• General
    • What is diabetic retinopathy?
      Diabetic retinopathy is a complication of diabetes and it can seriously affect vision and lead to blindness. Retinopathy can occur with all types of diabetes. It is a leading cause of blindness worldwide for people who are between 20 and 74 years old (working age). However 90% of blindness and vision loss caused by diabetic eye disease can be prevented with regular dilated eye examinations and timely treatment. It is absolutely critical that every patient with diabetes understands that diabetic retinopathy often causes no symptoms until a lot of damage has already occurred.
    • What causes diabetic retinopathy?
      The longer a person has diabetes, the higher the chance of developing diabetic retinopathy. Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. The retina is the light-sensitive film at the back of the eye that sends electrical impulses to your brain, allowing you to see. A healthy retina is essential for good vision. With diabetic retinopathy, the blood vessels become leaky and then may close off. The leaky vessels can lead to hemorrhages (spots of bleeding), clear fluid (serum) and exudates (blood fats and proteins) within the retina. This may also cause significant swelling, known as edema of the retina. The blocked vessels can starve the retina of oxygen, leading to the growth of new, abnormal vessels as well as damage to the retina from lack of oxygen. Good control of diabetes, including blood glucose, blood pressure and blood cholesterol helps reduce the chances of developing retinopathy or having it progress to more serious stages.
  • Types of Diabetes
    • Type 1 diabetes
      Type 1 diabetes used to be called insulin-dependent, immune-mediated or juvenile-onset diabetes. It is caused by an auto-immune reaction where the body’s defense system attacks the insulin-producing beta cells of the pancreas. The reason why this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but is usually diagnosed in childhood or young adults. People with this form of diabetes need injections of insulin every day in order to control levels of glucose in their blood.
    • Type 2 diabetes
      Type 2 diabetes used to be called non-insulin dependent diabetes or adult-onset diabetes, and accounts for at least 90% of all cases of diabetes. It is characterized by insulin resistance (the body’s cells are unable to use insulin properly) and relative insulin deficiency, either of which may be present at the time of diagnosis. The diagnosis of type 2 diabetes usually occurs after the age of 40 but can occur earlier, especially in populations with high diabetes prevalence and obesity. Type 2 diabetes can remain undetected for many years and the diagnosis is often made from associated complications (such as diabetic retinopathy) or incidentally through an abnormal blood glucose test. It is most often associated with obesity, which itself can cause insulin resistance and lead to elevated blood glucose levels.
    • Gestational diabetes (GDM)
      When diabetes is diagnosed during pregnancy it is called gestational diabetes (GDM). It develops in one in every 25 pregnancies worldwide and is associated with complications in the period immediately before and after birth. GDM usually disappears after pregnancy but women with GDM and their offspring are at an increased risk of developing type 2 diabetes later in life. Approximately half of women with a history of GDM go on to develop type 2 diabetes within five to ten years after delivery.
  • Complications of Diabetes
    • General
      Type 1 and type 2 diabetes are chronic, life-long conditions that require careful monitoring and control. Without proper management diabetes causes long term damage to various organs and tissues.
    • Cardiovascular disease
      Cardiovascular disease (CVD) affects the heart and blood vessels and may cause fatal complications such as coronary heart disease and stroke. Cardiovascular disease is the major cause of death in people with diabetes, accounting in most populations for 50% or more of all diabetes fatalities. It is important to know that diabetic retinopathy and its worsening are both associated with increased risk of CVD.
    • Kidney disease
      Kidney disease (diabetic nephropathy) can result in kidney failure and the need for dialysis or kidney transplant. Diabetes is an increasingly important cause of renal failure, and indeed has now become the single most common cause of end stage renal disease. Diabetic retinopathy and nephropathy often occur at the same time.
    • Nerve disease
      Nerve disease (diabetic neuropathy) can lead to ulceration and amputation of the toes, feet and lower limbs. Loss of feeling is a particular risk because it can allow foot injuries to escape notice and treatment, leading to major infections and amputation.
