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Diabetic Retinopathy
Diabetic retinopathy is damage to the retina's blood vessels caused by diabetes — the most common diabetic eye complication and a leading cause of blindness in American adults, with no symptoms in its early, most treatable stages. Dr. Michael E. Rom examines diabetic eyes at Insight Eye Center in Mentor and coordinates treatment before vision is lost.
What is diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes that affects the eyes. High blood sugar weakens the tiny blood vessels that nourish the retina — the light-sensitive lining at the back of the eye where vision is focused — so they swell, leak and eventually close off. It is the most common diabetic eye complication and a leading cause of blindness in American adults.
The longer a person has had diabetes, and the less well the blood sugar has been controlled, the more likely retinopathy becomes. High blood pressure, high cholesterol, kidney disease and pregnancy raise the risk further. Both type 1 and type 2 diabetes cause it.
The good news is that it develops slowly and can be found long before it threatens vision — but only by an eye examination, because the early stages have no symptoms.
What are the stages of diabetic retinopathy?
Diabetic retinopathy has four stages, each more serious than the last: mild, moderate and severe nonproliferative retinopathy, then proliferative retinopathy. As the disease progresses more and more blood vessels are damaged. In the proliferative stage the retina grows new vessels to replace the blocked ones, but their walls are so thin that they bleed easily — and that bleeding can cause severe vision loss.
- Mild nonproliferativeTiny bulges (microaneurysms) form in the retinal vessels and may leak small amounts of fluid. No symptoms; found at a dilated exam.
- Moderate nonproliferativeMore vessels swell and become distorted; some begin to close, reducing blood flow to parts of the retina.
- Severe nonproliferativeMany vessels are blocked, starving areas of the retina of blood. The retina signals for new vessels to grow.
- ProliferativeFragile new vessels grow on the retina and into the gel of the eye. They bleed, scar and can pull the retina away from the back of the eye. Vision loss at this stage can be severe and permanent.
What are the symptoms of diabetic retinopathy?
In the early stages there are usually no symptoms at all, which is why people with diabetes need a dilated eye exam every year even when their vision seems fine. When symptoms do appear they include blurred or double vision, dark spots or floaters, flashing lights, blank or dark areas in the field of vision, trouble seeing at night, and pain or pressure in one or both eyes.
- blurred or double vision
- floaters, blank spots or dark areas
- flashing lights
- colors that look faded
- difficulty seeing at night
- pain or pressure in the eye
- problems with peripheral vision
- vision that fluctuates with blood sugar
In advanced stages diabetic retinopathy can cause irreversible blindness. Any of the symptoms above in a person with diabetes should be examined promptly.
How is diabetic retinopathy diagnosed and treated?
Diabetic retinopathy is diagnosed at a dilated eye exam, where Dr. Rom examines the retina directly and, when needed, photographs or scans it to measure swelling and leakage. In the early stages treatment is usually not required: controlling blood sugar, blood pressure and cholesterol slows the disease, and the retina is re-examined every year or more often. Once vision is threatened, prompt treatment is necessary to preserve it.
Treatments for advancing disease include injections of medication into the eye that stop abnormal vessels from leaking and growing, laser treatment that seals leaking vessels or shrinks new ones, and, for bleeding or scar tissue, a surgery called vitrectomy. Dr. Rom monitors your retina at the Mentor office and coordinates prompt referral to a retina specialist when these treatments are needed.
- No retinopathyDilated exam every year. Keep blood sugar, blood pressure and cholesterol at target.
- Mild–moderateCloser monitoring, often every 6–12 months; sugar control is the treatment.
- Severe / macular edemaRetinal imaging; injections or laser to protect vision.
- ProliferativeInjections, laser and, when needed, vitrectomy surgery.
How can I protect my eyes if I have diabetes?
Keep your A1C, blood pressure and cholesterol at the targets your physician sets, do not smoke, and have a dilated eye exam every year — even when your vision is fine, because the earliest and most treatable stages have no symptoms. Report any change in vision promptly. Those steps prevent most of the vision loss that diabetic retinopathy would otherwise cause.
Insight Eye Center sends a report of your eye exam to your primary care physician or endocrinologist, so your diabetes care team knows the state of your eyes.
Common questions about diabetic retinopathy
Short answers to the questions patients ask most often. For anything specific to your eyes, ask Dr. Rom at your visit or call the office at (440) 286-1188.
How often should someone with diabetes have an eye exam?
At least once a year, with dilation, even if vision seems normal. Dr. Rom may recommend more frequent exams if retinopathy is found, and during pregnancy.
Can diabetic retinopathy be reversed?
Early changes can stabilize or improve with good blood sugar control, and treatments can stop leakage and abnormal vessel growth, but damage from advanced disease is often permanent. Early detection is what protects vision.
Does good blood sugar control prevent retinopathy?
It greatly reduces the risk and slows progression, but retinopathy can still develop after many years of diabetes. Control plus yearly exams is the combination that works.
Are the injections painful?
The eye is numbed first; most patients feel pressure rather than pain, and the injection itself takes seconds. Injections are given by a retina specialist and are often repeated over months.
Is diabetic eye care covered by insurance?
Yes. Diabetic eye exams and treatment are medical eye care, covered by Medicare and most medical plans, subject to your deductible and coinsurance.
Diabetes? Have your retina checked every year.
Request a diabetic eye exam with Dr. Rom in Mentor. The exam finds retinopathy years before it affects your vision, and the results go to your diabetes care team.
