DIABETIC RETINOPATHY

Diabetic retinopathy is an eye condition related to diabetes, and it happens when the blood vessels in the eye are damaged by high blood glucose levels. If the condition is left undiagnosed and untreated it can lead to blindness, however this stage can take several years to reach.

SIGNS AND SYMPTOMS

As diabetic retinopathy does not present noticeable symptoms until the condition develops over time, early signs are usually picked up during a diabetic eye screening – this is when photographs of your eyes are taken to check for damage. However, you should alert your GP or diabetic carer if you experience any of the following:

Your vision becomes steadily worse.
You suddenly lose your vision.
You start seeing floaters (shapes floating in your eyes).
Your vision becomes blurred.
You feel pain in your eyes.
Your eyes become reddened.

These symptoms may not always indicate diabetic retinopathy, but as diabetics may be at extra risk of eye damage it’s important to get any symptoms looked at as soon as possible.

COMPLICATIONS OF DIABETIC RETINOPATHY

Diabetic retinopathy can lead to other complications within the eye:

Retinal detachment – Proliferative diabetic retinopathy is a later stage of the condition where fragile new blood vessels are formed in the eyes. These can bleed easily, and scar tissue that accompanies it can cause the retina to become detached.

Diabetic Maculopathy – The central area of the retina is known as the macula, and it is responsible for the type of vision we use to read or drive. Diabetic maculopathy is when the macula is damaged – an example of macular damage is diabetic macular oedema, which involves fluid leaking into the macula and causing loss of vision.

Rubeosis Iridis – This is when blood vessels grow in the coloured part of the eye called the iris. It may cause a reddish colour to develop in the iris, but it can also lead to neovascular glaucoma, a severe form of glaucoma that can be very painful.

WHAT CAUSES DIABETIC RETINOPATHY?

Diabetic retinopathy occurs as a complication of diabetes; as high levels of blood glucose can damage the blood vessels in the eye. The following factors can increase the risk of developing the condition:

If you have been diabetic for a long period of time
If your blood glucose levels are regularly high
If your blood pressure or cholesterol is high
If you are pregnant
If you have an Asian or Afro-Caribbean Background

HOW DO YOU TREAT DIABETIC RETINOPATHY?

Treatment is normally only offered if the retinopathy has reached the proliferative stage or if you present symptoms of diabetic maculopathy. If this is the case, the main options are laser treatment, eye injections, and eye surgery.

LASER TREATMENT

Laser treatment for diabetic retinopathy involves treating the new blood vessels that have formed in your eyes as a result of the retinopathy progressing. The lasers stabilise the weak blood vessels to prevent them from bleeding into the eye because otherwise, bleeding can lead to diabetic maculopathy.

During the laser surgery, a local anaesthetic is used to numb your eyes and you are given eye drops to enlarge your pupils. Your eyelids are then held open by contact lenses that allow the laser to focus on your retina.

You shouldn’t feel any pain as the procedure takes place, however, there may be a slight pricking sensation. The process usually takes between 20 and 40 minutes.

EYE INJECTIONS

If you develop diabetic maculopathy as a result of the retinopathy progressing, you may be given anti-VEGF injections. These are injected directly into your eyes to stop the formation of new blood vessels. The anti-VEGF injections are normally administered once a month, becoming less frequent as your vision stabilises. The treatment procedure involves:

Cleaning and covering the skin around your eyes.
Using small clips to hold your eyes open.
Numbing your eyes with a local anaesthetic.
Guiding a fine needle into your eyeball to administer the injection.

In some cases, steroids may be injected either in place of the anti-VEGF injections or if the injections do not work.

EYE SURGERY

If there has been significant bleeding in your eye, or there is scar tissue that increases the risk of retinal detachment, you may be offered an operation called vitreoretinal surgery to take away part of the vitreous humour in the eye.

A small incision is made in the eye before some of the vitreous humour is removed along with any scar tissue. A laser is then used to prevent your vision from getting worse.

You may need to wear a patch over the affected eye as it can become fatigued quickly due to activities such as reading or watching television. Your sight may also be blurry but this will steadily get better.