Diabetic Eye Disease: Retinopathy and Maculopathy
What Is Diabetic Eye Disease?
Diabetes is a systemic condition that affects different parts of the body. Here at The Retina Clinic London, we focus on Retinopathy, a condition that begins to affect the walls of the smaller vessels within the eye, resulting in pouching (bulging) of the vessels. As this manifestation occurs it can result in leakages and bleeding within the eye. The lack of oxygen being supplied to the eye can cause abnormal vessels to grow and consequently lead to blindness.
Uncontrolled blood glucose levels can cause visual disturbances such as diabetic macula oedema, advanced diabetic eye complications and cataracts
Symptoms are not always noticeable however, blurred, or distorted central vision, sudden onset of floaters or loss of visual field in diabetic patients must be assessed at the earliest opportunity.
We recommend you have regular eye examinations regardless of whether you do not have any visual changes. This is because the diabetes can gradually affect your vision and if the Diabetic Retinopathy is too advanced, there is a chance it cannot be treated successfully.
What Is the Retina and How Does It Function?
The retina is a thin layer of tissue that lines the inside of the back of the eye.
The retina is supplied with oxygen and nourishment by blood vessels. Light enters through the front of the eye (cornea, pupil, and lens) and focuses on the retina.
Simply speaking, the retina can be divided into two main areas: the macula: responsible for our sharp and detailed central vision, and the mid and peripheral retina: responsible for our peripheral (side) vision and helps to detect movement.
The retina converts this light into electrical signals that eventually travel to the brain.
Who Can Get Diabetic Retinopathy and things to remember?
All patients with Diabetes are at risk of developing Diabetic Retinopathy.
The longer you are diabetic, the greater the risk.
What can you do to improve your diabetes?
You can reduce your risk of developing serious diabetic retinopathy if you:
- Continue to attend your regular diabetic eye appointments with OCT Scans and Ultra Widefield imaging of your retina. Here at The Retina Clinic London, we specialise in Diabetic screening and we would be happy to book an appointment for you to be checked.
- Maintain blood sugar (HbA1c), blood pressure and cholesterol at the levels agreed with your diabetic specialist (Endocrinologist) and GP.
- Exercise regularly, stay active and have a healthy diet involving portion control
- If you are a smoker, try to cut down or perhaps quit.
- Reduce alcohol consumption.
- We recommend visiting websites such as Diabetes UK for the most up to date information about the condition, diet, local social groups, and research, to help you better manage your diabetes.
What Does Diabetic Retinopathy Look Like?
Non-Proliferative Diabetic Retinopathy
Non-Proliferative Retinopathy is the term used to describe the earlier stages of Diabetic Retinopathy.
Small changes develop in the blood vessels that look like tiny red dots called microaneurysms. There may also be larger red blotches which are the result of haemorrhages that lie within the retina.
Non-Proliferative Retinopathy usually does not affect your sight and may not need treatment. However, it is essential that the condition is monitored and that your Diabetes is controlled as well as possible by your GP or Diabetic Specialist. The appropriate interval for visits to monitor the condition will be determined by Prof. Stanga. As time goes on, the blood vessels may become constricted, and the retina starved of oxygen and nutrition. This progression can lead to proliferative retinopathy and blindness if left untreated.
Proliferative Diabetic Retinopathy
This stage follows on from Non-Proliferative Retinopathy. At this point, you may develop abnormal, new, and fragile blood vessels.
By themselves, these new vessels may not cause symptoms or loss of vision. However, at this stage, your sight is already at risk as the new vessels may bleed or may develop scar tissue that can pull the retina away from the underlying layers of the eye. These complications may require vitrectomy surgery and laser to targeted areas to stabilise or improve vision and prevent blindness
Fundus Fluorescein Angiography (FFA) highlighting leaking new blood vessels (white areas) caused by Proliferative Retinopathy
If Diabetic Maculopathy is present, your central vision becomes affected. Reading the small print, distinguishing fine detail or faces and differentiating colours can become difficult.
This is normally caused by the small blood vessels leaking fluid, fats, and proteins into the macula. The swelling alongside this leakage is called Oedema. Intraocular injections such as Anti-VegF injections, or steroid implants of medications may be used to prevent further loss of vision and in some patients even improve it.
If the blood vessels in the macula become too constricted, oxygen cannot flow to the retina and the tissue will “starve”. This causes the cells that capture light to die and your sight to deteriorate.
The term for this condition is “Ischaemic Maculopathy”. There is no treatment for Ischaemic Maculopathy at the current time.
Prevention, by maintaining the best possible control of your Diabetes and other different blood parameters such as blood pressure are again essential.
How Will I Know If I Have Diabetic Retinopathy or Maculopathy?
Diabetic Retinopathy and Maculopathy may present on their own or in combination.
Initially, neither may cause visual symptoms. Even stages that require treatment may not cause visual symptoms in some patients.
Diabetic Retinopathy and Maculopathy are detected by examining the back of your eyes (retina) annually through fully dilated pupils. Non-invasive retinal imaging using OCT scans will be necessary.
Innovative technology such as Ultra-Wide Field photography which allows the visualisation of a significantly larger area of the retina compared to standard photography, as well as Swept-Source Optical Coherence Tomography (SS-OCT) and Angiography (SS-OCT) may allow for an earlier diagnosis.
Treatment For Diabetic Retinopathy and Maculopathy
If you develop Proliferative Diabetic Retinopathy (the growth of abnormal and new blood vessels) or Maculopathy, you will be advised to undergo tests and treatment.
The aim of treatment in Proliferative Diabetic Retinopathy is to stop the retina from forming new abnormal blood vessels.
If the treatment is successful, the new vessels will shrink and some of them even disappear over a few months.
The aim of treatment in Diabetic Maculopathy is to reduce the swelling or Oedema.
Treatment is tailored to the stage of disease and patient and can include one or more of the following: anti-VEGF or steroid injections, Pascal® laser or vitrectomy surgery.
Laser treatment can be applied either to a localised area or the entire retina with the exception of the macula, or both.
If you develop high eye pressure or glaucoma, then drops may be given to help control the pressure and decrease the change for any long-term damage.
If you have developed a cataract, then surgery is needed to remove the lens in your eye which is replaced with a clear artificial lens implant (intraocular lens).
If you have developed a vitreous haemorrhage (bleeding) or scar tissue causing a retinal detachment, it may be necessary for you to undergo vitrectomy surgery.