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Diabetic Retinopathy- symptoms, causes & stages - MyHealth

Diabetes

Diabetic Retinopathy- symptoms, causes & stages

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Medically Reviewed By
Dr Divya Rohra

Written By Prekshi Garg
on Jun 1, 2022

Last Edit Made By Prekshi Garg
on Mar 15, 2024

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Diabetic retinopathy Symptoms, causes & stages
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Diabetic retinopathy is an extension of diabetic complications. It is an eye disorder caused due to diabetes or high sugar levels in your blood over a period of time. Diabetic retinopathy is now emerging as a crucial non-communicable disease in India thereby increasing ocular morbidity. According to the Diabetes and Diabetic Retinopathy Survey conducted by the Union Health Ministry between 2015 - 2019, reported cases of diabetic retinopathy in India to be around 16.9% and sight-threatening diabetic retinopathy to be around 3.6%. The prevalence of mild retinopathy as per the survey is around 11.8%. With the increase in the cases of diabetic retinopathy at such a huge scale in India, it is very important to educate the masses about the disease and its effects. In this article, let us talk in detail about diabetic retinopathy, its types, stages, symptoms, causes, risk-factors, treatment, and complications that may arise due to diabetic retinopathy.

What is Diabetic Retinopathy?

Diabetic retinopathy is an abnormal eye condition caused due to increased blood sugar levels, due to the side effects of the disease diabetes. When your blood contains too much sugar, it can cause the blood vessels  present in your body to get damaged over a period of time. This includes the blood vessels of the retina as well. The retina is the membrane present in the eye that covers the back of the eye and also detects light and sends signals to the brain via the optic nerve. The presence of excess sugar in the blood blocks the blood vessels that reach the retina causing leakage of bleeding to occur. Depending upon the occurrence, diabetic retinopathy can be of two types:

  • Nonproliferative diabetic retinopathy (NPDR)

    • It is referred to as the early stage of diabetic retinopathy.
    • It is characterised by the leakage of the blood vessels into the retina.
    • This results in haemorrhage, lipid, or fluid observed in the retina.
    • Finally, the blood vessels close leading to poor blood flow or ischemia.
  • Proliferative diabetic retinopathy (PDR)

    • This is an advanced stage of diabetic retinopathy and occurs when the situation advances.
    • It is characterised by the growth of the abnormal blood vessels due to ischemia.
    • This abnormal growth of blood vessels can lead to complete vision loss at a later stage due to the leakage of blood into the vitreous fluid (gel like substance) leading to the detachment of the retina due to the tractional changes to the surface.

What are the Stages of Diabetic Retinopathy?

According to the National Health Society (NHS), the progression of diabetic retinopathy can occur in three different stages. These stages include:

Stage I: Background Retinopathy

  • Stage I occurs when microaneurysms, that is, tiny bulges appear in the blood vessels in the back of the eye (retina).
  • The presence of these tiny bulges can cause leakage of small amounts of blood.
  • This can commonly occur in people with diabetic retinopathy.
  • At this stage, you are at a higher risk of developing eye problems, although vision issues have not occurred till now.
  • At this stage, you need to take measures to prevent the worsening of this condition. No treatment is required at this time.
  • If, in any case, both your eyes are affected, then the chances of worsening your sight are higher.

Stage II: Pre-proliferative Retinopathy

  • At this stage, the condition worsens and more severe changes can be seen on the retina.
  • At this stage, bleeding into the retina continues.
  • At this stage, you are at a higher risk of affecting your vision.
  • Monitoring of eyes is very crucial, therefore, more frequent appointments are scheduled for you at this stage.

Stage III: Proliferative Retinopathy

  • At this stage, the formation of new blood vessels and scar tissue takes place on your retina.
  • This can lead to excessive bleeding and detachment of the retina from the back of your eye.
  • At this stage, you are at a very high risk of losing your vision
  • The treatment given to you will help in stabilising your vision, however, the complete restoration of the vision is not possible.

What are the Symptoms of Diabetic Retinopathy?

Diabetic retinopathy generally does not show any symptoms at the initial stage. This is because it is not necessary for the bleeding to occur at the onset of the disease. Therefore, there are chances that you might have diabetic retinopathy but you yourself don’t know about it. However, as the stage progresses, the symptoms become more and more evident. Usually both the eyes are affected due to diabetic retinopathy, therefore, you may observe symptoms in both your eyes. The signs and symptoms of diabetic retinopathy include:

  • Impaired colour vision
  • Blurred vision
  • Appearance of patches or streaks that may block your vision
  • Presence of transparent spots, eye floaters or dark strings. These float in your field of vision and move in the direction in which you look.
  • Poor or decreased night vision
  • Sudden complete loss of vision
  • Presence of an empty or dark spot in the centre of your vision.

These are some common symptoms that you may experience in either one or both your eyes. Therefore, if you experience any of the above stated symptoms, make sure that you consult your doctor as soon as possible.

What are the Causes of Diabetic Retinopathy?

Now that we have discussed the symptoms, you must have learnt the main reason behind diabetic retinopathy. 

Yes, you guessed it right, the uncontrolled blood sugar levels are the leading cause of diabetes retinopathy. 

