What is diabetic retinopathy?

08 June 2024
What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes that affects the retina. The retina is a thin layer of tissue on the inner surface of the back of the eye that is responsible for converting light signals into nerve impulses that are then transmitted to the brain. In diabetic retinopathy, high blood sugar levels damage the small blood vessels of the retina, causing them to leak or become blocked, as well as to the formation of abnormal blood vessels.

There are two main forms of diabetic retinopathy: nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is an early stage of the disease and is characterized by microaneurysms and small hemorrhages. PDR, the more severe stage, is characterized by the growth of abnormal blood vessels that can cause serious complications, including retinal detachment.

Types of diabetic retinopathy

Nonproliferative diabetic retinopathy

Nonproliferative diabetic retinopathy (NPDR) is the initial stage of diabetic retinopathy and is characterized by changes in retinal microvessels. At this stage, the small blood vessels that feed the retina begin to suffer damage. As a result, microaneurysms are formed - tiny swellings of the vessel walls, which can lead to the flow of blood and fluid into the retina. This process causes swelling of the retina and can cause vision loss.

NPDR is also characterized by the appearance of solid exudates, which are formed as a result of the leakage of lipid and protein components of the blood plasma. Retinal hemorrhages and blurred vision may also occur. This stage can last for many years without significant symptoms, but it is important to diagnose and control the disease in time to prevent its progression.

Proliferative diabetic retinopathy

Proliferative diabetic retinopathy (PD) is a more severe stage of the disease and occurs when the blood vessels of the retina are so damaged that there is a need for neovascularization. The body tries to compensate for insufficient blood supply by creating new, but abnormal and fragile vessels. This process is called neovascularization.

The new vessels have a tendency to rupture, which can cause significant hemorrhages into the vitreous body of the eye, causing sudden vision loss. In addition, these abnormal vessels can form fibrous tissue that pulls on the retina, which can lead to retinal detachment. Retinal detachment is a serious complication that requires immediate surgical intervention.

AMD can also cause neovascular glaucoma, when newly formed blood vessels block the outflow of intraocular fluid, which leads to increased intraocular pressure and can damage the optic nerve.

Both types of diabetic retinopathy - NPDR and PDR - require regular monitoring and timely treatment to preserve vision and quality of life of patients. Early diagnosis and effective treatment can significantly reduce the risk of serious complications caused by this disease.

Causes and risk factors

The main reasons

Diabetic retinopathy develops as a result of a long-term increase in the level of glucose in the blood, which is characteristic of diabetes. High sugar levels damage small blood vessels, particularly those in the retina of the eye. This leads to a violation of their structure and function, in particular to leakage of fluid, hemorrhages and the formation of abnormal vessels.

The main cause of diabetic retinopathy is hyperglycemia, a condition in which the level of glucose in the blood is constantly higher than normal. This disrupts metabolic processes in the body and causes cell damage, in particular vascular endothelium. Another reason is the duration of diabetes: the longer a patient has diabetes, the higher the risk of developing retinopathy.

Risk factors

In addition to hyperglycemia, there are a number of factors that increase the risk of developing diabetic retinopathy. One of them is arterial hypertension, which additionally loads blood vessels, increasing their vulnerability to damage. A high level of cholesterol also has a negative effect on blood vessels, contributing to the formation of plaques and impaired blood supply.

Smoking is another important risk factor because nicotine and other toxic substances in tobacco smoke damage blood vessels and reduce oxygen levels in the blood, making diabetes worse. Obesity also increases the risk of developing retinopathy due to its effect on metabolic processes and increased sugar and cholesterol levels.

Pregnancy can affect the progression of diabetic retinopathy, especially in women who already have diabetes. During pregnancy, hormonal changes occur and blood volume increases, which can increase the risk of eye complications.

Additionally, genetic factors and heredity play a role in susceptibility to diabetes and its complications, including retinopathy. Lack of proper glucose control, irregular medical examinations, and neglecting the doctor's recommendations also increase the risk of developing this disease.