    • Eye disease
      Eye disease (diabetic retinopathy) characterized by damage to the eye’s light-sensitive retina can lead to vision loss. The capillaries (small blood vessels) in the retina become blocked, may bulge slightly (microaneurysm formation) and may leak blood (hemorrhages) or fluid with associated protein and fat (exudates). Annual dilated eye examinations will allow your eye doctor to monitor these early changes and make sure that progression to more serious stages of retinopathy is detected early, and treated appropriately. It is absolutely critical that every patient with diabetes understands that diabetic retinopathy often causes no symptoms until a lot of damage has already occurred. Other parts of the eye are often affected by diabetes, including the lens (leading to early cataract formation), the cornea (causing loss of normal sensation and corneal erosion), the muscles controlling eye movement (leading to double vision) and the optic nerve (increased risk of optic nerve stroke and glaucoma).
  • Management of Diabetes
    • General
      Today, there is no cure for diabetes, but effective treatment exists. Appropriate medications, high quality medical care and good lifestyle choices (diet and exercise), allow most patients to lead an active and healthy life and reduce the risk of developing complications. Good diabetes control means keeping your blood sugar levels as close to normal as possible, as well as your blood pressure and cholesterol levels.
    • Physical activity
      Aim for at least 30 minutes of moderate physical activity per day.
    • Body weight
      Weight loss improves insulin resistance, blood glucose, lipid levels and reduces blood pressure. It is important to reach and maintain a healthy weight. One pound of excess body weight = 3500 calories, so reducing 500 calories per day will allow 1 lb of weight loss per week.
    • Healthy eating
      Avoid foods high in sugars and saturated fats, and limit alcohol consumption. Increase vegetable intake and variety. Avoid highly processed carbohydrates (packaged crackers, cookies, cereals, pastas). Increasing dietary fiber lowers blood glucose and is associated with a lower risk for diabetic retinopathy.
    • Avoid tobacco
      Tobacco use is associated with more complications in people with diabetes, including sight-threatening eye disease.
    • Monitoring for complications
      Monitoring and early detection of complications is an essential part of good diabetes care. This includes regular foot and eye examinations, controlling blood pressure and blood glucose, and assessing risks for cardiovascular and kidney disease.
  • Stages of Diabetic Retinopathy
    • Nonproliferative retinopathy (NPDR)
      Nonproliferative diabetic retinopathy (NPDR) is the earliest stage of diabetic retinopathy. With this condition, damaged retinal capillaries form microaneurysms (small, balloon-like formations within the smallest blood vessels) and small hemorrhages, which appear as abnormal red spots in the back of the eye detected by your eye doctor.
    • Diabetic macular edema (DME)
      Swelling or thickening of the macula, the central part of the eye’s light-sensitive retina that is responsible for detailed and color vision. This is caused by fluid leaking from the retina's blood vessels. The macula doesn't function properly when it is swollen. Diabetic macular edema is the most common cause of vision loss in diabetes and requires treatment when it becomes “clinically significant” as determined by your eye doctor.
    • Pre-proliferative retinopathy (PPDR) AKA severe NPDR
      More severe retinopathy. In this condition the retina has been damaged by the higher than normal sugar levels over several years. More microaneurysms and hemorrhages form in the retina, the retinal veins become ‘beaded’ (like sausage casings) and capillaries begin to form abnormal twig-like outpouchings called IRMA. The condition is called 'pre-proliferative' as it usually progresses to proliferative retinopathy that threatens vision.
    • Proliferative retinopathy (PDR)
      Proliferative diabetic retinopathy (PDR) mainly occurs when many of the capillaries in the retina close, leading to inadequate supply of oxygen (hypoxia). The retina responds by growing new blood vessels. This is called neovascularization. However, these new blood vessels are abnormal and grow into the vitreous gel, where they may bleed. The new vessels are also often accompanied by scar tissue that may cause the retina to wrinkle or detach, leading to severe vision loss and even blindness.
    • Laser treatment (LT)
      Laser surgery is a form of treatment used to help prevent vision loss from DME and/or PDR. Best results are achieved if laser treatment is applied early or before any vision is lost. Retinal laser treatment is completely different from refractive laser surgery like LASIK.
  • Guidelines
    • Blood pressure
      Optimal blood pressure values for people with diabetes are at or below 130/80 or 130 systolic and 80 diastolic.
    • Blood glucose
      Optimal fasting blood sugar is less than 100 mg/dl. Optimal HbA1c is less than or equal to 6.5% for most people with diabetes but the target must be individualized. The risk of diabetic retinopathy increases by about a third as the HbA1c goes up by 1%. Conversely, each 10% reduction in HbA1c (for example, from 8% to 7.2%) reduces the risk of diabetic retinopathy progression by about 40%.