Diabetic retinopathy (DR) is a leading cause of severe and permanent blindness for diabetics. A common complication of diabetes, it arises from the damage diabetes causes to the vasculature or blood vessels in the retina, the light-sensitive layer of the eye.
Despite the condition’s ability to leave lasting effects, the early stages of diabetic retinopathy can be asymptomatic. This makes management of it difficult, as people typically only learn they have it at the advanced stage, when vision loss has already started to occur.
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The risk of diabetic retinopathy is also among the reasons diabetics are advised to get regular eye assessments. Among other things, diabetics are often advised to get comprehensive dilated eye exams at least each year to check for this condition.
Most people see no symptoms for the early stages of diabetic retinopathy, as mentioned earlier. However, some do notice changes in their vision.
Generally, the more advanced the condition, the more likely a person is to see the following symptoms (especially the ones at the bottom of the list):
Difficulty reading
Difficulty seeing faraway objects
Blurry or patchy vision
Distortion of straight lines
Dark, cobweb-like floating lines and spots in one’s vision
Sudden loss of vision
How Long Does Diabetic Retinopathy Take to Develop?
Because diabetic retinopathy often goes undiagnosed in its early stages, it can be very difficult to estimate how long the condition takes to actually develop. The UK NHS estimates that the condition takes several years, with most experts estimating around 3 to 5 years for its development.
Risk Factors of Diabetic Retinopathy
There are certain things that can put a person at higher risk of developing diabetic retinopathy. Here are several of the most noteworthy ones:
Duration of disease – The longer you have had diabetes, the more likely you are to develop the condition. Indeed, the US National Eye Institute estimates that over half of all diabetics will get retinopathy over time. Type 1 diabetics also seem more likely to develop it.
Poor diabetic control – It is natural to expect that the poorer the sugar control, the more likely it is to develop diabetic retinopathy. Also, individuals with significant fluctuations in blood sugar levels have shown to be more likely to develop this condition. Therefore, it is not only important to control the sugar levels, but to be consistent in the control.
Pregnancy – Pregnancy can make sugar control more difficult for diabetics. Moreover, it can trigger gestational diabetes, which can also convert to chronic diabetes. Diabetics who are pregnant can aggravate their pre-existing retinopathy.
Complications of Diabetic Retinopathy
Complications of diabetic retinopathy are more likely to appear once you have had the condition for a while. The usual compounding of symptoms is also why the condition is more likely to be diagnosed later. During the earlier stages of the problem, small blood spots appear in the retina. Your eye doctor should still be able to see these in a dilated eye examination.
As the condition worsens over time, however, complications begin. Fragile abnormal blood vessels often start to grow. In the retina, these vessels can break easily and leak blood into the cavity at the back of the eye – the vitreous cavity, obscuring vision. In the front of the eye, these abnormal vessels grow into the eye’s drainage angles and cause glaucoma. In the end stage, this can lead to blindness.
Macular edema or swelling is also a complication of DR. The macula is the region of the retina responsible for central sharp vision. This occurs when leaks out of the blood vessels in the macula. As more and more fluid accumulates there, it results in blurring of the central vision. Left untreated, this can lead to irreversible vision loss.
Another serious complication of untreated DR is the formation of scar tissue on the retina. This can cause traction and lead to devastating conditions such as retinal detachments, which is difficult to treat and can lead to permanent vision loss.
Treatment of Diabetic Retinopathy
Because treatment of this condition is not a cure, it is generally advised to prevent diabetic retinopathy first with healthy lifestyle and eye care choices. DR can be managed and its effects even slowed, but it is better to reduce your risk of needing to do that in the first place.
That means practising good sugar control, among other things. This can be achieved by having regular meals, a healthy diet, and regular exercise. Controlling other chronic medical conditions like high blood pressure and high cholesterol is important as well, as they are hypothesised to have adverse effects on the tiny blood vessels in the eyes.
Beyond prevention, there is also early detection. The earlier the condition is found, the sooner it can be managed, which means it has less time to progress into a severe enough state for lasting vision loss. Annual eye screening is crucial in picking up any developing DR early, due to this. Screening should be done more frequently in newly diagnosed diabetics too, as these are typically patients whose blood sugar control is not yet optimal. The same goes for those with a condition that puts them at higher risk for DR, e.g. pregnancy with diabetes.
Once diagnosed, diabetic retinopathy itself can be treated in several ways:
Argon laser treatment
Anti-VEGF agents
Surgery
Argon laser treatment
Also known as panretinal photocoagulation, this is a procedure that involves using a laser to treat the retina. The main aim is to prevent the growth of the abnormal fragile vessels, and to prevent severe vision loss.
Anti-VEGF agents
Injection of anti-VEGF agents into the back cavity of the eye, is another common treatment option. VEGF stands for vascular endothelial growth factor. The agents therefore prevent the growth of new blood vessels, and also help to prevent leakage from other blood vessels that are causing swelling at the macula.
Surgery
In some cases of severe diabetic retinopathy, where bleeding into the vitreous cavity has already occurred, or there is tractional retinal detachment which is threatening the central vision, a surgery known as a vitrectomy is performed. This is done to remove the scar tissue and blood, and further argon laser can be done during the surgery
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