Symptoms of diabetic retinopathy

Early symptoms

In the early stages, diabetic retinopathy often occurs without any noticeable symptoms. This is one of the main reasons why the disease can go unnoticed for a long time. Patients may not experience any changes in vision, even if pathological processes have already begun in their eyes. Despite the absence of visible signs, the small blood vessels of the retina can be gradually damaged, which will eventually lead to more serious complications. That's why regular eye exams are critical for people with diabetes to detect early changes and start treatment in time.

Progressive symptoms

As diabetic retinopathy progresses, more noticeable symptoms begin to appear. One of the first signs is blurred vision, which can occur episodically or be permanent. Patients may notice floating spots or dark spots in the field of vision that appear due to small hemorrhages in the retina. Such spots can move with eye movement and sometimes disappear on their own, but their appearance indicates active damage to the retina.

Over time, if no measures are taken, vision can gradually deteriorate. Proliferative diabetic retinopathy, which is a more severe stage of the disease, can lead to serious complications. One such complication is retinal detachment, when abnormal newly formed blood vessels pull on the retina, causing it to separate from the back of the eye. This can cause sudden vision loss that requires immediate surgery.

Other progressive symptoms may include the sensation of blind spots in the central or peripheral vision, difficulty recognizing colors, and problems with night vision. Such symptoms can significantly affect quality of life, limiting the patient's ability to perform everyday tasks such as reading, driving, or working with small objects.

It is important to remember that diabetic retinopathy can have an asymptomatic beginning, but its progressive forms can lead to serious and irreversible changes in vision. Regular examinations by an ophthalmologist, control of blood sugar levels and timely treatment are key factors in preserving vision and preventing complications.


Examination methods

Diagnosing diabetic retinopathy begins with a comprehensive examination by an ophthalmologist. One of the main examination methods is a fundus examination, which allows the doctor to directly see the retina and its blood vessels. For this, the patient is instilled with special drops that dilate the pupils, which allows the doctor to examine the back of the eye in detail with the help of an ophthalmoscope.

Fluorescent angiography is another important diagnostic method. During this procedure, a fluorescent dye is injected into the patient's vein, after which a series of pictures of the retina is taken. This makes it possible to detect dye leakage from damaged vessels, determine the locations of newly formed vessels, and assess the degree of retinal damage.

Optical coherence tomography (OCT) is another advanced examination method that provides detailed images of the layers of the retina. This painless and non-invasive test can detect retinal swelling, the presence of fluid or other abnormalities in the early stages of the disease. OCT helps to evaluate the effectiveness of treatment and monitor the progression of retinopathy.

Early detection

Early detection of diabetic retinopathy is critical to preserving vision and preventing serious complications. In the early stages of the disease, there may be no symptoms, so regular eye exams are extremely important for all patients with diabetes. Annual examinations are recommended, and in some cases more often, depending on the doctor's recommendations.

Early detection allows early treatment and measures to control blood sugar, blood pressure and cholesterol. This helps slow the progression of the disease and reduce the risk of serious complications, such as retinal detachment or significant vision loss.

It is also important to note that patients can contribute to the early detection of retinopathy themselves by closely monitoring changes in their vision. If symptoms such as blurred vision, floating spots or dark spots appear, it is necessary to consult an ophthalmologist immediately.

Thus, the use of modern examination methods in combination with regular preventive examinations makes it possible to effectively diagnose diabetic retinopathy in the early stages, providing patients with the opportunity for timely treatment and preservation of vision.

Treatment of diabetic retinopathy

Drug treatment

Drug treatment of diabetic retinopathy is aimed at slowing the progression of the disease and reducing swelling of the retina. One of the main approaches is the use of anti-VEGF drugs (vascular endothelial growth factor inhibitors). These drugs are injected directly into the vitreous body of the eye. They block a protein that stimulates the formation of abnormal blood vessels, reducing swelling and bleeding. Several injections are often given at intervals of several weeks, and the duration of treatment depends on the degree of retinal damage and the response to therapy.

