Published on Sep 27, 2018 and last reviewed on Oct 10, 2019 - 3 min read
Diabetes has become a lifestyle-related epidemic in our country. It being a vascular disease manifests in blood vessels throughout our body. The eye is the one and only place where we can see these changes happening to our blood vessels in vivid detail. Hence, diabetic retinopathy has been given a lot of importance and screening for it is seen in many diabetics. This article looks at what symptoms patients with diabetic retinopathy experience and when would be the best time to have a doctor examine the retina to screen for diabetic retinopathy.
Diabetes has become a lifestyle-related epidemic in our country. It being a vascular disease manifests in blood vessels throughout our body. The eye is the only place where we can see these changes happening to our blood vessels in vivid detail. Hence, diabetic retinopathy has been given a lot of importance and screening for it is in vogue in all diabetics. This article looks at what symptoms patients with diabetic retinopathy experience and about when would be the best time to have a doctor examine the retina to screen for diabetic retinopathy.
Symptoms of Diabetic Retinopathy
The most common symptom of diabetic retinopathy is blurred vision. This can happen because of various vascular retinal changes caused by diabetes.
A sudden severe blackout over a matter of minutes to seconds can be due to vitreous hemorrhage.
A distorted image can be due to diabetic macular edema. It can also be due to secondary retinal vein occlusions.
A retinal detachment can happen in advanced proliferative diabetic retinopathy.
Other vision-threatening problems are ischemic optic neuropathy and severe dry eyes.
Importance of Screening for Diabetic Retinopathy
As diabetic retinopathy is a disease which can be prevented from worsening by screening, the screening of all patients with diabetes is of utmost importance. There are several known instances wherein an asymptomatic person would be diagnosed to have diabetes by merely performing retinal screening for diabetes. Patients already diagnosed with diabetes, whether on medication or not, will need to be screened for diabetic retinopathy as soon as possible, so as to not miss out on diabetic retinopathy and to prevent any future complications that might arise due to his/her retinopathy not being adequately managed.
The usual follow up schedule is yearly for mild to moderate cases, while severe cases will need three-monthly monitoring. The more severe the disease, the more frequent are the follow-ups required. Advanced cases will need to be reviewed every three months.
Screening is a hassle-free and non-invasive process requiring a dilated examination of the fundus. A few cases with high diabetic damage inside the eye will also need an estimation of their intraocular pressure, gonioscopy to check for blood vessels in their anterior chamber angles and slit lamp examination to look for bleeding vessels in their iris on every screening visit apart from fundus examination.
Importance of Controlling Diabetic Changes in the Retina
Since problems due to diabetic retinopathy are quite preventable when picked up at an early stage, the importance of regular screening and yearly follow-ups cannot be overemphasized. The retina is a nerve tissue, and just like any other nerve in our body, it has no regenerative potential. So, damage once done would be irreparable except in the very early stages of the disease in some patients.
The main dictum that applies in the treatment of diabetic retinopathy is the same as in the treatment of retinal disorders in general, and it is that we can never recover lost vision and treatment would only be aimed at minimizing the loss in visual potential. Hence, it makes all the sense in the world to screen for and prevent diabetic complications than to try to manage it later.
Medical Treatment of Diabetic Retinopathy
The mainstay of treatment of diabetes is oral/injectable antidiabetic medication, and the importance of diabetic control in the prevention of retinopathy cannot be overemphasized.
Retinopathy, in the proliferative stage, is usually treated with argon green laser, in a process called photocoagulation wherein the bleeding vessels are heat-sealed using lasers. This prevents bleeding into the eye and further loss of vision.
Ocular medication only becomes relevant in the case of neovascular glaucoma, a form of glaucoma resulting from the growth of new vessels over the anterior chamber angle causing a rise in the pressure inside the eye. The treatment for this involves the use of antiglaucoma medications such as Timolol maleate and/or Brimonidine, but even with these measures, patients with neovascular glaucoma rarely improve.
Surgery for Diabetic Retinopathy
Surgery for retinal disorders, in general, is only done as a palliative measure and will not result in any visual gains in general. These are usually required by diabetics with advanced disease and complications such as vitreous hemorrhage requiring vitrectomy or tractional retinal detachment due to proliferative diabetic retinopathy needing scleral buckling. The overall prognosis for such cases is poor. It is advisable to patients that they control their sugars well so as not to land up in such complications.
In general, diabetics with retinopathy can expect a wide and visual symptoms, but the symptoms which need a visit to an ophthalmologist are:
1. A sudden onset of blurring or diminution of vision.
2. Multiple floating objects in front of the eye.
3. Experiencing a sensation such as a falling of curtains followed by diminution of vision.
4. Pain in and around the eye with blurred or foggy vision.
Diabetic retinopathy is a preventable and treatable disease, provided patients have good compliance to follow-ups and present early on during the disease progression. Proper treatment with control of sugars can mitigate vision loss and support a healthy eye and good vision.
