April 20, 2024

Diabetic Retinopathy: A Leading Cause Of Vision Loss

What is Diabetic Retinopathy?

Diabetic retinopathy is a medical condition in which damage occurs to the retina due to complications from diabetes mellitus. The retina is the light-sensitive tissue at the back of the eye. Over time, high blood sugar levels from diabetes can cause damage to the tiny blood vessels inside the retina. Diabetic retinopathy occurs in two forms – non-proliferative and proliferative.

Non-Proliferative Retinopathy

Non-proliferative retinopathy is characterized by microaneurysms (microscopic bulges in blood vessel walls), retinal hemorrhages (bleeding), hard or cotton-wool spots, and retinal edema (swelling). These signs usually do not cause changes in vision but may be associated with symptoms of floaters or flashes in some people. If left untreated, non-proliferative retinopathy can progress to proliferative retinopathy.

Proliferative Retinopathy

In proliferative retinopathy, new fragile blood vessels grow on the surface of the retina or into the vitreous gel in the eye. This Angiogenesis (blood vessel growth) occurs because diabetic retinopathy starves the retina of oxygen. The new blood vessels are abnormal and can leak blood into the vitreous cavity or pull on the retina to cause a retinal detachment, both of which can greatly impair vision. Scarring also may cause the retina to pull away from the back of the eye.

Risk Factors of Diabetic Retinopathy

– Duration of diabetes – Longstanding diabetes increases the risk. Nearly all people with type 1 diabetes and >60% of people who have had type 2 diabetes for >20 years have some stage of diabetic retinopathy.

– Poor blood glucose control – Higher average blood glucose and greater glucose variability over time further increase the risk and progression of retinopathy.

– Hypertension – High blood pressure significantly increases the risk of developing and progression of diabetic retinopathy.

– Kidney disease – Nephropathy or kidney disease from diabetes further raises retinopathy risk.

– Dyslipidemia – Uncontrolled high cholesterol and high triglyceride levels may increase diabetic retinopathy risk.

– Pregnancy – Retinopathy can advance more quickly in pregnant women with diabetes.

Screening and Treatment

Screening
Anyone diagnosed with diabetes, especially those with had it for over 5 years or poor glucose control, should undergo a comprehensive eye exam to check for signs of retinopathy. Exams are then repeated regularly based on severity and findings.

Treatment
For non-proliferative or mild Retinopathy, close monitoring and control of blood glucose, blood pressure and lipids usually suffice. For more advanced cases, photocoagulation (laser treatment), intraocular injections of corticosteroids/anti-VEGF drugs or vitrectomy surgery may be done to reduce vision loss risk.

Prevention is Key

Some key ways to prevent or slow the onset and progression of diabetic retinopathy include:

– Maintaining optimal blood glucose control. Target HbA1c level is usually <7% but may need to be even lower in people with retinopathy.

– Controlling blood pressure to the recommended range of <130/80 mmHg.

– Managing cholesterol and triglyceride levels through lifestyle changes and medications if required.

– Not smoking and drinking alcohol in moderation.

– Having regular dilated eye exams after being diagnosed with diabetes, even if no symptoms.

– Taking medications as prescribed and following all treatment plans suggested by doctors.

– Keeping pregnancy well controlled if a woman has pre-existing diabetes.

Diabetic Retinopathy: A Growing Public Health Challenge

As the number of people with diabetes increases globally, diabetic retinopathy poses a major ophthalmic challenge. By some estimates, over 1/3rd of Americans and nearly 1/2 of the elderly diabetes population have some stage of retinopathy. It is estimated that diabetic retinopathy causes over 5 million people worldwide to be blind or have severe vision impairment. Further, as more people live longer with diabetes, the incidence of vision-threatening retinopathy is projected to continue rising in the coming years.

Governments and health organizations worldwide have started extensive awareness and large-scale screening programs for diabetic retinopathy. However, greater focus on diabetes management and prevention holds the key to significantly curb this avoidable cause of blindness. With sustained efforts towards early detection, timely treatment and multifactorial control of diabetes and its complications, the impact of diabetic retinopathy can be markedly reduced. But a concerted worldwide approach is needed to address this growing public health challenge effectively.

In summary, diabetic retinopathy remains one of the leading microvascular complications and causes of vision loss associated with diabetes. Maintaining optimal control of blood glucose, blood pressure and other risk factors along with regular eye screening offers the best approach to prevent or slow its onset and progression.

*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it