* Retina: The retina is the lining at the back of the eye. It is designed to sense light coming into the eye.
* Vitreous: The vitreous is a jelly-like fluid that fills the back of the eye.
* Lens: The lens is at the front of the eye. It focuses light onto the retina.
* Optic nerve: The optic nerve is the eye’s main nerve to the brain.

Diabetic retinopathy is the medical term for the most common diabetic eye disease. Two other common conditions are cataracts and glaucoma. People without diabetes can get these eye problems, too; however, people with diabetes get them more often and at a younger age.

Diabetic Retinopathy

Retina damage happens slowly. Your retinas have tiny blood vessels that are easy to damage. Having high blood glucose and high blood pressure for a long time can damage these tiny blood vessels.

First, these tiny blood vessels swell and weaken. Some blood vessels then become clogged and do not let enough blood through. At first, you might not have any loss of sight from these changes. This is why you need to have a dilated eye exam once a year even if your vision seems fine.

What Is Diabetic Eye Disease? Treatment Options for Diabetic Retinopathy What Is a Vitrectomy? Diabetic Retinopathy Treatment: An Introduction Questions to Ask Symptoms of Diabetic Retinopathy

One of your eyes may be damaged more than the other, or both eyes may have the same amount of damage. As diabetic retinopathy becomes worse, new blood vessels grow. These new blood vessels are weak. They break easily and leak blood into the vitreous of your eye. The leaking blood keeps light from reaching the retina.

You may see floating spots or almost total darkness. Sometimes, the blood will clear out by itself; in other cases, surgery is required to remove it.

Over the years, the swollen and weak blood vessels can form scar tissue and pull the retina away from the back of the eye. If the retina becomes detached, you may see floating spots or flashing lights. You may feel as if a curtain has been pulled over part of what you are looking at. This condition can cause loss of sight or blindness if you don’t take care of it right away.

Call your doctor right away if you are having any vision problems or if you have had a sudden change in your vision.

Symptoms of Diabetic Retinopathy

Often, there are no symptoms in the early stages of this diabetic eye disease. Vision may not change until the disease becomes severe, nor is there any pain. Blurred vision may occur when the macula — the part of the retina that provides sharp, central vision — swells from the leaking fluid. This condition is called macular edema.

If new blood vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision. Even in more advanced cases, the disease may progress a long way without any noticeable symptoms, so regular eye examinations for people with diabetes are important.

Another treatment option for proliferative retinopathy is scatter laser treatment (see Diabetic Retinopathy Treatment for more information).

What You Need to Know

You may need a vitrectomy to restore your sight if you have a lot of blood in the center of the eye (vitreous gel). If you need this procedure in both eyes, they are usually done several weeks apart.

A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original gel.

Recovering From a Vitrectomy

You will probably be able to return home after the vitrectomy. Some people stay in the hospital overnight. Your eye will be red and sensitive, and you will need to wear an eye patch for a few days or weeks to protect your eye. Immediately after the surgery, you also will need to use medicated eyedrops to protect against infection.

How Effective Is It?

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Vitrectomy is effective in reducing vision loss. People with proliferative retinopathy have less than a 5 percent chance of becoming blind within five years after a vitrectomy that is performed as part of timely and appropriate diabetic retinopathy treatment.

Although this procedure has a high success rate, it does not cure diabetic retinopathy. Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment for diabetic retinopathy more than once to protect your sight.

Cataracts

Glaucoma

Glaucoma originates as pressure builds up in the eye. Over time, this pressure damages your eye’s main nerve — the optic nerve. The damage first causes you to lose sight from the sides of your eyes. Treating glaucoma is usually simple. Your eye doctor will give you special drops to use every day to lower the pressure in your eye. Or your eye doctor may want you to have laser surgery.

Preventing Diabetic Eye Disease

Here are some things you can do that may help prevent or slow down diabetic eye disease:

* Keep your blood glucose and blood pressure as close to normal as you can.

* Have an eye doctor examine your eyes once a year. Have this exam even if your vision is okay. The eye doctor will use drops to make the black part of your eyes (pupils) bigger. This is called dilating your pupil, which allows the doctor to see the back of your eye. Finding diabetic eye disease early and getting treatment right away will help prevent more serious problems later on.

* Ask your eye doctor to check for signs of cataracts and glaucoma.

* If you are pregnant and have diabetes, see an eye doctor during your first three months of pregnancy.

* If you are planning to get pregnant, ask your doctor if you should have an eye exam.

* Don’t smoke.