Glucose is the main source of energy and generally does not cause any harm to the body when it is in controlled levels. But in case of diabetes, the absorption of glucose is improper due to the deficiency of insulin hormone in the body. This insulin hormone is secreted by the pancreas. When the levels of insulin hormone are low, the absorption of glucose does not occur which increases the levels of glucose in your blood. This increased level starts blocking the nerves in the retina resulting in diabetic retinopathy.

Apart from increased blood glucose level, there is a certain group of people which are comparatively at a higher risk of developing diabetic retinopathy than it is in some other people. The group of people with a high risk of diabetic retinopathy include:

  • High blood pressure
  • Uncontrolled sugar levels in your blood
  • Pregnant women are at a higher risk of diabetic retinopathy than non-pregnant females
  • High cholesterol levels in blood
  • Regular smokers are also at a higher risk of developing diabetic retinopathy
  • People who have had diabetes for a prolonged time

What are the Complications that may arise due to Diabetic Retinopathy?

It is very important to treat diabetic retinopathy. If the condition is left untreated, it can give rise to various complications in your eyes.

Cataract

The untreated diabetic retinopathy can cause cataract. Cataract refers to the condition of the eye where the natural lens of the eye appears cloudy. The cataract in eyes can develop due to following reasons:

Glaucoma

It is another complication that may arise due to diabetic retinopathy. Glaucoma is characterised by the exertion of increased pressure in your eyes. This increased pressure poses an effect on the optic nerve, increasing your chances of vision loss. The most common type of glaucoma that is diagnosed in people with diabetes is the primary open-angle glaucoma (POAG). A rare form of severe glaucoma also exists which is known as neovascular glaucoma that causes permanent loss of vision. Glaucoma occurs when the new blood vessels formed in the retina prevent the drainage of the fluids out of your eyes, thereby, increasing the pressure on your eyes.

Diabetic Macular Edema (DME)

DME is another complication that may arise due to diabetic retinopathy. In this condition, the fluid accumulates in your eyes, leading to thickening or swelling of the macula region, that is, the centre of the retina. DME can occur at any stage and is one of the most common causes of loss of vision in people with diabetic retinopathy. It may be characterised by symptoms like having difficulty in reading or focusing, poor colour vision, and blurry vision.

Retinal Detachment

During diabetic retinopathy, new blood vessels may form. The formation of new blood vessels lead to the development of scar tissue in the retina which shrinks in future causing distortion of the retina. If a large portion of the retina is distorted, then you may see symptoms like flashes of light appearing on eyes, increased eye floaters, and observing a dark shadow like a curtain in the middle or the sides of the eyes. Retinal detachment is a medical emergency and must be concerned with a doctor immediately.

Vitreous Haemorrhage

The rupturing and bleeding of the abnormal blood vessels in your eye is common in people with diabetic retinopathy. This can cause the leakage of blood in the vitreous fluid as well causing vitreous haemorrhage. The vitreous fluid is a clear fluid present in the centre of your eye. If you have vitreous haemorrhage, you may experience the presence of floaters and flashes of light in your eyes and a blurry vision that is at its worst during the mornings. The treatment of vitreous humour includes the use of laser or the complete removal of the vitreous humour.

Blindness

The complications of diabetic retinopathy like vitreous haemorrhage, retinal detachment, and glaucoma can lead to the complete loss of vision and blindness as well. Almost 0.8 million people have blindness because of diabetic retinopathy across the globe. 

How is Diabetic Retinopathy Treated?

The effects of diabetic retinopathy cannot be reversed, however they can be managed efficiently to reduce their severity and prevent them from worsening. Certain methods by which diabetic retinopathy can be treated include:

  • Managing blood sugar levels efficiently so that they remain within the permissible limit and the risk of development of diabetic retinopathy can be minimised.
  • Laser surgery or photocoagulation is another treatment option that can reduce the production of abnormal blood vessels and the swelling in the retina.
  • Steroid injections and anti-VEGF medicines can also be used to reduce inflammation and prevent the formation of new abnormal blood vessels.
  • Vitrectomy refers to an eye surgery generally recommended for people with proliferative diabetic retinopathy. The surgery involves treating problems related to the retina and vitreous humour. 

Takeaway

Diabetic retinopathy is a very common eye condition occurring in people with diabetes across the globe. It is extremely essential to know about this disease in detail and prevent yourself from such vision impairments. Uncontrolled blood sugar levels are the major cause of diabetic retinopathy, therefore, you must ensure that you keep your blood sugar levels at check at all times. Now that you know diabetic retinopathy, its types, symptoms, causes, treatment, and complications you will better be able to diagnose such issues at an early stage. Since, most of the effects of diabetic retinopathy are irreversible, prevention of such issues is more crucial than its treatment.

Frequently Asked Questions (FAQs)

  1. Does diabetic retinopathy get cured without treatment?

    Diabetic retinopathy cannot be reversed but the condition can be managed and its worsening can be prevented.

  2. Can lowering blood sugar improve vision?

    Yes, if you keep your sugar levels within the permissible limit, you can prevent the occurence of diabetic retinopathy, thereby improving your vision.

  3. Can metformin cause vision changes?

    Yes, metformin reduces the risk of high blood pressure that ultimately affects your vision.

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