Retinopathy - diabetic; Photocoagulation - retina
Diabetic retinopathy is damage to the eye's retina that occurs with long-term diabetes.
Diabetic retinopathy is caused by damage to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. It changes light and images that enter the eye into nerve signals that are sent to the brain.
There are two types, or stages of diabetic retinopathy:
Having more severe diabetes for a longer period of time increases the chance of getting retinopathy. Retinopathy is also more likely to occur earlier and be more severe if your diabetes has been poorly controlled.
Almost everyone who has had diabetes for more than 30 years will show signs of diabetic retinopathy.
Most often, diabetic retinopathy has no symptoms until the damage to your eyes is severe.
Symptoms of diabetic retinopathy include:
Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.
The health care provider can diagnose diabetic retinopathy by dilating your pupils with eye drops and then carefully examining the retina. A retinal photography or fluorescein angiography test may also be used.
If you have nonproliferative diabetic retinopathy, your health care provider may see:
If you have proliferative retinopathy, your health care provider may see:
To prevent diabetic retinopathy:
People with the earlier form (nonproliferative) of diabetic retinopathy may not need treatment. However, they should be closely followed by an eye doctor who is trained to treat diabetic retinopathy.
Treatment usually does not reverse damage that has already occurred. However, it can help keep the disease from getting worse. Once your eye doctor notices new blood vessels growing in your retina (neovascularization) or you develop macular edema, treatment is usually needed.
Several procedures or surgeries are the main treatment for diabetic retinopathy.
Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels.
A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may also be used to repair retinal detachment.
Drugs that prevent abnormal blood vessels from growing, and corticosteroids injected into the eyeball are being investigated as new treatments for diabetic retinopathy.
If you cannot see well:
American Diabetes Association -
National Diabetes Information Clearinghouse -
Prevent Blindness America -
You can improve your outcome by keeping good control of your blood sugar and blood pressure.
Treatments can reduce vision loss. They do not cure diabetic retinopathy or reverse the changes that have already occurred.
Once proliferative retinopathy occurs, there is always a risk for bleeding. You will need to be monitored regularly, and you may need more treatment.
Other problems that may develop are:
Call for an appointment with an eye doctor (ophthalmologist) if you have diabetes and you have not seen an ophthalmologist in the past year.
Call your doctor if any of the following symptoms are new or are becoming worse:
Tight control of blood sugar, blood pressure, and cholesterol is very important for preventing diabetic retinopathy.
Do not smoke. If you need help quitting, ask your doctor or nurse.
You may not know there is any damage to your eyes until the problem is very bad. Your doctor can catch problems early if you get regular exams. You will need to see an eye doctor who is trained to treat diabetic retinopathy.
Begin having eye examinations as follows by an eye doctor skilled in the treatment of diabetic retinopathy:
If you are beginning a new exercise program or are planning to get pregnant, have your eyes examined. Avoid resistance or high-impact exercises, which can strain already weakened blood vessels in the eyes.
If you are at low risk, you may need follow-up exams only every 2 - 3 years. The eye exam should include dilation to check for signs of retinal disease (retinopathy).
American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.
O'Doherty M, Dooley I, Hickey-Dwyer M. Interventions for diabetic macular oedema: a systematic review of the literature. Br J Opthalmol. 2008;92:1581-1590.
Diabetic Retinopathy Clinical Research Network (DRCR.net), Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009;127:245-251.
© 2011 University of Maryland Medical Center (UMMC). All rights reserved.
UMMC is a member of the University of Maryland Medical System,
22 S. Greene Street, Baltimore, MD 21201. TDD: 1-800-735-2258 or 1.866.408.6885