Diabetic Retinopathy Exam Toowoomba | Diabetic Retinopathy Exam Highfields
Diabetic retinopathy is a diabetes complication that affects eyes. It’s caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). Changes to your blood sugar can cause changes to your vision as well.
At first, diabetic retinopathy might cause no symptoms or only mild vision problems. But it can lead to blindness.
The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication.
You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, you might develop:
- Spots or dark strings floating in your vision (floaters)
- Blurred vision
- Fluctuating vision
- Dark or empty areas in your vision
- Vision loss
When to see an optometrist
Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your optometrist for a yearly eye exam – even if your vision seems fine. Your optometrist may need to put dilating drops in your eyes.
Developing diabetes when pregnant (gestational diabetes) or having diabetes before becoming pregnant can increase your risk of diabetic retinopathy. If you’re pregnant, your optometrist might recommend additional eye exams throughout your pregnancy.
Contact your optometrist right away if your vision changes suddenly or becomes blurry, spotty or hazy.
To monitor patients with diabetic retinopathy, we often take Ultra Wide Field retinal photos using the EIDON camera – see photo below of an eye with diabetic retinopathy including haemorrhages in the retina (dark spots).
Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don’t develop properly and can leak easily.
There are two types of diabetic retinopathy:
- Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy (NPDR). When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter as well. NPDR can progress from mild to severe as more blood vessels become blocked. Sometimes retinal blood vessel damage leads to a build-up of fluid (odema) in the centre portion (macula) of the retina. If macular oedema decreases vision, treatment is required to prevent permanent vision loss.
- Advanced diabetic retinopathy. Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the centre of your eye (vitreous). Eventually, scar tissue from the growth of new blood vessels can cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure can build in the eyeball. This build-up can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma.
Anyone who has diabetes can develop diabetic retinopathy. The risk of developing the eye condition can increase as a result of:
- Having diabetes for a long time
- Poor control of your blood sugar level
- High blood pressure
- High cholesterol
- Tobacco use
- Being Black, Hispanic or Native American
Diabetic retinopathy involves the growth of abnormal blood vessels in the retina. Complications can lead to serious vision problems:
- Vitreous haemorrhage. The new blood vessels may bleed into the clear, jellylike substance that fills the centre of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision. Vitreous haemorrhage by itself usually doesn’t cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision will likely return to its previous clarity.
- Retinal detachment. The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This can cause spots floating in your vision, flashes of light or severe vision loss.
- Glaucoma. New blood vessels can grow in the front part of your eye (iris) and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build. This pressure can damage the optic nerve that carries images from your eye to your brain.
- Blindness. Diabetic retinopathy, macular oedema, glaucoma or a combination of these conditions can lead to complete vision loss, especially if the conditions are poorly managed.
You can’t always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.
If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:
- Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.
- Monitor your blood sugar level. You might need to check and record your blood sugar level several times a day — or more frequently if you’re ill or under stress. Ask your doctor how often you need to test your blood sugar.
- Ask your doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test, or Hba1C test, reflects your average blood sugar level for the two- to three-month period before the test. For most people with diabetes, the A1C goal is to be under 7%.
- Keep your blood pressure and cholesterol under control. Eating healthy foods, exercising regularly and losing excess weight can help. Sometimes medication is needed, too.
- If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including diabetic retinopathy.
- Pay attention to vision changes. Contact your optometrist right away if your vision suddenly changes or becomes blurry, spotty or hazy.
Remember, diabetes doesn’t necessarily lead to vision loss. Taking an active role in diabetes management can go a long way toward preventing complications.
Diabetic retinopathy is best diagnosed with a comprehensive dilated eye exam. For this exam, drops may be placed in your eyes widen (dilate) your pupils to allow your optometrist a better view inside your eyes. The drops can cause your close vision to blur until they wear off, several hours later. During the exam, your optometrist will look for abnormalities in the inside and outside parts of your eyes. It is advised that you bring a driver, as you are not able to drive afterwards.
Optical coherence tomography (OCT)
With this test, pictures provide cross-sectional images of the retina that show the thickness of the retina. This will help determine how much fluid, if any, has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working.
Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping the progression.
Early diabetic retinopathy
If you have mild or moderate nonproliferative diabetic retinopathy, you might not need treatment right away. However, your optometrist will closely monitor your eyes to determine when you might need treatment. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.
Advanced diabetic retinopathy
If you have proliferative diabetic retinopathy or macular oedema, you’ll need prompt treatment.
While treatment can slow or stop the progression of diabetic retinopathy, it’s not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.
Even after treatment for diabetic retinopathy, you’ll need regular eye exams. At some point, you might need additional treatment. Your optometrist will refer you to an ophthalmologist.
Information sourced from the Mayo Clinic https://www.mayoclinic.org/