During the initial stages of the disease, the patient is usually asymptomatic. The first signs that the patient with diabetic retinopathy will show are the feeling of floaters or strings in the visual field that causes blurring of vision that might require medical consultation with a physician.
There are four stages of diabetic retinopathy. They are:
- Mild nonproliferative retinopathy.
- Moderate nonproliferative retinopathy.
- Severe nonproliferative retinopathy.
- Proliferative retinopathy.
The predominant cause for diabetic retinopathy would be diabetes. Over prolonged periods of uncontrolled blood glucose levels would lead to vasculopathy of the optic vasculature leading to damage and weakening of the eye vessels. At a severe stage, it might lead to starvation of oxygen to the eye vessels, and in a worst-case scenario, the patient might develop blindness.
Early diabetic retinopathy is more common and can be usually seen even immediately on the diagnosis of type 2 diabetes. However, late diabetic retinopathy or the proliferative retinopathy is seen only in case of poor treatment of diabetes, which is at uncontrolled levels.
There is no exact cure for diabetes, and diabetic retinopathy also has no cure. Surgery can temporarily relieve diabetic retinopathy, but it is not a cure. Especially with uncontrolled levels of diabetes, diabetic retinopathy can be promoted to further damage to retinal vessels and vision. You should ask your doctor for an opinion.
As diabetic retinopathy progresses due to increased levels of blood glucose from a range of being asymptomatic, the patient might mildly start developing symptoms. Initially, the patient will start seeing floaters, followed by strings, and later the vision begins to appear blurred. The vessel begins to get damaged, disposing of the retina with poor oxygenation. Once the retina has been progressively damaged, the patient might present with blindness, which is the worst complication of diabetes.
It is a chronic process from being diagnosed with diabetic retinopathy to blindness. It at least takes 20 years for the patient to develop severe visual symptoms if the blood glucose levels are uncontrolled and the failure to follow up even if treatment is started. Adequate treatment and follow up with the physician is mandatory for diabetic retinopathy to not progress to blindness.
The reversal of diabetic retinopathy is currently cannot be reversed. However, early symptoms can be treated and provided with symptomatic relief. But once the disease progresses to proliferative stages and especially blindness cannot be reversed. So treating the disease at the earlier stages with medications and surgery, maintaining a controlled level of blood glucose is the only solution.
The vision in a diabetic retinopathy patient is usually determined by the stage of the disease. It usually ranges from asymptomatic, followed by blurred, cloudy vision, and at the most terminal stages of retinopathy, the patient might present with blindness. If you are experiencing a lot of disturbances in the vision, you should contact your doctor immediately.
If diabetic retinopathy is not diagnosed early and treated with adequate follow-ups as per the advice of the physician, it might progress slowly to vision loss. Once vision loss occurs, then it is permanent damage. You should consult your doctor about the treatment plan that suits the best for you.
At the very early stages of diabetic retinopathy, the basic modality of treatment would be the prescription of glasses to treat diabetic retinopathy. It can help in coping up with the visual defect. But wearing glasses is not a cure for diabetic retinopathy.
A diabetic patient presenting with mild or severe visual deficits at the hospital would be subjected to a series of focused and detailed ophthalmic exams by the ophthalmologist, considering the history of diabetes. Diabetic retinopathy is usually diagnosed with the help of the results of the examination, and also, the stage is determined.
The early stages of diabetic retinopathy is not an emergency. However, during the late stages of the disease, when the patient experiences sudden acute unilateral or bilateral loss of vision, it is considered to be an emergency, and immediate medical care is warranted.
It is usually a chronic process that involves years to develop. But the level of increase in the blood glucose levels actually determines how quickly it might progress in different individuals based on their individual health.
No, retinopathy does not always lead to blindness in all affected individuals. It progresses to blindness only if left untreated or if the blood glucose levels are uncontrolled. Proper medical care limits the progression of the disease.
No, diabetic retinopathy is not rare. However, blindness is not common. At least 1 in 3 diabetics go through retinopathy in diabetes. Early awareness and patient education about the complications of diabetes may decrease the prevalence of diabetic retinopathy.
Some medical reports say that diabetic retinopathy is more common in type 2 diabetes, and at least 21% of type 2 diabetes patients suffer from diabetic retinopathy.
One of the common symptoms experienced by patients suffering from diabetes is eye pain. So, diabetic retinopathy is painful. When the patient experiences eye pain, the patient is suggested to immediately seek medical care.
Laser surgery is used to treat angiogenesis in diabetic retinopathy. It can treat and help in dealing with mild to moderate symptoms, but laser surgery is not the definitive cure. Laser surgery is not established, especially in the treatment of blindness in diabetic retinopathy.
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