Diabetic retinopathy can happen when the blood vessels in the retina become damaged due to diabetes.

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What Is Diabetic Retinopathy?

Types and Stages of Diabetic Retinopathy

Diabetic retinopathy progresses through several stages:

Nonproliferative Diabetic Retinopathy (NPDR)

This is the earliest stage of diabetic retinopathy. In NPDR, the tiny blood vessels in the retina begin to
weaken and leak blood or fluid. This can cause swelling in the retinal tissue and lead to the formation of
small deposits called exudates. Many individuals with mild NPDR may not notice changes in their vision.

Macular Edema

Macular edema occurs when fluid leaks into the macula, the central portion of the retina responsible for sharp, detailed vision. This swelling or thickening of the macula is the most common cause of vision loss in people with diabetes. Vision changes can range from mild blurring to more significant impairment, although peripheral vision may remain unaffected.

Macular Ischemia

Macular ischemia develops when small retinal blood vessels (capillaries) close or become blocked. As a result, the macula does not receive adequate blood supply, causing blurred or reduced central vision.

Proliferative Diabetic Retinopathy (PDR)

In advanced stages of diabetic retinopathy, abnormal new blood vessels grow on the surface of the retina and extend into the vitreous cavity of the eye. These vessels are fragile and may rupture, causing bleeding that can obstruct vision. Scar tissue may also develop, potentially distorting the retina or leading to retinal detachment. These abnormal vessels develop when diabetes causes closure of normal blood vessels in the peripheral retina.

Causes of Diabetic Retinopathy

Diabetic retinopathy develops as a complication of diabetes mellitus. When blood sugar levels remain elevated for prolonged periods, the delicate blood vessels within the retina can become damaged.

The retina relies on a healthy network of blood vessels to deliver oxygen and nutrients. Damage to these vessels interferes with normal retinal function and may lead to swelling, bleeding, or abnormal blood vessel growth.

Risk Factors

Individuals with diabetes are at risk of developing diabetic retinopathy. The best protection against vision loss is early detection and proper diabetes management.

Risk reduction strategies include:

• Maintaining good control of blood glucose levels
• Managing blood pressure and cholesterol
• Attending regular eye examinations with an ophthalmologist

People with diabetes should have a comprehensive eye examination at least once per year. Pregnant women with diabetes should schedule an eye examination during the first trimester, as diabetic retinopathy may progress more rapidly during pregnancy.

Diagnosis

Diabetic retinopathy often develops without noticeable symptoms in its early stages. By the time vision problems appear, the disease may already be advanced.

Regular comprehensive eye examinations are essential for early detection.

During a medical eye examination, your ophthalmologist can examine the retina for signs of diabetic damage. If diabetic retinopathy is detected, additional diagnostic tests may be recommended, including:

• Fluorescein Angiography – evaluates blood flow in the retinal vessels and identifies areas of leakage or blockage
• Optical Coherence Tomography (OCT) – provides detailed cross-section images of the retina to detect swelling or structural changes

Following diagnosis, more frequent monitoring may be required to track disease progression.

Treatment Options

In the earliest stages of diabetic retinopathy, treatment may not be necessary unless macular edema is present. However, as the condition progresses, several treatment options are available to help preserve vision.

Macular Edema

Anti-VEGF Injections

Anti-vascular endothelial growth factor (anti-VEGF) medications are currently the first-line treatment for diabetic macular edema. These medications are injected into the eye to reduce fluid leakage from damaged blood vessels and improve vision.

Focal Laser Treatment

Focal laser therapy may be used in some cases to seal leaking blood vessels in the retina. However, this treatment is used less frequently today due to the effectiveness of anti-VEGF medications.

Macular Ischemia

Currently, there are no effective treatments available to restore vision once macular ischemia develops.

Proliferative Diabetic Retinopathy

Pan-Retinal Photocoagulation (Laser Treatment)

This laser procedure targets the peripheral retina to shrink abnormal blood vessels and reduce the risk of bleeding. Treatment is usually performed over two or more sessions. Although some peripheral or night vision may be affected, this procedure can significantly reduce the risk of severe vision loss.

Vitrectomy Surgery

If significant bleeding occurs inside the eye or if retinal detachment develops, a surgical procedure called a vitrectomy may be required. During this procedure, a retinal specialist removes blood and scar tissue from the eye and performs laser treatment to prevent further abnormal vessel growth.

Regular eye examinations are essential for individuals living with diabetes. Early detection and timely treatment can help protect vision and prevent complications associated with diabetic retinopathy. At Ajax Ophthalmology Associates, our ophthalmology team is dedicated to providing comprehensive diabetic eye care and advanced diagnostic and treatment options.