Diabetic retinopathy (or diabetic eye disease) affects the blood vessels of the retina, the layer of the eye found at the back of the eyeball. The retina is responsible for converting light entering the eye lens into electrical signals sent through the optic nerve to the brain. The brain in turn creates the images a person sees. When the retina is damaged, a person’s vision is compromised because the brain doesn’t receive the necessary signals and information to process the image.
The retina consists of cells called photoreceptors responsible for converting light into the signals sent to the brain. There are two types of photoreceptors: rods (which work at night or in low light conditions) and cones (which process colors). Retinopathy means disease (“-pathy”) affecting the retinas and includes macular degeneration, retinitis pigmentosa, and diabetic retinopathy.
What is diabetic retinopathy?
Diabetic retinopathy occurs when diabetes is uncontrolled to the point of creating a blockage to the vessels supplying blood and nutrients to the retinas. The eye will attempt to grow new blood vessels to overcome; however, these vessels won’t develop or function properly (early diabetic retinopathy), or these new abnormal vessels will grow and leak a jelly-like substance (called the vitreous) that will fill the eye (advanced diabetic retinopathy).
Eventually, the growth of these abnormal blood vessels will create scar tissue that will cause detachment of the retina from the back of the eye. These vessels can also interfere with the flow of fluid out of the eye and build pressure within the eyeball. This pressure can damage the optic nerve leading to glaucoma. Recall, the optic nerve is responsible for carrying the signals to the brain necessary for vision. Without proper management glaucoma (and/or other retinopathies) can lead to blindness.
Risk factors for diabetic retinopathy
Diabetic retinopathy affects up to 80% of patients who have had diabetes for 20 years or more, and more than 90% of diabetic retinopathy cases are preventable with proper treatment and monitoring. Other risk factors for diabetic retinopathy include:
- Poor blood sugar control: Consistently high blood sugar levels can damage the blood vessels in your eyes.
- High blood pressure: Hypertension can exacerbate damage to the retina.
- High cholesterol levels: Elevated cholesterol can increase the risk of vascular problems, including in the eyes.
- Pregnancy: Women with diabetes who are pregnant may have a higher risk of developing or worsening retinopathy.
Symptoms of diabetic retinopathy
In its early stages, diabetic retinopathy may not cause any noticeable symptoms, which is why regular eye exams are critical for people with diabetes. As the condition progresses, symptoms can include:
- Blurred or distorted vision
- Difficulty seeing at night
- Dark spots or floaters in your field of vision
- Sudden vision loss
If you experience any of these symptoms, it’s important to seek immediate medical attention, as early treatment can help prevent further damage.
How to reduce your risk of diabetic retinopathy?
- Stabilize blood sugars every day through testing. Maintaining healthy blood sugar levels is crucial in preventing damage to your eyes and other organs. Work closely with your healthcare provider to monitor your glucose levels and aim for a target range that reduces the risk of complications. Continuous glucose monitoring systems or regular blood sugar checks can help you stay on track. Measure your blood sugars on waking and 2 hours after every meal to ensure that these readings get as close to 4−6 mmol/L (or 72−108 mg/dL) when fasting and below 7.8 mmol/L (140 mg/dL) 2 hours after meals.
- Adhere to any prescribed diabetes treatments, and use a pill reminder (like Ayudahealth) to ensure you take your medications on time.
- Eat a balanced diet for diabetes control. A Mediterranean-style diet has been clinically demonstrated to improve outcomes
- Report any changes in your vision to your doctor as soon as possible. Schedule regular vision check appointments with an optometrist. Since diabetic retinopathy may not cause symptoms in its early stages, regular eye exams are essential for catching the condition before it becomes severe. The American Diabetes Association recommends:
⦁ People with type 1 diabetes have an eye exam within five years of diagnosis.
⦁ People with type 2 diabetes have an exam at the time of diagnosis.
⦁ Pregnant women with diabetes should have an eye exam in the first trimester and monitor any changes throughout pregnancy.
Dilated eye exams, where eye drops are used to widen the pupil, allow your eye doctor to see the retina more clearly and check for signs of damage. - Manage blood pressure and cholesterol: High blood pressure and elevated cholesterol can worsen diabetic retinopathy and increase your risk of other complications. Maintaining healthy blood pressure and cholesterol levels through diet, exercise, and medication (if prescribed) can reduce the strain on your blood vessels, including those in the eyes.
- Exercise Regularly: Physical activity can help regulate blood sugar, improve circulation, and lower blood pressure. Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking or swimming. Always check with your doctor before starting a new exercise program, especially if you have existing health conditions.
- Avoid Smoking: Smoking can accelerate the damage to blood vessels and worsen complications from diabetes, including retinopathy. If you smoke, quitting is one of the best things you can do for your overall health, including your eye health. There are numerous resources available to help you quit, including support groups, counselling, and medications.
Conclusion
Diabetic retinopathy is a serious complication of diabetes, but with proper care and regular eye check-ups, it can often be prevented or managed. Controlling your blood sugar, blood pressure, and cholesterol, along with maintaining a healthy lifestyle, will significantly reduce your risk of developing diabetic retinopathy. By staying proactive about your eye health and diabetes management, you can protect your vision and maintain a high quality of life.
Frequently asked questions about diabetic retinopathy
The treatment of diabetic retinopathy depends on its severity:
⦁ Early Stages: In mild to moderate cases, managing diabetes by controlling blood sugar, blood pressure, and cholesterol levels can slow or stop progression.
⦁ Advanced Stages: In more advanced cases, treatments may include:
⦁ Laser Surgery: To shrink abnormal blood vessels and prevent bleeding.
⦁ Injections: Medications such as anti-VEGF agents (e.g., ranibizumab, aflibercept) or corticosteroids can be injected into the eye to reduce swelling and prevent new blood vessels from forming.
⦁ Vitrectomy: A surgical procedure that removes blood from the middle of the eye (vitreous) and scar tissue on the retina that can cause detachment.
A healthy diet can play a crucial role in managing diabetes and preventing complications like diabetic retinopathy. Some key dietary recommendations include:
⦁ Leafy Greens: Vegetables like spinach, kale, and collard greens are rich in lutein and zeaxanthin, antioxidants that help protect the retina from damage.
⦁ Omega-3 Fatty Acids: Found in fatty fish like salmon, sardines, and mackerel, omega-3s can reduce inflammation and may help protect against diabetic eye complications.
⦁ Vitamin C and E: Citrus fruits, berries, and nuts provide vitamins that have antioxidant properties and may help protect the eyes.
⦁ Whole Grains: Foods like brown rice, quinoa, and oats have a low glycemic index, helping to control blood sugar levels.
⦁ Nuts and Seeds: Almonds, walnuts, and flaxseeds contain healthy fats and antioxidants that support overall eye health.
⦁ Avoid Refined Carbs and Sugary Foods: Reducing the intake of foods that cause blood sugar spikes is essential for controlling diabetes and lowering the risk of retinopathy.
While there are no specific medications to prevent diabetic retinopathy, managing diabetes with medications like insulin, metformin, or other glucose-lowering drugs is critical. Additionally, medications for high blood pressure (like ACE inhibitors) and cholesterol (such as statins) can help protect blood vessels and reduce the risk of retinopathy.
There is no cure for diabetic retinopathy, but with proper treatment and lifestyle modifications, the progression of the disease can be slowed, and vision loss can be minimized. Early detection and prompt treatment are key to preserving vision in people with diabetes.
