Diabetic retinopathy

There are four stages of diabetic retinopathy: mild, moderate and severe nonproliferate, and proliferative retinopathy. In the mild form (pictured), microaneurysms occur. As the disease progresses to the moderate form, blood vessels that nourish the retina are blocked. In the severe form more blood vessels are blocked and the retinal sends signals to grow new blood vessels.

During the most advanced stage, proliferative retinopathy, new blood vessels form that are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. If they leak blood, severe vision loss and even blindness can result. This photo simulates the vision changes in a patient with proliferative retinopathy.

Macular edema occurs when fluid leaks into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. In this image, red blood vessels are seen emerging from the optic disc (right), and dark and yellow patches over the macula (center). These patches are exudates that have leaked from blood vessels damaged by diabetes.

Patients with diabetic retinopathy need more frequent eye exams. It is possible to reduce the risk of blindness by 95% with timely treatment and appropriate follow-up care.

The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight-saving laser surgery.

Treatment is with scatter laser treatment. It involves applying 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment.

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.

Diabetic retinopathy can develop in anyone who has type 1 diabetes or type 2 diabetes. Risk increases the longer a patient has diabetes and with uncontrolled blood glucose.

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