Eye and vision care

What is diabetic retinopathy?

Diabetes is a very serious disease that can cause problems like blindness, heart disease, kidney failure, and amputations. But by taking good care of yourself through diet, exercise, and special medications, you can control diabetes. And there is more good news. Diabetic eye disease, a complication of diabetes, can be treated before vision loss occurs.

All people with diabetes need to get a dilated eye exam at least once a year.

What is diabetic eye disease?

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of this disease. All can cause severe vision loss or even blindness.

Diabetic eye disease may include:

• diabetic retinopathy—damage to the blood vessels in the retina
• cataract—clouding of the eye's lens
• glaucoma—increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision

Diabetic retinopathy

Of the three diseases listed above, diabetic retinopathy is the most common diabetic eye disease. This disease is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. These changes may result in vision loss or blindness.

What are the syptoms of diabetic retinopathy?

Often there are no symptoms in the early stages of the disease. Vision may not change until the disease becomes severe. Nor is there any pain. Blurred vision may occur when the macula, the part of the retina that provides sharp, central vision, swells from the leaking fluid. This condition is called macular edema. If new vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. But, even in more advanced cases, the disease may progress a long way without symptoms. That is why regular eye examinations for people with diabetes are so important.

Who's at risk?

Anyone with diabetes is at risk. The longer someone has diabetes, the more likely he or she will get diabetic retinopathy. Between 40 and 45 percent of those with diagnosed diabetes have some degree of diabetic retinopathy.

How is diabetic retinopathy detected?

If you have diabetes, you should have your eyes examined at least once a year. Your eyes should be dilated during the exam. That means eyedrops are used to enlarge your pupils. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease.

How is diabetic retinopathy treated?

Your eye care professional may suggest laser surgery in which a strong light beam is aimed onto the retina.

Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why finding diabetic retinopathy early is the best way to prevent vision loss.

Can diabetic retinopathy be prevented?

Not totally, but your risk can be greatly reduced. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar level slows the onset and progression of retinopathy and lessens the need for laser surgery for severe retinopathy.

The study found that the group that tried to keep their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. This level of blood sugar control may not be best for everyone, including some elderly patients, children under 13, or people with heart disease. So ask your doctor if this program is right for you.

How common are other diabetic eye diseases?

If you have diabetes, you are also at risk for other diabetic eye diseases. Cataracts develop at an earlier age in people with diabetes. Cataracts can usually be treated by surgery.

Glaucoma may also become a problem. A person with diabetes is nearly twice as likely to get glaucoma as other adults. And, as with diabetic retinopathy, the longer you have had diabetes, the greater your risk of getting glaucoma. Glaucoma may be treated with medications, laser, or other forms of surgery.

What research is being done?

Much research is being done to learn more about diabetic eye disease. For instance, the National Eye Institute is supporting a number of research studies in the laboratory and with patients to learn what causes diabetic retinopathy and how it can be better treated. This research should provide better ways to detect and treat diabetic eye disease and prevent blindness in more people with diabetes.