Diabetes is not only a disease where your blood glucose levels are elevated than usual, in fact diabetes affects many organs like the kidneys, the heart and of course the eyes. Uncontrolled diabetes is the leading cause for blindness in many developed countries.

What is diabetic retinopathy?

It is a name given to describe any retinal damage that happens because of diabetes either directly or indirectly.

The retina is like the film of the camera, it is the light sensitive tissue that prints the image on itself and wires it through the optic nerve to the brain for the image to be processed and understood.

If anything happens to the retina including its tissue, its blood supply, its nerve endings and/or  its surrounding tissue this means a faulty image will be sent to the brain and in some cases no image would be sent at all causing: total vision loss (aka blindness)!

How can diabetes affect the retina and its function?

High blood sugar has direct effects on our vessels’ walls, it can damage these vessels mildly, moderately and severely.

• In early mild cases, this damage only restricts the blood flow to the retinal tissue, this is usually a symptomless stage as the vessels quickly regenerates.
• In moderate, late cases these damaged vessels start to leak blood, still not affecting your vision but it has become an alarming situation.
• In severe and advanced stages, these vessels are totally blocked, giving our eyes no other option but to create new vessels. Unfortunately, these new vessels are abnormal, weak and rupture easily, leaking blood into the vitreous fluid of the eye.

This affects your vision by making it go blurry, patchy and blocking the light falling on the retina.

• In more advanced cases, uncontrolled bleeding may form retinal scars, separating the retina from itself: this known as retinal detachment. This means sudden vision loss.

What are the symptoms of diabetic retinopathy?

As we just mentioned, early stages of diabetic retinopathy can show no symptoms at all! You can go around living your life freely not knowing that leaving your diabetes uncontrolled is damaging your eyes. In more advanced stages, both your eyes are affected and you can suffer from:

• Eye floaters.
• Blurred vision
• Defect in color vision
• Dark areas in your visual field
• Finally, sudden or gradual vision loss.

Please consider visiting your ophthalmologist more often especially if you suspect any of the aforementioned symptoms and If you are:

1. A long-standing diabetic: the longer you have diabetes, the higher the risk of DR. the less control you have over your blood glucose levels, the higher the risk.
2. Of African origin: they are at higher risk for diabetic retinopathy.
3. A smoker: tobacco usage doubles your risks at DR.
4. Hypertensive or hypercholesterolemia: they are also considered risk factors of diabetic retinopathy.

How is diabetic retinopathy diagnosed?

A full general and local examination is in order. Many diabetic patients are diagnosed with diabetes type 2 for the first time inside the ophthalmology clinic!

So, when your doctor suspects DR he will ask you to do a complete blood picture and a postprandial, random and accumulative blood sugar tests.

This helps him diagnose diabetes and knows really how much is it under control!

For your local eye examination, your doctor will start with:

• Visual acuity tests
• Intra-ocular pressure test (since glaucoma is a complication of uncontrolled diabetes too)
• A slit-lamp examination for cataract diagnosis.

Then a more comprehensive examination is in order: Fundus examination!

This examination needs dilation of the pupils first, so your doctor can clearly see the insides of your eyes, as he needs to look for:

• Retinal blood vessels abnormalities.
• Retinal tissue swelling or fatty deposits.
• New blood vessels in the retina
• Retinal scar tissue
• Blood accumulation inside the vitreous body.
• Retinal detachment
• Any optic nerve abnormality.

Other tests include:

Fluorescein angiography and Optical coherence tomography.

All these tests and findings are crucial to diagnose retinal detachment and determine its stage and the best treatment plan!

Is diabetic retinopathy preventable?

Yes, DR is a preventable disease, if you put your blood sugar under control, avoid the risk factors of smoking and increased blood cholesterol levels and visit your doctor at least twice a year, then you are on the safe side of diabetes and your retina shall remain healthy.

What is diabetic retinopathy’s latest treatment options?

What if I already damaged my retinal blood vessels and the doctor diagnosed me with DR? What if you knew the consequences of leaving your diabetes uncontrolled too late?

Then according to your retinal injury your doctor will recommend many treatment options like:

1. Photocoagulation: it is a laser assisted therapeutic option, that can slow down and stop blood leakage from the newly formed abnormal vessels. It uses laser heat energy to close up those new vessels in a single outpatient session.
2. Vitrectomy: under local or general anesthesia, a simple surgery is needed where your eye surgeon removes the leaked blood from the vitreous body or remove the vitreous body itself!
3. Injecting Growth factors: some medications namely VEGF (Vascular Endothelial Growth Factors) could be injected directly into the eye. These factors halt the growth of new blood vessels by blocking their growth signals. It is still under study.

Magrabi’s advice

Diabetes is a disease not to be taken lightly, it has major effects on all your body, your eyes included. Its effect on your retina is undeniable and the cost may be your vision! To avoid most complications of diabetes it is best to keep your blood sugar under control, eat healthier and exercise more. And what is also important, is scheduling visits to your doctor at least twice a year. This helps detect unseen signs, diagnose diabetic retinopathy as early as possible and keep it under supervision and control!