What Is Diabetic Retinopathy: Symptoms, Causes, and Treatment

Diabetic retinopathy (also known as diabetic eye) is an eye condition that can affect people with diabetes. If the blood glucose levels are left unchecked for too long, it can cause severe complications, like blindness.

However, that complete loss of vision is the very late stage of the disease. There are many symptoms of high blood sugar and early stages of retinopathy that you can recognize before it’s too late.

As for patients already experiencing the condition, there are laser operations and surgeries that can help alleviate the symptoms and improve your vision.

Diabetic retinopathy is an eye condition that results from prolonged, uncontrolled diabetes due to damage and pathologic overgrowth of blood vessels on the light-sensitive layer of the eye, the retina.

People with diabetes usually have blood sugar levels that are constantly too high (hyperglycemia). This increase causes swelling and fluid leakage in the retina’s tiny blood vessels.

In more severe cases, abnormal blood vessels grow on the retina's surface, leading to various complications.

In most cases, people with diabetes who develop diabetic retinopathy don’t experience any symptoms until a considerable amount of damage has already been inflicted.

That’s why it’s always a good idea to visit an eye doctor periodically when a person is diagnosed with diabetes.

Once the symptoms show up, the person is in the intermediate stage of diabetic retinopathy. If the condition is still ignored, it may progress to an advanced stage with more severe symptoms.

Blurry or fuzzy vision may appear gradually or suddenly, depending on how fast the ocular blood vessels are affected. It’s often the first sign that tells a person with diabetes that something is wrong.

The blur affects both close and distant vision. If you have uncontrolled diabetes, you might find reading, driving, or recognizing faces a bit harder than usual.

Besides the affected vision, a person with uncontrolled diabetes may experience consistent floaters, which are dark spots or thread-like structures that look like they’re floating in the air.

These floaters result from leaking blood vessels or fluid buildup on the retina.

Peripheral vision is recognizing the presence of objects or people at the edge of your vision.

On developing diabetic retinopathy, a person with diabetes may gradually lose peripheral vision, rendering their eyesight similar to looking through a pair of binoculars.

The human eye gradually adapts to low light conditions by widening the pupil to let in more light.

However, a person with diabetes may not be able to fully utilize that extra light because of the blood vessel damage, leading to vision difficulties at night and low light conditions.

The constant damage and bleeding around the blood vessels can make the eye appear red. This is especially apparent if the bleeding is accompanied by abnormal formation of blood vessels.

It’s normal for us not to be able to directly look at excessively bright surfaces like the sun or mirrors that reflect it.

However, once the sensitivity to bright lights and regular reflections becomes heightened, regular day-to-day activities like driving become uncomfortable and even risky.

Unlike blurred vision, distorted vision is more severe. The person would see distorted lines and off-looking objects.

Distorted vision typically serves as one of the last warnings before losing vision, and it should be treated as a medical emergency requiring immediate hospitalization.

Extensive damage to blood vessels or severe bleeding within the eye can lead to complete retinal detachment, which causes gradual or sudden loss of vision in one or both eyes.

This is the most severe symptom of diabetic retinopathy, and people who experience it should immediately go to the emergency room.

Retinal detachment can be cured depending on how severe it is, but the primary step to take is to stop the damage before it proceeds further by seeking medical attention.

Despite having other causes, retinopathy’s most common cause is uncontrolled diabetes.

The chronically elevated glucose levels damage the small blood vessels in the retina through multiple mechanisms:

• Increase in osmotic stress (the minimum pressure before fluids start going through cell membranes), which causes the blood vessels around the eye to weaken and leak.
• Accumulation of Advanced Glycation End products (AGEs). These products result from the reaction between sugar and protein, and they result in inflammation and blockage of blood vessels.
• The fluctuating blood sugar levels damage the blood vessels by repeatedly inducing swelling and contraction.

The longer the person lives with uncontrolled diabetes, the more prominent the damage will become.

Increased blood pressure can cause retinopathy on its own or contribute to increasing an existing retinopathy. The increased pressure creates mechanical stress on the delicate retinal blood vessels, causing damage and bleeding.

