Diabetic retinopathy occurs when the circulation to the retina is compromised by diabetes mellitus. It can occur in patients with type I or type II diabetes.

Diabetic Retinopathy is classified in two forms:

• Non Proliferative or Background Diabetic Retinopathy (BDR)
• Proliferative Diabetic Retinopathy (PDR)

Signs & Symptoms

• Not infrequently, there are no symptoms until the disease has progressed to an advanced stage.
• Blurred vision (This is often linked to blood sugar levels)
• Floaters and flashes
• Sudden loss of vision (One or both eyes)

Non Proliferative or Background Diabetic Retinopathy (BDR)

BDR is the earliest stage of diabetic retinopathy. It is classified by small spots of blood (hemorrhages), on the retina. This stage usually has no symptoms and the patient may be unaware of the problem. Patients with BDR may also develop a condition called Diabetic Macular Edema (DME), characterized by the accumulation of fluid within the macula. This occurs when the retina loses its ability to remove the fluid through normal circulation. The result is swelling (edema), in the central area of the retina (macula). This condition may cause vision changes and possible vision loss. Diabetic Macular Edema is treated with injections of Lucentis, Eylea, Ozurdex or Iluvein. In some cases laser can be used to seal the leaking blood vessels(focal laser photocoagulation) or stimulate the retinal pumps to pump out the fluid ( Micropulse laser). Some vision loss may be permanent, despite treatment, due to the amount of leakage and the damage caused.

Proliferative Diabetic Retinopathy (PDR)

PDR is the advanced stage of diabetic retinopathy. Abnormal blood vessels form in the peripheral retina as a result of compromised circulation. This condition is treated with extensive retinal laser photocoagulation or with injections of Lucentis, Eylea, or sometimes both laser and injections. Laser treatment destroys the areas of lost circulation which is the catalyst for the growth of the abnormal blood vessels. The injections block the growth hormone released by the dying retinal cells so injections result in less cellular damage but the effect only lasts for a few weeks and the injections need to be continued.

Even with treatment, these fragile, abnormal blood vessels can rupture, causing the vitreous gel inside the eye to fill with blood. This makes the vision cloudy causing mild to severe vision loss. A vitreous hemorrhage will sometimes resolve on its own without intervention. If it does not, vitrectomy surgery may be recommended to remove the vitreous gel and the blood. If the abnormal vessels and hemorrhaging are not treated and progress, scar tissue can form which can lead to a retinal detachment.

Detection and Diagnosis

Diabetic eye disease is the leading cause of blindness in working age Americans. Unfortunately, Diabetic Retinopathy often progresses to one of the more serious stages before symptoms may be noticed by the patient. For this reason, dilated eye examinations are recommended yearly for all diabetics. Only a dilated eye exam allows the doctor to fully examine the retina which is where signs of the disease would be evident. The best management for diabetic retinopathy is control of your diabetes. Fluctuations in blood sugar can cause damage to blood vessels in all parts of the body, including the retina. Loss of circulation and the resulting damage to the retina can not be reversed. Any treatments or surgeries for diabetic retinopathy are not a cure for the disease but are done to prevent further vision loss.