Other medications include corticosteroids, which are also given by injection or as implants. They reduce inflammation and swelling of the retina, improving vision. However, such drugs can have side effects, such as increased intraocular pressure and the development of cataracts, so their use should be monitored by a doctor.

Laser therapy

Laser therapy is one of the main methods of treating diabetic retinopathy, especially in the later stages of the disease. Focal laser coagulation is used to treat swelling of the macula, the central part of the retina that is responsible for visual acuity. This method aims to reduce fluid leakage from damaged vessels, which helps reduce swelling and improve vision.

Panretinal photocoagulation is used to treat proliferative diabetic retinopathy. It consists in creating multiple laser burns on the periphery of the retina, which reduces the formation of new abnormal vessels and reduces the risk of retinal detachment. Laser therapy can be painful, so the procedure is often performed under local anesthesia.

Surgical methods

Surgical methods of treatment are used in those cases when drug and laser therapy do not give the desired result or in case of serious complications. Vitrectomy is a major surgical procedure that involves removing the vitreous body that fills the inside of the eye. This operation allows you to eliminate hemorrhages, scar tissue and newly formed vessels that cause retinal detachment. After a vitrectomy, the inside of the eye is filled with a special solution or gas that helps hold the retina in place while it heals.

General recommendations

General recommendations for patients with diabetic retinopathy include regular monitoring of blood sugar, blood pressure, and cholesterol levels. This helps to slow down the progression of the disease and reduce the risk of complications. It is important to regularly visit an ophthalmologist for examinations and timely detection of changes in the condition of the retina.

A healthy lifestyle, including a balanced diet and regular physical activity, are also important components of diabetic retinopathy prevention. Avoiding bad habits, such as smoking, helps to improve the general state of health and reduce the risk of developing complications.

Thus, effective treatment of diabetic retinopathy requires a comprehensive approach that includes drug therapy, laser treatment, surgery, and adherence to general diabetes management guidelines. Regular medical monitoring and timely treatment help preserve vision and improve the quality of life of patients.

Prevention of diabetic retinopathy

Healthy Lifestyle

A healthy lifestyle is a key factor in the prevention of diabetic retinopathy. One of the most important aspects is maintaining stable blood sugar levels. This can be achieved by eating a balanced diet that includes foods with a low glycemic index, rich in fiber, protein and healthy fats. Reducing the consumption of simple carbohydrates and sugar helps to avoid sharp fluctuations in blood glucose levels.

Regular physical activity also plays an important role in diabetes control. Exercise helps improve insulin sensitivity, lowering blood sugar. It is recommended to exercise at least 150 minutes a week, choosing activities such as walking, running, swimming or cycling.

Avoiding bad habits such as smoking and excessive alcohol consumption is another important aspect of a healthy lifestyle. Smoking damages blood vessels and increases the risk of developing cardiovascular diseases, which can complicate the course of diabetic retinopathy. Reducing or completely giving up alcohol helps to reduce the risk of complications and improve the general state of health.

Maintaining a normal weight is also important for the prevention of diabetic retinopathy. Obesity increases the risk of developing diabetes and its complications, so weight loss through diet and exercise helps reduce this risk.

Regular medical supervision

Regular medical supervision is an integral part of the prevention of diabetic retinopathy. Patients with diabetes should visit an ophthalmologist at least once a year for a comprehensive eye examination. These examinations help to identify the initial signs of retinopathy and start treatment in the early stages, which significantly increases the chances of saving vision.

In addition to examinations by an ophthalmologist, it is important to regularly visit an endocrinologist or therapist to monitor blood sugar, blood pressure, and cholesterol levels. Control of these indicators helps to avoid complications and maintain the general state of health at an appropriate level.

Independent monitoring of the level of glucose in the blood is also an important part of prevention. Modern glucometers allow patients to quickly and accurately measure sugar levels at home, which helps to detect deviations in a timely manner and take appropriate measures.

Compliance with the treatment and recommendations prescribed by the doctor is no less important. Regular medication, adherence to a diet and physical activity plan contribute to effective control of diabetes and reduce the risk of developing retinopathy.