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Diabetic retinopathy is anÌýeye diseaseÌýin which high blood sugar damagesÌýsmallÌýblood vessels in theÌýretina, the light-sensitive layer at the back of the eye.ÌýThese weakened vessels canÌýleak fluid or blood, causingÌýswellingÌýin the central part ofÌývisionÌý(macular edema). Without treatment, the conditionÌýcan progress to vision loss or blindness.ÌýThough there are otherÌýdiabetes-related eye diseases,Ìýit is theÌýleading cause of vision loss among working-ageÌýadults.ÌýÌý

What are the different stages?

There are two stages of diabetic retinopathy:Ìýproliferative and non-proliferative.ÌýNon-proliferative diabetic retinopathyÌý(NPDR) is the earlyÌýstage of diabeticÌýretinopathy in whichÌýthe bloodÌývessels are compromised.ÌýIndividuals may appear asymptomatic, yet internal signsÌýsuch as bleeding at the back of the eyeÌýand reduced oxygen supply to the retina may be present.ÌýThese changesÌýresult inÌýmicroaneurysms, orÌýtiny bulges inÌýblood vesselsÌýin the retina.ÌýNPDR is managed through regular monitoring and careful control of blood sugar levels and other contributing risk factors to prevent disease progression.Ìý

Proliferative diabeticÌýretinopathyÌý(PDR)Ìýis theÌýadvancedÌýstage of diabetic retinopathy,Ìýcharacterized byÌýneovascularization,ÌýwhereÌýnewÌýblood vessels begin to growÌýin response to aÌýlack of oxygen.ÌýThese blood vessels are prone toÌýleakage andÌýbleedÌýinto the vitreous fluid.ÌýScar tissue resulting from neovascularization can lead toÌýadditionalÌýcomplications, potentially causing irreversible loss of both central and peripheral vision.Ìý

Who does it affect?

Diabetic retinopathyÌýaffectsÌýindividuals with diabetes,Ìýespecially those with longer duration of disease or poor glucose control.ÌýAdditionalÌýrisk factors include high blood pressure, high cholesterol, smoking, kidneyÌýdisease and sleep apnea. It often appears earlier in people with type 1 diabetes and later in those with type 2 diabetes.Ìý

Symptoms are minimal or absent inÌýearly stages, but as diabetic retinopathyÌýprogressesÌýindividuals may notice:Ìý

• Blurred orÌýfluctuatingÌývisionÌý

• DifficultyÌýseeing at night orÌýdrivingÌýin the darkÌý

• Dark floatersÌýor spotsÌýin the visionÌý

• Flashes of lightÌýÌý

• GradualÌýor suddenÌýworseningÌýofÌývisionÌý

If you notice any of these symptoms,ÌýcontactÌýyour eye care providerÌýimmediately.ÌýAnnualÌýeye exams are extremely importantÌýforÌýpeopleÌýwithÌýdiabetesÌýsinceÌýtheyÌýare at a higher risk of developing eye diseases.ÌýThe frequencyÌýof eye examinationsÌýdepends on the stage of diabetic retinopathy.ÌýÌý

How is diabetic retinopathy diagnosed?Ìý

There are several methods and tools used to diagnose diabetic retinoscopy.Ìý

• Dilated fundus examination:ÌýThis exam involves enlarging the pupil with eye drops to allow a clearer view of the retina and other internal structures of the eye.ÌýIt helps detect early signs of diabetic retinopathy and otherÌýabnormalities andÌýis recommended annually for individuals with diabetes.Ìý

• Fundus photography:ÌýThis medical test takes pictures of theÌýback of the eye, including theÌýmaculaÌýand optic nerve.Ìý

• Optical Coherence Tomography (OCT) scans:ÌýThese are non-invasive imagingÌýtests that take cross-sectional images of the retinaÌýand retinal lining. This scan can give us useful informationÌýsuch as whetherÌýdiabetic macular edemaÌýis present. It can alsoÌýtrackÌýtreatment progression.Ìý

• Fluorescein angiography:ÌýThis procedureÌýisÌýcompleted by an ophthalmologist andÌýinvolves injecting aÌýcontrastÌýdye called fluoresceinÌýinto theÌýbloodstreamÌýand a detailed photo is then takenÌýto detect anyÌýleaks,ÌýblockagesÌýand neovascularization.ÌýÌý

Treatment for NPDR may or may not beÌýnecessary butÌýwillÌýincludeÌýclose monitoring ofÌýendocrineÌýhealth and prioritizingÌýhealthy blood sugar levels.ÌýTight blood sugar management and control of other risk factors can slow progression and sometimes improveÌývision.ÌýMaking dietary adjustments, exercising regularlyÌýandÌýclosely managingÌýdiabetes can keep diabetic retinopathy from developing rapidly.ÌýHowever,ÌýifÌýthe disease progresses toÌýPDRÌýor macular edema,Ìýophthalmic treatment will be necessary.ÌýÌý

