Diabetic Retinopathy What you Need to Know

Learn what you need to preserve and optimize your vision in 20 minutes or less

Check out our video on Youtube with all of the below information.

The 5 steps to maintaining your vision with diabetes

Step 1 – Learn the facts about diabetic eye disease (diabetic retinopathy)

Step 2 – Learn the risk factors for the development and progression of diabetic retinopathy

Step 3 – Learn about the evaluation of diabetic retinopathy

Step 4 – Learn about the treatment of diabetic retinopathy

Step 5 Β – Maximizing your vision

The Facts About Diabetic Retinopathy

The eye can be thought of as similar to a camera, with two main parts, a lens and a film. The film layer is called the retina and lines the back wall of the eye.Β The retina is supplied by an intricate network of blood vessels.Β The area of the retina responsible for the central vision is called the macula.Β 

Diabetes causes damage to the blood vessels. This results in bleeding and the development of new blood vessels in the retina (neovascularization). It may also cause leaking of fluid within the layers of the macula (macular edema).

Diabetic retinopathy is the leading cause of blindness among the working age population. There are no symptoms at the beginning stages. The more advanced stages may cause decreased vision once the vision loss is already irreversible. This is why routine monitoring with an eye care specialist is so important.

Diabetic retinopathy can be split into several categories:

By the presence of absence of new blood vessels (proliferative diabetic retinopathy). These vessels may bleed and cause decreased vision.

By the presence or absence of swelling (edema) in the macula (area of the retina responsible for central vision). Edema in the macula causes decreased vision.

Let me take you through the spectrum of diabetic retinopathy now. Then we will talk about how to optimize your results and vision.

Early non-proliferative diabetic retinopathy
Characterized by a few small microaneuryms (outpouching of normal blood vessels)
Moderate non-proliferative diabetic retinopathy
Characterized by more extensive retinal hemorrhages
Severe non-proliferative diabetic retinopathy
Characterized by extensive retinal hemorrhages in all 4 quadrants of the retina
Proliferative diabetic retinopathy
Characterized by new blood vessels that leak and bleed
Diabetic Tractional Retinal Detachment
This condition may be prevented by appropriate treatment at prior stages. This is a condition that can lead to permanent blindness, despite surgical management (due to poor blood flow and chronic swelling)
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What is Diabetic Macular Edema?

Diabetic macular edema (DME) refers to the leakage of fluid into the macula (edema) as a result of diabetic retinopathy. If the edema involves the central vision, it will cause a decrease in the central vision. Patients will perceive this as a blurring of vision. The optical coherence tomography (OCT) images seen below demonstrate a patient with no edema (top) and with edema on the bottom. The edema on OCT appears as black circles within the retina (see below).


What are the symptoms of diabetic retinopathy?

There are no symptoms of early, moderate, severe, or proliferative diabetic retinopathy if there is no bleeding into the vitreous cavity or edema involving the central vision.

This is why patients need routine examination when they have diabetes. For example, patients who have proliferative diabetic retinopathy who do not undergo prompt treatment have a very high risk of irreversible vision loss within 1 year.

Risk Factors For The Development and Progression of Diabetic Retinopathy.

Risk Factors

Hemoglobin A1C

The hemoglobin A1C goal for diabetic retinopathy is 7.0 or less. Every 10% increase in hemoglobin A1C results in a 64% increased risk of developing diabetic retinopathy.

Duration of Diabetes

Greater duration of diabetes is a risk factor for development of diabetic retinopathy as well as its progression.

Blood pressure

High blood pressure is a major contributor to the development and progression of diabetic retinopathy. It is critical to maintain a blood pressure of 140/90 or less.


10 minutes per day of moderate to vigorous activity is associated with a 75% decreased risk of developing diabetic retinopathy.

Evaluating Diabetic retinopathy - The exam and diagnostic imaging

Clinical exam

The eye care specialist examines the eye, looking for signs of diabetes in the front of the eye, such as cataracts or new blood vessels in the iris. A dilated eye exam is performed and the retina is visualized for signs of diabetic retinopathy.

Optical coherence tomography (OCT)

This technology allows the examiner to look at all of the layers of the retina, demonstrating areas of swelling or poor blood flow. It is often repeated to see if new swelling is present or if existing swelling is changing. The image on the top is a normal OCT. The bottom demonstrates a patient with swelling (the black circular areas).

Fluoroscein angiography (FA)

This exam allows the physician to evaluate the blood flow to the retina. It can elucidate areas of poor blood flow, abnormal blood vessel growth, and demonstrate the sources of edema (swelling). It is very useful in guiding therapy.

Diabetic Retinopathy Treatment

Diabetic macular edema

Any stage of diabetic retinopathy may potentially be accompanied by diabetic macular edema. Swelling that is involving the central vision is treated with injections into the eye (intravitreal injections). Edema that is not involving the central vision, but is threatening the center vision may either be observed, treated with an in-office laser procedure, or be treated with an intravitreal injection. This a complex decision and a recommendation will be provided by a general ophthalmologist or Β retina specialist.

Diabetic macular edema can be divided into two categories: Center-involving and non-center-involving.

Non-center involving refers to patients in whom the edema is not located in the area of central vision. It therefore does not effect the patients vision. These patients may benefit from a gentle painless in-office laser procedure which decreases the risk by 50% of the swelling traveling from outside the area of central vision, and into the central vision.

How is diabetic macular edema treated?

Center-involving edema decreases the quality of the vision. The decreased vision may be as good as 20/20 or as bad as being unable to read any letters on the chart, despite the most updated glasses. Fortunately, there is excellent treatment for this condition which can be delivered in a painless treatment. Diabetic macular edema is typically treated with a class of medications called anti-vascular endothelial growth factors and possibly corticosteroids. These medications are very well tolerated with most patients gaining a substantial amount of vision. The average number of treatments for a patient receiving injections of anti-vascular endothelial growth factors is approximately 9 treatments in the first 12 months, 5 treatments in the second year, and 3 treatments in the third year. Patients receiving corticosteroids may potentially need less treatments, but still require frequent follow-up. Many patients will also require focal laser during their treatment for this condition.

Will my vision get better?

Nearly all patients experience a significant improvement in their vision with treatment. In general, The vision typically improves over a period of 4 months, and then levels off from there. This is certainly not true in all cases, especially if other causes of vision loss, such as cataract are present.

What can i do to optimize my vision?

It is critically important to optimize blood pressure and blood sugar. Missing appointments causes delays in treatments which tends to cause a decrease in vision and worsening edema. Following up and continuing treatment is very important.

Proliferative diabetic retinopathy (PDR)

A spectrum

PDR may be treated with an in-office laser procedure or alternatively by intravitreal injections. It is important to follow-up with the treating physician, as lapses in therapy may result in the new blood vessel growth returning, and permanent visual loss.

PDR causes abnormal blood vessels that leak and bleed. Many patients have bleeding within the vitreous cavity (which is located in front of the retina). This causes vision from the entire eye to become very blurry (vitreous hemorrhage). It is important this is evaluated by a retina specialist, as numerous other conditions may have a similar presentation.

Maximizing Your vision with treatment

Step 1) Optimize all of the risk factors for diabetic retinopathy development and progression.

Step 2) Attend all scheduled appointments with your eye care specialist. Schedule an appointment promptly if you have diabetes and have not been evaluated by an eye care specialist.

Step 3) Do not wait to see an eye care specialist if you are having visual changes.

Step 4) Attend all scheduled treatment visits. Delaying treatment can cause permanent visual decline.

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