If you've been diagnosed with diabetes, no doubt you have a lot of questions, especially about how the condition can affect your eyesight. Suddenly you're hearing terrifying phrases like "diabetic retinopathy" and heading down an internet rabbit hole of worry.
However, there is good news: With careful monitoring and early treatment, there is a lot you can do to protect your vision. Here are questions you can ask your ophthalmologist at your next visit.
What Is Diabetic Retinopathy?
Diabetic retinopathy (DR) is the most common form of diabetes-related eye disease and the leading cause of blindness in working-age Americans, according to the Centers for Disease Control and Prevention (CDC).
Usually, the retina receives focused light from the eye's lens and converts it into signals the brain can use to create visual recognition. When people with diabetes have uncontrolled blood sugar, diabetic retinopathy can occur, causing the blood vessels in the retina to leak and distort vision.
"The most common way diabetic retinopathy causes vision loss is via swelling in the central part of the retina, called diabetic macular edema, or DME," says Frank Siringo, M.D., a retina surgeon at Omni Eye Specialists Denver in Colorado. The macula is responsible for our most detailed vision. Diabetic retinopathy can also cause vision loss as the result of bleeding inside the eye or retina detachment. This is why early detection and treatment is so critical for protecting your sight.
What Are My Risk Factors for Developing Diabetic Retinopathy?
There are few factors that can increase your risk of DR. The first? Having a high A1C level. As many people with diabetes know, hemoglobin A1C is a blood test used to diagnose diabetes as well as monitor how well you are keeping your blood sugar under control over a two- to three-month period. The lower your hemoglobin A1C level, the better your blood sugar control, which lowers your risk of complications from diabetes, including diabetic retinopathy.
"Maintaining the hemoglobin A1c below seven percent is a very important way to lower the risk of diabetic retinopathy and lower the risk of vision loss," says Dr. Siringo.
Another risk factor for developing diabetic retinopathy is the length of time you've had diabetes. Approximately half of people with diabetes for longer than 20 years will have diabetic retinopathy, but they do not all develop vision loss, according to Dr. Siringo.
And finally, having high cholesterol and/or high blood pressure can also increase the risk of damage to the vessels in your eyes.
What Are the Symptoms of Diabetic Retinopathy?
According to the Mayo Clinic, diabetic retinopathy symptoms can include:
- vision that is blurred or fluctuating
- impaired color recognition
- dark or empty spaces in the vision
- spots or dark strings floating in your vision (also known as floaters)
- vision loss
Diabetic retinopathy usually affects both eyes.
If I Don't Have Symptoms, Does That Mean I Don't Have Diabetic Retinopathy?
Unfortunately, in its early stages, you can have diabetic retinopathy without symptoms. This is why it's important to speak with your ophthalmologist about how frequently you should have eye exams that dilate the pupil and examine the back of the eye, according to ophthalmologist Paula Pecen, M.D., an assistant professor of ophthalmology at the University of Colorado School of Medicine who specializes in vitreoretinal surgery. "Some patients need to be seen every year and some need to be seen more," says Dr. Pecen. "Follow up can prevent vision loss."
According to recent findings from the American Academy of Ophthalmology, currently only about 60% of people with diabetes have annual screenings for diabetic retinopathy. The academy recommends the following screening schedule:
- Those with type 1 diabetes should have annual screenings five years after the onset of their disease.
- Those with type 2 diabetes should have a prompt examination upon diagnosis and at least yearly examinations after that.
- Women who had diabetes before conceiving should be screened early in pregnancy.
Is Diabetic Retinopathy Reversible?
While there's no known cure for diabetic retinopathy, retinal specialists can preserve and often restore vision loss from diabetic retinopathy through a variety of methods. These include injecting medication into the back of the eye, performing laser procedures and/or retinal surgery.
Which Medications Can Help With Diabetic Retinopathy?
The severity of diabetic retinopathy can be greatly reduced with medications called VEGF inhibitors, which are periodically injected into the eye by a retinal specialist, says Dr. Siringo. These VEGF inhibitors include:
- Avastin (bevacizumab)
- Beovu (brolucizumab)
- Eylea (aflibercept)
- Lucentis (ranibizumab)
They work by making the blood vessels in the retina less leaky, which allows the swelling in the macula to improve and the vision to become clearer. They have the added benefit of reducing the overall level of diabetic retinopathy. "These medications do not last forever," says Dr. Siringo. "Patients often need treatment every one-to-three months for two or more years to have a successful and lasting outcome."
Steroid implants injected into the eye are a very effective second-line treatment when anti-VEGF is not enough, Dr. Siringo says. "Steroids have the added benefit of providing long-lasting treatment for diabetic macular edema."
Approved drugs include Ozurdex (a dexamethasone implant), which is effective for three to four months, and Iluvien (a fluocinolone implant), which lasts two to three years. "On the research horizon are newer medications that act in different ways than anti-VEGF or steroids, some of which may not need to be injected into the eye," Dr. Siringo says.
How Can Laser Treatments Help With Diabetic Retinopathy?
Lasers do not reverse diabetic retinopathy, but they can halt the progression of the disease, says Dr. Siringo.
They are used as an adjunct treatment alongside injections in patients with advanced diabetic retinopathy, or with diabetic macular edema. "New laser platforms are safer and deliver treatment quicker with less discomfort for the patient during and after the procedure," Dr. Siringo says.
When Is Surgery Best?
Retinal surgery is the treatment of choice when there is severe vision loss from bleeding into the eye (vitreous hemorrhage) or when advanced diabetic retinopathy causes the retina to detach. "Modern surgical techniques employ tiny instrumentation, which often does not require stitches, leading to quicker recovery time and minimal post-operative discomfort," Dr. Siringo says.
What Else Is Important to Know About Diabetic Retinopathy?
According to recent findings from the American Academy of Ophthalmology, maintaining near-normal blood sugar, blood pressure, and cholesterol lowers the risk for developing diabetic retinopathy or having it worsen. Dr. Pecen suggests talking to your doctor about medications and other lifestyle changes that can help with these conditions.
For more information on diabetic retinopathy, visit The American Society of Retina Specialists.