The lens focuses light onto the retina. A cataract makes everything you look at seem cloudy, and surgery is needed to remove it. During surgery, your lens is taken out and a plastic lens — like a contact lens — is put in. The plastic lens stays in your eye all the time. Cataract surgery helps you see clearly again.

* Blood sugar
* Blood pressure
* Blood cholesterol.

Diabetic Retinopathy Treatment for Proliferative Retinopathy
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.

Laser Scatter Treatment as a Diabetic Retinopathy Treatment
Because a high number of laser burns are necessary, two or more sessions usually are required to complete diabetic retinopathy treatment.
Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision.

Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding.

Scatter laser treatments are performed in your doctor’s office or eye clinic. Before the surgery, your doctor will dilate your pupil and apply drops to numb the eye. The area behind your eye also may be numbed to prevent discomfort.

The lights in the office will be dim. As you sit facing the laser machine, your doctor will hold a special lens to your eye. During the procedure, you may see flashes of light. These flashes eventually may create a stinging sensation that can be uncomfortable.

You will need someone to drive you home after surgery. Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.

For the rest of the day, your vision will probably be a little blurry. If your eye hurts, your doctor can suggest treatment.

Vitrectomy as a Diabetic Retinopathy Treatment

What Is Diabetic Eye Disease? Treatment Options for Diabetic Retinopathy What Is a Vitrectomy? Diabetic Retinopathy Treatment: An Introduction Questions to Ask Symptoms of Diabetic Retinopathy

If you have a lot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight. If you need vitrectomies in both eyes, they are usually done several weeks apart.

A vitrectomy is performed under either local or general anesthesia. Your doctor makes a tiny incision in your eye. Next, a small instrument is used to remove the vitreous gel that is clouded with blood. The vitreous gel is replaced with a salt solution. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel.

You will probably be able to return home after the vitrectomy, although some people stay in the hospital overnight. Your eye will be red and sensitive. You will need to wear an eye patch for a few days or weeks to protect your eye. You also will need to use medicated eyedrops to protect against infection.

Effectiveness of Diabetic Retinopathy Treatment

Both laser treatment and vitrectomy are effective in reducing vision loss. People with proliferative retinopathy have less than a 5 percent chance of becoming blind within five years when they get timely and appropriate diabetic retinopathy treatment. Although both diabetic retinopathy treatments have high success rates, they do not cure diabetic retinopathy.

Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment for diabetic retinopathy more than once to protect your sight.

Diabetic Retinopathy Treatment for Macular Edema
Macular edema is treated with laser surgery, using a procedure known as focal laser treatment. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session, although further treatment may be needed.

A patient may need focal laser surgery more than once to control the leaking fluid. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart.

Focal laser treatment stabilizes vision. In fact, focal laser treatment reduces the risk of vision loss by 50 percent. In a small number of cases, if vision is lost, it can be improved. Contact your eye care professional if you have vision loss.

If you have lost some sight as a result of diabetic retinopathy, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services as well.

Questions to Ask

You can protect yourself against vision loss by working with your eye care professional. Ask questions and get the information you need to take care of yourself and your family.

You might want to ask your eye care professional the following questions about your diabetic retinopathy:

* What is my diagnosis?
* What caused my condition?
* Can my condition be treated?
* How will this condition affect my vision now and in the future?
* Should I watch for any particular symptoms and notify you if they occur?
* Should I make any lifestyle changes?

You should ask the following questions about your diabetic retinopathy treatment:

* What is the treatment for my condition?
* When will the treatment start and how long will it last?
* What are the benefits of this treatment? How successful is it?
* What are the risks and side effects associated with this diabetic retinopathy treatment?
* Are there foods, drugs, or activities I should avoid while I’m on this treatment?
* If my treatment includes taking medicine, what should I do if I miss a dose?

You should ask the following questions about tests available for diabetic retinopathy:

* What kinds of tests will I have?
* What can I expect to find out from these tests?
* When will I know the results?
* Do I have to do anything special to prepare for any of the diabetic retinopathy tests?
* Do these tests have any side effects or risks?
* Will I need more tests later?

Other Suggestions

What Is Diabetic Eye Disease? Treatment Options for Diabetic Retinopathy What Is a Vitrectomy? Diabetic Retinopathy Treatment: An Introduction Questions to Ask Symptoms of Diabetic Retinopathy

Some other suggestions that people with diabetic retinopathy find helpful include:

* If you don’t understand your eye care professional’s responses, ask questions until you do understand.
*
Take notes or get a friend or family member to take notes for you. Or, bring a tape recorder to help you remember the discussion.
* Ask your eye care professional to write down his or her instructions to you.
* Ask your eye care professional for printed material about your condition.
* If you still have trouble understanding your eye care professional’s answers, ask where you can go for more information.
* Other members of your healthcare team, such as nurses and pharmacists, can be good sources of information. Talk to them as well.
* Be an active patient in your eye care.