Eye injections, known asÌýanti-VEGF medications,ÌýareÌýa common treatmentÌýoptionÌýas they can help reduceÌýblood vessel growthÌýandÌýleakage.ÌýAnÌýophthalmologist will administer these injections andÌýcreate an individualizedÌýtreatment schedule.ÌýSometimes the frequency can be reduced if the patient responds well to the treatment.Ìý

³¢²¹²õ±ð°ùÌý³Ù°ù±ð²¹³Ù³¾±ð²Ô³ÙÌýis used to seal off leaky blood vessels to reduce swelling. ItÌýcan also be used to shrinkÌýbloodÌývessels and prevent new growth.ÌýÌý

³Õ¾±³Ù°ù±ð³¦³Ù´Ç³¾²âÌýsurgery may be necessary inÌýadvanced cases with persistent vitreous hemorrhage or retinal detachment.ÌýThis procedure clears blood or scar tissue.ÌýAs part of the process, the ophthalmologist will remove the eye’sÌýnatural vitreousÌýhumour, a gel-like substance,ÌýandÌýreplaceÌýit withÌýaÌýsolution such as saline or silicone oil.ÌýAs the eye heals, it will replace this solution withÌýnatural vitreousÌýhumour.ÌýThese treatments are performedÌýbyÌýophthalmologistsÌýand the treatment choice and frequency depend on disease stage and individual response; your eye care provider will recommend the best plan.Ìý

If you have diabetes, it is crucial to workÌýwith your health-care teamÌýto control your blood sugar levels as best you can.ÌýReducing large fluctuations in blood sugar levelsÌýcan play a huge role. Additionally,Ìýmanaging other systemic conditionsÌýsuch as high blood pressure or cholesterol, and working along with a diabetic dietician, familyÌýdoctorÌýand/or endocrinologistÌýare some of the best ways to prevent diabetic retinopathy.ÌýEnsuring you get your eyes checked regularly by your eye care provider is essential in helping to prevent diabetic retinopathy orÌýother diabetes-related eye diseases.Ìý

If you haveÌýprediabetes,ÌýmetabolicÌýsyndromeÌýor a family history of diabetes, workingÌýwith your physician to controlÌýfactors such as your weight, cholesterol levels and blood pressure may preventÌýor delayÌýthe onset ofÌýdiabetes. This is important because the longer you have diabetes, the greaterÌýyourÌýrisk of diabetic retinopathy.Ìý

At theÌýÀ¶Ý®ÊÓƵ Eye Institute, weÌýoffer specialized care forÌýpatients with diabetes and diabetic retinopathy, from earlyÌýdetection to advanced treatment coordination.ÌýOur team providesÌýcomprehensive eye exams, including dilated fundus examinationsÌýtoÌýidentifyÌýsigns of diabetic eye disease. For patients with diabetic retinopathy, we focus on staging the condition andÌýworking closely with your health-care providers to manage systemic factors like blood sugar, bloodÌýpressureÌýand cholesterol.ÌýIn more advanced cases, such as proliferative diabetic retinopathy, we may refer patients to anÌýophthalmologist for further treatment.ÌýÌý

Appointments for diabetic retinopathy care can be made directly or through referral from our Primary Care Service, which offers full-scope eye exams.ÌýIf you have diabetes, theÌýOntario Health Insurance Plan (OHIP) coversÌýone comprehensive eye exam and two follow-ups a year.ÌýYour optometrist may recommend advanced tests, such as OCT scans, which carry anÌýadditionalÌýcost to the patient.Ìý

University of À¶Ý®ÊÓƵ students, employees and theirÌýdependentsÌýare eligibleÌýfor discounts on eye exams and glasses.ÌýSpeak to À¶Ý®ÊÓƵ Eye Institute staff forÌýmoreÌýdetails.Ìý

The University of À¶Ý®ÊÓƵ School of Optometry and Vision Science ranks fifth worldwide in research output among optometry schools.ÌýResearchers at the University of À¶Ý®ÊÓƵ have contributed to severalÌýimportantÌýstudiesÌýon diabetic eye disease.ÌýÌý

IfÌýyou’reÌýinterested inÌývolunteering as a research participant, considerÌýjoining one of our ongoing research studies currently seeking participants.Ìý

Article by Kavya Piraba

Reviewed by Dr. Jennifer Li, OD, FAAO