This bleeding eventually results in edema (swelling caused by fluid leakage), which progresses to ischemia (inadequate blood supply) that causes even more damage.

Pregnancy on its own is unlikely to cause retinopathy. However, if the mother is suffering from uncontrolled gestational diabetes, pregnancy can increase the severity of diabetic retinopathy symptoms.

Gestational diabetes happens because of hormonal changes that alter both glucose control in the bloodstream and the vascular permeability of blood vessels in general.

Uncontrolled high cholesterol, often resulting from relying heavily on fatty foods or those who have genetic abnormalities, can also contribute to the development of neuropathy.

High cholesterol promotes inflammation, blood vessel occlusion, and atherosclerotic changes in the retina.

Further, high cholesterol exacerbates ischemia and abnormal blood vessel growth in the retina.

One of the common causes of retinopathy is diabetes, which is why you should begin your treatment by addressing the primary concern: the dangerously high blood sugar levels.

You can start by visiting a doctor to get a clear assessment of your condition. If you have type 2 diabetes, then you should immediately start modifying your lifestyle, exercising, adhering to an insulin resistance diet, and avoiding stress. In some cases, your doctor may even prescribe injectable insulin.

On the other hand, if you have type 1 diabetes, then you should go back to taking your insulin regularly. Pair that with a healthy, balanced diet to give your body the strength it needs to stay healthy.

If the reason behind your inconsistent insulin administration is fear of needles, consider utilizing InsuJet injectors, a modern approach to insulin administration that painlessly injects insulin without a needle and without pain.

InsuJet injectors not only take the needle out of the equation but also reduce infection rates, improve insulin absorption, and save the environment by eliminating needle waste.

By controlling blood sugar levels, you eliminate the primary causative factor.

Laser surgery isn’t just for correcting eyesight but also for sealing the leaking blood vessels. Using a focal laser will stop the fluid accumulation. Alternatively, grid pattern laser (pan-retinal photocoagulation) can shrink the abnormal blood vessels.

VEGF, or Vascular Endothelial Growth Factor, is an angiogenic factor that promotes the growth of abnormal blood vessels in proliferative retinopathy.

It’s possible to use anti-VEGF injections to the eye, like ranibizumab or bevacizumab, to treat macular edema by reducing leaking and inflammation.

Vitrectomy is a surgical procedure that treats various ocular problems.

The vitreous is a gel-like substance inside the eye. The vitreous gets inflamed and/or infected when there's excessive bleeding. The hemorrhage may also cause scar tissue, which further worsens the condition.

This surgery removes infected vitreous gel and excessive scar tissue, which can clear the clouded vision and reduce the growth of new blood vessels.

Anti-inflammatory medications and steroids can help reduce the constant inflammation within the vitreous and ocular blood vessels.

While this doesn’t directly treat the retinopathy, it’s often used with other methods to help alleviate the symptoms.

Whether the patient has diabetes or not, managing blood pressure and cholesterol can greatly reduce the severity of the retinopathy. You can reduce your high blood pressure and improve your cholesterol levels through various methods, including:

• Losing weight
• Eating a healthy diet
• Quitting alcohol and smoking
• Sleeping well
• Reducing stress

In some cases, management and lifestyle may not be enough to help you control your blood pressure and/or cholesterol levels. Sometimes, you’ll have to seek medical treatment and go on some medications.

Early diagnosis always puts you at an advantage against any disease. If you are well aware of the signs of hyperglycemia, like increased thirst, frequent urination, and feeling unusually tired, you’ll start handling the condition early, which improves the prognosis.

Diabetic retinopathy may threaten eyesight, but it’s a complication of the latest stages. Recognizing the early signs like blurry vision, eye redness, and peripheral vision loss can stop the progression of the diseases early on.

It’s best to prevent the condition rather than treat it. But, should it happen, you can seek medical attention. Corrective laser surgeries and anti-VEGF injections can go a long way in treating retinopathy.