Summary

The following points are important to keep in mind regarding diabetic retinopathy:

* If you have diabetes, get a comprehensive dilated eye exam at least once a year.
* Proliferative diabetic retinopathy can develop without symptoms. At this advanced stage, you are at high risk for vision loss.
* Macular edema can develop without symptoms at any of the four stages of diabetic retinopathy.
* You can develop both proliferative retinopathy and macular edema and still see fine. However, you are at high risk for vision loss.
* Your eye care professional can tell if you have macular edema or any stage of diabetic retinopathy. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.

If diabetic retinopathy symptoms do appear, you will see a few specks of blood, or spots, “floating” in your vision. If spots occur, see your eye care professional as soon as possible. You may need diabetic retinopathy treatment before more serious bleeding occurs. Hemorrhages tend to happen more than once, often during sleep.

Sometimes, without treatment, the spots clear, and your vision will improve; however, bleeding can recur and cause severely blurred vision. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.

If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. Also, the earlier you receive treatment, the more likely it will be effective.

Making a Diagnosis

Macular edema and diabetic retinopathy are detected during a comprehensive eye exam that includes:

* Visual acuity test. This eye chart test measures how well you see at various distances.

* Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.

* Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional checks your retina for early signs of diabetic retinopathy, including:

* Leaking blood vessels
* Retinal swelling (macular edema)
* Pale, fatty deposits on the retina — signs of leaking blood vessels
* Damaged nerve tissue
* Any changes to the blood vessels.

What Is Diabetic Eye Disease? Treatment Options for Diabetic Retinopathy What Is a Vitrectomy? Diabetic Retinopathy Treatment: An Introduction Questions to Ask Symptoms of Diabetic Retinopathy

If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.

Treating Diabetic Retinopathy

During the first three stages, no diabetic retinopathy treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of:

* Blood sugar
* Blood pressure
* Blood cholesterol.

For proliferative diabetic retinopathy, treatment may involve laser surgery or a vitrectomy.

Rotecting Vision

People with diabetes need to have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate followup care.

A major study has shown that better control of blood sugar levels slows the onset and progression of diabetic 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.

This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Be sure to ask your doctor if such a control program is right for you.

Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health as well as help protect your vision.

If a lot of blood has leaked into your vitreous and your sight is poor, your eye doctor might suggest you have surgery called a vitrectomy. This procedure removes blood and fluids from the vitreous of your eye. Then, clean fluid is put back into the eye. The surgery often makes your eyesight better.

What Is Diabetic Retinopathy?

Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. Diabetic retinopathy occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.

If you have diabetic retinopathy, at first, you may notice no changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

Stages

Diabetic retinopathy has four stages:

# Mild nonproliferative retinopathy. At this earliest stage of diabetic retinopathy, microaneurysms occur. These are small areas of balloon-like swelling in the retina’s tiny blood vessels.

# Moderate nonproliferative retinopathy. As the diabetic retinopathy progresses, some blood vessels that nourish the retina are blocked.

# Severe nonproliferative retinopathy. In this stage of diabetic retinopathy, many more blood vessels are blocked, depriving several areas of the retina of blood. These areas of the retina send signals to the body to grow new blood vessels for nourishment.

# Proliferative retinopathy. At this advanced stage of diabetic retinopathy, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called proliferative retinopathy. These new blood vessels 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. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

Who’s at Risk?

What Is Diabetic Eye Disease? Treatment Options for Diabetic Retinopathy What Is a Vitrectomy? Diabetic Retinopathy Treatment: An Introduction Questions to Ask Symptoms of Diabetic Retinopathy

All people with diabetes — both type 1 and type 2 — are at risk for diabetic retinopathy. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year.

Between 40 percent to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.

During pregnancy, diabetic retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

Diabetic Retinopathy and Vision Loss
Blood vessels damaged from diabetic retinopathy can cause vision loss in two ways:

* Fragile, abnormal blood vessels can develop and leak blood into the center of the eye, blurring vision. This is proliferative retinopathy, the fourth (and most advanced stage) of the disease.

* Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs. The fluid makes the macula swell, blurring vision. This condition is called macular edema. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative retinopathy also have macular edema.