Diabetic retinopathy (DR) or blurry vision in diabetes is the loss of sharpness of eyesight, making objects appear out of focus and hazy. It is a leading cause of vision loss globally estimating 300 million people with type 1 diabetes globally, approximately one-third of the diabetic population have symptoms of DR and out of these, a further one-third of DR is vision-threatening DR condition, including diabetic macular edema. When you are diabetic & often find yourself blinking, squinting, or rubbing your eyes to gain a clearer view. This condition could be the risk for an eye disease called diabetic retinopathy.
Over time, high blood sugar can damage the tiny blood vessels in your retina, the part of your eye that senses light. That can lead to swelling in a part of the retina called the macula, new and unwanted blood vessels growing in the eye, and bleeding inside the eye. 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.
Along with blurry vision, diabetic eye disease may also cause:
- Floating” spots in your field of vision
- Permanent loss of vision
- Spots or dark strings floating in your vision (floaters)
- Blurred vision
- Fluctuating vision
- Dark or empty areas in your vision
- Vision loss
Am I at risk for diabetic retinopathy?
Anyone with any kind of diabetes can get diabetic retinopathy — including people with type 1, type 2, and gestational diabetes (a type of diabetes that can develop during pregnancy). Your risk increases the longer you have diabetes. Over time, more than half of people with diabetes will develop diabetic retinopathy. The good news is that you can lower your risk of developing diabetic retinopathy by controlling your diabetes.
Women with diabetes who become pregnant — or women who develop gestational diabetes — are at high risk for getting diabetic retinopathy. If you have diabetes and are pregnant, have a comprehensive dilated eye exam as soon as possible. Ask your doctor if you’ll need additional eye exams during your pregnancy.
Stages of diabetic retinopathy
Mild nonproliferative diabetic retinopathy (NPDR) In this stage, small areas of balloon-like swelling — called microaneurysms — form in the retinal blood vessels and may leak fluid into the retina.
Moderate NPDR As the disease progresses, blood vessels that provide important nourishment to the retina may swell and lose their ability to transport blood. During this stage, the appearance of the retina may change as a result of these symptoms. But these changes would only be visible to your eye doctor during a comprehensive eye exam.
Severe NPDR In this stage, the blood supply to the retina is disrupted, leading to more damage in the blood vessels.
Proliferative diabetic retinopathy (PDR) At this advanced stage of DR, the retina secretes growth factors (substances that stimulate cell growth) to generate new blood vessels. These new blood vessels grow along the inside surface of the retina as well as in the vitreous gel, the jelly-like fluid that fills the center of the eye. Because they’re fragile, these new blood vessels are more likely to leak and bleed, producing scar tissue that can shrink and lead to retinal detachment — the pulling away of the retina from underlying tissue.
Risk factors
Long untreated diabetes can lead to diabetic retinopathy. The risk of developing the eye condition can increase as a result of:
- Having untreated diabetes for a long time
- Poor control of your blood sugar level
- Unstable blood pressure
- High cholesterol
- Pregnancy
- High Tobacco use
Other problems of diabetic retinopathy
Diabetic macular edema (DME). Over time, about 1 in 15 people with diabetes will develop DME. DME happens when blood vessels in the retina leak gel-like fluid into the macular region (a part of the retina needed for sharp, central vision). This causes blurry vision.
Neovascular glaucoma. Diabetic retinopathy can cause abnormal blood vessels to grow out of the retina and block fluid from draining out of the eye. This causes a type of glaucoma (a group of eye diseases that can cause vision loss and blindness).
Retinal detachment. Diabetic retinopathy can cause scars to form in the back of your eye. When the scars pull your retina away from the back of your eye, it’s called tractional retinal detachment.
Vitreous hemorrhage. The new blood vessels may bleed into the clear, jellylike substance that fills the center 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.
Blindness. Diabetic retinopathy, macular edema, glaucoma or a combination of these conditions can lead to complete vision loss, especially if the conditions are poorly managed.
Prevention
In early diabetic retinopathy, laser photocoagulation treatment can be used effectively for preventing loss of vision. However, early diabetic retinopathy is not noticed by patients because of the absence of visual loss in early diabetic retinopathy. Thus, regular retinal exams with dilation of the pupil are necessary in patients with diabetes problems in order to detect sight-threatening changes timely and enable ophthalmologists to perform the timely treatment.
In type 2 diabetes, the first retinal diagnostics should be performed immediately after the first diagnosis of diabetes, because the previous duration of the disease is unknown. Annual follow-up examinations are recommended in the absence of retinal changes, otherwise shorter intervals are recommended.
Pregnancy bears an increased risk of worsening of diabetic retinopathy due to hormonal changes. During pregnancy, diabetic retinopathy may start in about 10% of cases and may worsen in an even higher percentage in case of preexisting diabetic retinopathy at time of conception
You can reduce your risk of developing diabetic retinopathy, or help stop it from getting worse, by keeping your blood sugar levels, blood pressure, and cholesterol levels under control. This can often be done by making healthy lifestyle choices, although some people will also need to take medication. Adopting a few lifestyle changes can improve your general health and reduce your risk of developing retinopathy. These include:
- Eating a healthy, balanced diet – in particular, try to cut down on salt, fat, and sugar & focus on eye health nutrients and supplements.
losing weight if you’re overweight – you should aim for a BMI of 18.5-24.9; use the BMI calculator to work out your BMI
- Exercising regularly
Aim to do at least 150 minutes of moderate-intensity activity, such as walking or cycling, a week; doing 10,000 steps a day can be a good way to reach this target
- Stopping smoking if you smoke
not exceeding the recommended alcohol limits – men and women are advised not to regularly drink more than 14 alcohol units a week
- Keep track of your blood sugar
If you check your blood sugar level at home, it should be 4 to 10mmol/l. The level can vary throughout the day, so try to check it at different times.
The check done at your GP surgery is a measure of your average blood sugar level over the past few weeks. You should know this number, as it is the most important measure of your diabetes control.
It’s called HbA1c, and for most people with diabetes it should be around 48mmol/l or 6.5%
- Maintaining blood pressure
You can ask for a blood pressure test at your GP surgery, or you can buy a blood pressure monitor to use at home. Blood pressure is measured in millimeters of mercury (mmHg) and is given as 2 figures.
If you have diabetes, you’ll normally be advised to aim for a blood pressure reading of no more than 140/80mmHg, or less than 130/80mmHg if you have diabetes complications,
- Maintaining cholesterol
Your cholesterol level can be measured with a simple blood test carried out at your GP surgery. The result is given in millimoles per liter of blood (mmol/l).
If you have diabetes, you’ll normally be advised to aim for a total blood cholesterol level of no more than 4mmol/l.
Ask your eye doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test, or hemoglobin A1C 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% 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 eye doctor right away if your vision suddenly changes or becomes blurry, spotty, or hazy.
- Regular screening
Even if you think your diabetes is well controlled, it’s still important to attend your annual diabetic eye screening appointment, as this can detect signs of a problem before you notice anything is wrong. Early detection of retinopathy increases the chances of treatment being effective and stopping it from getting worse.
You should also contact your doctor or diabetes care clinic immediately if you develop any problems with your eyes or vision, such as:
- gradually worsening vision
- sudden vision loss
- shapes floating in your field of vision (floaters)
- blurred vision
- eye pain or redness
