye surgery, pars plana vitrectomy, is used to remove scar tissue and/or if you have had a large leakage of blood at the back of your eyes in the vitreous. Excessive scar tissue can cause a retinal detachment and this would need to be treated too.

‍

For more information on a private diabetic retinopathy screenings, please call us on 0208 524 2887