Diabetic retinopathy is the leading cause of blindness in working-age Americans. People with both type 1 diabetes and type 2 diabetes are at risk for this condition.  Diabetic retinopathy is damage to the eye’s retina that occurs during long-term diabetes. Many people with early diabetic retinopathy have no symptoms before major bleeding occurs in the eye. This is why everyone with diabetes should have regular eye exams.  Having more severe diabetes for a longer period of time increases the chance of getting retinopathy. Retinopathy is also more likely to occur earlier and be more severe if your diabetes has been poorly controlled.

Diabetic Retinopathy Description

Diabetic retinopathy is caused by damage to blood vessels of the retina. The retina is the layer of tissue at the back of the inner eye. It changes light and images that enter the eye into nerve signals that are sent to the brain.

There are two types, or stages of retinopathy: non-proliferative or proliferative.

• Non-proliferative diabetic retinopathy develops first. Blood vessels in the eye become larger in certain spots (called microaneurysms). Blood vessels may also become blocked. There may be small amounts of bleeding (retinal hemorrhages), and fluid may leak into the retina. This can lead to noticeable problems with your eyesight.
• Proliferative retinopathy is the more advanced and severe form of the disease. New blood vessels start to grow in the eye. These new vessels are fragile and can bleed (hemorrhage). Small scars develop, both on the retina and in other parts of the eye (the vitreous). The end result is vision loss, as well as other problems.

Other problems that may develop are:

• Macular edema — the macula is the area of the retina that provides sharp vision straight in front of you. If fluid leaks into this area, your vision becomes more blurry.
• Retinal detachment — scarring may cause part of the retina to pull away from the back of your eyeball.
• Glaucoma — increased pressure in the eye is called glaucoma. If not treated, it can lead to blindness.
• Cataracts

Treatment

The following are very important for preventing diabetic retinopathy:

• Tight control of blood sugar (glucose), blood pressure, and cholesterol
• Stopping smoking

People with nonproliferative diabetic retinopathy may not need treatment. However, they should be closely followed by an eye doctor trained to treat diabetic retinopathy. If new blood vessels growing in your retina (neovascularization) or macular edema is noted, treatment is usually needed.

Several procedures or surgeries are the main treatment for diabetic retinopathy.

Laser eye surgery creates small burns in the retina where there are abnormal blood vessels. This process is called photocoagulation. It is used to keep vessels from leaking or to get rid of abnormal, fragile vessels.

• Focal laser photocoagulation is used to treat macular edema.
• Scatter laser treatment or panretinal photocoagulation treats a large area of your ischemic retina. Often two or more sessions are needed.
• A surgical procedure called vitrectomy is used when there is bleeding (hemorrhage) into the eye. It may be used in conjunction with other procedures to repair retinal detachments. 
• Drugs that prevent abnormal blood vessels from growing, and corticosteroids injected into the eyeball are being investigated as new treatments.

Diabetic Retinopathy: Treatment Overview